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Wilmoth K, Brett BL, Emmert NA, Cook CM, Schaffert J, Caze T, Kotsonis T, Cusick M, Solomon G, Resch JE, Cullum CM, Nelson LD, McCrea M. Psychometric Properties of Computerized Cognitive Tools and Standard Neuropsychological Tests Used to Assess Sport Concussion: A Systematic Review. Neuropsychol Rev 2023; 33:675-692. [PMID: 36040610 DOI: 10.1007/s11065-022-09553-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/03/2022] [Indexed: 11/29/2022]
Abstract
Athletic programs are more frequently turning to computerized cognitive tools in order to increase efficiencies in concussion assessment. However, assessment using a traditional neuropsychological test battery may provide a more comprehensive and individualized evaluation. Our goal was to inform sport clinicians of the best practices for concussion assessment through a systematic literature review describing the psychometric properties of standard neuropsychological tests and computerized tools. We conducted our search in relevant databases including Ovid Medline, Web of Science, PsycINFO, and Scopus. Journal articles were included if they evaluated psychometric properties (e.g., reliability, sensitivity) of a cognitive assessment within pure athlete samples (up to 30 days post-injury). Searches yielded 4,758 unique results. Ultimately, 103 articles met inclusion criteria, all of which focused on adolescent or young adult participants. Test-retest reliability estimates ranged from .14 to .93 for computerized tools and .02 to .95 for standard neuropsychological tests, with strongest correlations on processing speed tasks for both modalities, although processing speed tasks were most susceptible to practice effects. Reliability was improved with a 2-factor model (processing speed and memory) and by aggregating multiple baseline exams, yet remained below acceptable limits for some studies. Sensitivity to decreased cognitive performance within 72 h of injury ranged from 45%-93% for computerized tools and 18%-80% for standard neuropsychological test batteries. The method for classifying cognitive decline (normative comparison, reliable change indices, regression-based methods) affected sensitivity estimates. Combining computerized tools and standard neuropsychological tests with the strongest psychometric performance provides the greatest value in clinical assessment. To this end, future studies should evaluate the efficacy of hybrid test batteries comprised of top-performing measures from both modalities.
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Affiliation(s)
- Kristin Wilmoth
- Departments of Psychiatry and Physical Medicine & Rehabilitation, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9055, USA.
| | - Benjamin L Brett
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Natalie A Emmert
- Department of Neurology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Carolyn M Cook
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jeffrey Schaffert
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Todd Caze
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Kotsonis
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Margaret Cusick
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gary Solomon
- Player Health and Safety Department, National Football League and Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - C Munro Cullum
- Departments of Psychiatry, Neurology, and Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Lindsay D Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
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Thompson XD, Erdman NK, Walton SR, Broshek DK, Resch JE. Reevaluating clinical assessment outcomes after unrestricted return to play following sport-related concussion. Brain Inj 2021; 35:1577-1584. [PMID: 34543089 DOI: 10.1080/02699052.2021.1975818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PRIMARY OBJECTIVE The objective of this study was to examine neurocognition, postural control, and symptomology at multiple timepoints following concussion. We hypothesized that collegiate athletes would perform similar to or better than their baseline in terms of each outcome at both timepoints. RESEARCH DESIGN This was a retrospective study of 71 collegiate athletes (18.3 ± 0.89 years old; 182.2 ± 10.05 cm; 84.2 ± 20.07 kg) to observe changes in outcomes from a previously established clinical protocol. METHODS AND PROCEDURES Participants were administered ImPACT™, the Sensory Organization Test (SOT), and the revised head injury scale (HIS-r) prior to their seasons (baseline); upon reporting symptom-free following concussion (post-injury); and approximately 8-months after return-to-play to establish a new baseline. MAIN OUTCOMES AND RESULTS There were no changes in ImPACT scores or HIS-r reporting over time. ImPACT total symptom score (TSS) decreased over time (p = .002, ηp2 = 0.08). Significant main effects occurred for the SOT equilibrium score (p < .01, ηp2 = 0.34) and Vestibular sensory ratio (p < .001, ηp2 = 0.22). CONCLUSIONS Our data suggest no decline in neurocognition, balance, or symptom burden approximately eight months post-injury. As clinicians continue to explore "best practices" for concussion management and potential long-term implications of these injuries it is important to monitor outcome measures longitudinally.
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Affiliation(s)
- Xavier D Thompson
- UVA Department of Kinesiology, The University of Virginia, Charlottesville, Virginia, USA
| | - Nicholas K Erdman
- Postdoctoral Research Fellow, George Mason University Sports Medicine, Research and Testing Lab, Fairfax, Virginia, USA
| | - Samuel R Walton
- Postdoctoral Research Associate, UNC Center for the Study of Retired Athletes & Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Chapel Hill, North Carolina, USA
| | - Donna K Broshek
- UVA Department of Psychiatry and Neurobehavioral Sciences, UVA Health, Charlottesville, Virginia, USA
| | - Jacob E Resch
- UVA Department of Kinesiology, The University of Virginia, Charlottesville, Virginia, USA
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Abstract
Recent research has yielded multivariate base rates (MBRs) of low scores in healthy populations using a widely adopted concussion screening measure, Immediate Postconcussion and Cognitive Testing (ImPACT). However, the extent to which individuals with concussion obtain reliable changes at divergent frequencies relative to healthy individuals is largely unknown. The present study examined whether MBRs of reliable change accurately discriminated between those with and without concussion. This archival review consisted of 129 healthy individuals and 81 individuals with concussion. MBRs of reliable change scores were examined at varying cutoffs and frequencies between those with and without concussion. Composites showed small to medium effect sizes in differentiating between those with and without concussion. MBRs of reliable change scores on ImPACT provided limited discriminative utility in isolation. Computations of posttest probabilities using Bayes' Theorem yielded evidence for incremental gains when utilizing MBRs of reliable change under certain constraints.
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Affiliation(s)
- Charles E Gaudet
- Brown University, Providence, Rhode Island, USA.,University of Rhode Island, Kingston, Rhode Island, USA
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Keith J, Williams M, Taravath S, Lecci L. A Clinician’s Guide to Machine Learning in Neuropsychological Research and Practice. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2019. [DOI: 10.1007/s40817-019-00075-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lecci L, Williams M, Taravath S, Frank HG, Dugan K, Page R, Keith J. Validation of a Concussion Screening Battery for Use in Medical Settings: Predicting Centers for Disease Control Concussion Symptoms in Children and Adolescents. Arch Clin Neuropsychol 2019; 35:265-274. [DOI: 10.1093/arclin/acz041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/15/2019] [Accepted: 07/18/2019] [Indexed: 02/02/2023] Open
Abstract
Abstract
Objective
Effective screening for concussion is increasingly important, and medical professionals play a critical role in diagnostic and return-to-play decisions. However, few well-validated measures are available to assist in those decisions. This study aims to determine whether previously validated measures assessing neurocognitive and neurobehavioral abilities can predict Centers for Disease Control (CDC) concussion symptom endorsement in a sample of child or youth athletes.
Method
Participants were 113 individuals, aged 6–17, representing 29 consecutive cases undergoing a post-concussion evaluation by a pediatric neurologist and 84 consecutive cases completing standardized baseline assessments (i.e., not being evaluated as a follow-up to a concussion). All participants completed the same standardized battery of tests comprised of the Connors’ Continuous Performance Test (CPT 3), the Balance Error Scoring System (BESS), and the NIH 4-Meter Gait Test as well as completing a checklist of CDC concussion symptoms.
Results
Regression analyses indicate that the screening battery explained 33% of the variance (d = 1.4) in concussion symptom endorsement, after controlling for age. The neurocognitive test alone (CPT 3) accounts for 21.5% of the variance (d = 1.05) in symptoms after controlling for age, and the neurobehavioral measures (BESS and NIH 4-Meter Gait) then account for an additional 11.5% variance (accounting for 18.6% variance, d = .96, when entered first). These effect sizes are considered large to very large and reflect a marked increase in predictive validity relative to existing measures commonly used in concussion assessments.
Conclusions
A relatively brief screening battery can function in medical settings to predict significant and substantial variability in CDC concussion symptoms in a pediatric sample.
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Affiliation(s)
- Len Lecci
- Department of Psychology, University of North Carolina Wilmington, Wilmington, NC 28403, USA
| | - Mark Williams
- Internal Medicine, New Hanover Regional Medical Center, Wilmington, NC 28403, USA
| | - Sasidharan Taravath
- Pediatric Neurology, New Hanover Regional Medical Center, Wilmington, NC 28403, USA
| | - Harrison G Frank
- Frank Institute for Health and Wellness, Wilmington, NC 28403, USA
| | - Kelly Dugan
- Department of Psychology, University of North Carolina Wilmington, Wilmington, NC 28403, USA
| | - Ryan Page
- Department of Psychology, University of North Carolina Wilmington, Wilmington, NC 28403, USA
| | - Julian Keith
- Department of Psychology, University of North Carolina Wilmington, Wilmington, NC 28403, USA
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Yakoub KM, Davies DJ, Su Z, Bentley C, Forcione M, Toman E, Hammond D, Watson CN, Bishop J, Cooper L, Barbey AK, Sawlani V, Di Pietro V, Grey MJ, Belli A. Investigation into repetitive concussion in sport (RECOS): study protocol of a prospective, exploratory, observational cohort study. BMJ Open 2019; 9:e029883. [PMID: 31278105 PMCID: PMC6615833 DOI: 10.1136/bmjopen-2019-029883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Sport-related concussion management remains a diagnostic dilemma to clinicians in all strata of care, coaching staff and players alike. The lack of objective diagnostic and prognostic biomarkers and over-reliance on subjective clinical assessments carries a significant health risk of undiagnosed concussive episodes and early return to play before full recovery increasing the risk of sustaining additional concussion, and leading to long-term sequelae and/or unfavourable outcome. OBJECTIVE To identify a set of parameters (neuroimaging with neurophysiological, biological and neuropsychological tests) that may support pitch-side and outpatient clinical decision-making in order to objectively diagnose concussion, determine the severity of injury, guide a safe return to play and identify the potential predictors of the long-term sequelae of concussion. METHODS AND ANALYSIS An exploratory, observational, prospective, cohort study recruiting between 2017 and 2020. The participants will have a baseline preseason screening (brain imaging, neuropsychological assessments, serum, urine and saliva sampling). If a screened player later suffers a concussion and/or multiple concussions then he/she will be assessed again with the same protocol within 72 hours, and their baseline data will be used as internal control as well as normative data. Inferential statistical analysis will be performed to determine correlations between biological, imaging techniques and neuropsychological assessments. ETHICS AND DISSEMINATION This study was approved by the East of England-Essex Research Ethics Committee on 22 September 2017-REC 17/EE/0275; IRAS 216703. The results of this study will be presented at national and international conferences and submitted for publication in peer reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN16974791; Pre-results.
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Affiliation(s)
- Kamal M Yakoub
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Neurotrauma and Ophthalmology Research Group, Institute of Inflammation and Aging, University of Birmingham, Birmingham, UK
| | - David J Davies
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Neurotrauma and Ophthalmology Research Group, Institute of Inflammation and Aging, University of Birmingham, Birmingham, UK
| | - Zhangjie Su
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Conor Bentley
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Neurotrauma and Ophthalmology Research Group, Institute of Inflammation and Aging, University of Birmingham, Birmingham, UK
| | - Mario Forcione
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Neurotrauma and Ophthalmology Research Group, Institute of Inflammation and Aging, University of Birmingham, Birmingham, UK
| | - Emma Toman
- Head Injury Management Research Group, Faculty of Clinical and Biomedical Science, School of Dentistry, University of Central Lancashire, Preston, UK
| | - Douglas Hammond
- Head Injury Management Research Group, Faculty of Clinical and Biomedical Science, School of Dentistry, University of Central Lancashire, Preston, UK
| | - Callum N Watson
- Neurotrauma and Ophthalmology Research Group, Institute of Inflammation and Aging, University of Birmingham, Birmingham, UK
| | - Jon Bishop
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lauren Cooper
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Aron K Barbey
- The Beckman Institute for Advanced Science andTechnology, University of Illinois at Urbana Champaign, Illinois, USA
| | - Vijay Sawlani
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Neuroradiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Valentina Di Pietro
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Neurotrauma and Ophthalmology Research Group, Institute of Inflammation and Aging, University of Birmingham, Birmingham, UK
- The Beckman Institute for Advanced Science andTechnology, University of Illinois at Urbana Champaign, Illinois, USA
| | - Michael J Grey
- Acquired Brain Injury Rehabilitation Alliance(ABIRA), School of Health Sciences, University of East Anglia, Norwich, UK
| | - Antonio Belli
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Neurotrauma and Ophthalmology Research Group, Institute of Inflammation and Aging, University of Birmingham, Birmingham, UK
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7
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Merritt VC, Padgett CR, Jak AJ. A systematic review of sex differences in concussion outcome: What do we know? Clin Neuropsychol 2019; 33:1016-1043. [PMID: 30618335 DOI: 10.1080/13854046.2018.1508616] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: The purpose of this review was to examine sex differences in concussion, or mild traumatic brain injury (mTBI) outcome, updating previous critical reviews of the literature. Method: Within adult human studies, we reviewed a wide range of concussion outcome variables: prevalence of concussion, injury characteristics, postconcussion symptom trajectories and psychiatric distress, neuropsychological performance, and neuroimaging findings. Sports-related concussion, civilian, and military samples were included in the review. Results: Given the robust concussion literature, there is a relative paucity of research addressing sex differences following concussion. The majority of available studies focused on sports-related concussion, with fewer studies targeting other civilian causes of concussion or military-related concussion in females. Prevalence of concussion was generally reported to be higher in females than males. Although symptom reporting largely showed a pattern for females to report greater overall symptoms than males, examining individual symptoms or symptom clusters resulted in mixed findings between the sexes. Neuropsychological studies generally showed females performing more poorly than males on measures of visual memory following concussion, though this finding was not consistently reported. Conclusion: Research examining sex differences in humans following concussion, in general, is in its infancy, and exploration of sex differences in studies outside of the sports concussion domain is particularly nascent. Given the increased prevalence of concussion and potential higher symptom reporting among women, ongoing research is necessary to better understand the role of biological sex on outcome following concussion. Understanding sex differences has important implications for assessment, management, and treatment of concussion.
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Affiliation(s)
| | - Christine R Padgett
- b School of Medicine (Psychology), University of Tasmania , Hobart , TAS , Australia
| | - Amy J Jak
- a VA San Diego Healthcare System , San Diego , CA , USA.,c University of California San Diego (UCSD) School of Medicine, Department of Psychiatry , La Jolla , CA , USA
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8
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Alsalaheen B, Stockdale K, Pechumer D, Broglio SP, Marchetti GF. A Comparative Meta-Analysis of the Effects of Concussion on a Computerized Neurocognitive Test and Self-Reported Symptoms. J Athl Train 2017; 52:834-846. [PMID: 28809606 DOI: 10.4085/1062-6050-52.7.05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Meta-analyses examining construct-specific cognitive impairment concurrently with self-reported symptoms postconcussion are sparse. OBJECTIVE To review the literature on the effects of concussion on construct-specific neurocognitive declines and to compare them with self-reported symptoms before 1 week and between 1 and 3 weeks postconcussion. DATA SOURCES Relevant studies in PubMed, CINAHL, and PsycINFO published from January 1, 1999 through November 30, 2015. STUDY SELECTION Studies were included if participants completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) before and after concussion and if test performance and Postconcussion Symptom Scale (PCSS) scores were reported at both times. DATA EXTRACTION After reviewing the full texts, we extracted data from 17 studies consisting of 29 independent samples; therefore, this meta-analysis consisted of 1777 unique participants. DATA SYNTHESIS The Hedges g effect size (ES) was estimated. A random-effects or fixed-effects model was used based on heterogeneity findings. When heterogeneity was present, we used meta-regression to assess unexplained between-studies variance. Within the first week of injury, the ESs were small to moderate for cognitive declines, ranging from -0.43 (95% confidence interval [CI] = -0.52, -0.35) to -0.67 (95% CI = -0.77, -0.58), and large for the PCSS score (Hedges g = -0.81; 95% CI = -0.91, -0.71). After 1 week, the ESs for cognitive declines (Hedges g range = -0.25 [95% CI = -0.35, -0.15] to -0.37 [95% CI = -0.55, -0.19]) and PCSS score (Hedges g = -0.38; 95% CI = -0.53, -0.22) were also small. Within 2 weeks of injury, PCSS score and time since injury weakly moderated the cognitive ES. CONCLUSIONS When a neurocognitive test was administered within 1 week of injury, the ES was larger for self-reported symptoms than for ImPACT scores generated at the same session. After 1 week of injury, the ESs for ImPACT and PCSS scores were comparable. If the athlete reports symptoms within 1 week of injury, administering a cognitive test does not appear to offer additional information to the clinician. However, if the athlete does not report symptoms postconcussion, cognitive testing may inform the clinical management of the injury.
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Affiliation(s)
- Bara Alsalaheen
- Department of Physical Therapy, University of Michigan, Flint.,Department of Neurology, University of Michigan, Ann Arbor.,Michigan NeuroSport, University of Michigan Health System, Ann Arbor
| | - Kayla Stockdale
- Department of Physical Therapy, University of Michigan, Flint
| | - Dana Pechumer
- Department of Physical Therapy, University of Michigan, Flint
| | - Steven P Broglio
- Neurotrauma Research Laboratory, University of Michigan, Ann Arbor
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9
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Alsalaheen B, Stockdale K, Pechumer D, Broglio SP. Validity of the Immediate Post Concussion Assessment and Cognitive Testing (ImPACT). Sports Med 2017; 46:1487-501. [PMID: 27071989 DOI: 10.1007/s40279-016-0532-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The immediate post concussion assessment and cognitive testing (ImPACT) is the most widely used concussion assessment tool. Despite its popularity, it is unclear if validation studies for the ImPACT test covered all aspects of validity to support its widespread use in research and clinical practice. OBJECTIVE The purpose of this report is to review literature surrounding the validity and the utility of the ImPACT test. DATA SOURCES AND APPRAISAL A systematic review of relevant studies in PubMed, CINAHL, and PsycINFO was carried out. Studies were evaluated using the STROBE (strengthening the reporting of observational studies in epidemiology) or the STARD (standards for reporting of diagnostic accuracy) criteria. RESULTS The literature search yielded 5968 studies. Sixty-nine studies met the inclusion criteria and were included in the qualitative review. Although the convergent validity of ImPACT was supported, evidence of discriminant and predictive validity, diagnostic accuracy and responsiveness was inconclusive. The utility of the ImPACT test after acute symptom resolution was sparse. The review found many factors influenced the validity and utility of ImPACT scores. CONCLUSION Clinicians must consider the benefit of ImPACT testing for their patients on a case-by-case scenario and must take the psychometric properties of the test into account when interpreting results.
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Affiliation(s)
- Bara Alsalaheen
- Physical Therapy Department, University of Michigan-Flint, 2157 William S. White Building, 303 E. Kearsley Street, Flint, MI, 48502-1950, USA.
| | - Kayla Stockdale
- Physical Therapy Department, University of Michigan-Flint, 2157 William S. White Building, 303 E. Kearsley Street, Flint, MI, 48502-1950, USA
| | - Dana Pechumer
- Physical Therapy Department, University of Michigan-Flint, 2157 William S. White Building, 303 E. Kearsley Street, Flint, MI, 48502-1950, USA
| | - Steven P Broglio
- Neurotrauma Research Laboratory, University of Michigan, Ann Arbor, MI, USA
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Bishop SA, Neary JP. Assessing prefrontal cortex oxygenation after sport concussion with near-infrared spectroscopy. Clin Physiol Funct Imaging 2017. [DOI: 10.1111/cpf.12447] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Scott A. Bishop
- Faculty of Kinesiology and Health Studies; University of Regina; Regina SK Canada
| | - J. Patrick Neary
- Faculty of Kinesiology and Health Studies; University of Regina; Regina SK Canada
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11
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O’Brien AM, Casey JE, Salmon RM. Short-term test–retest reliability of the ImPACT in healthy young athletes. APPLIED NEUROPSYCHOLOGY-CHILD 2017. [DOI: 10.1080/21622965.2017.1290529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Joseph E. Casey
- Department of Psychology, University of Windsor, Windsor, Canada
| | - Rachel M. Salmon
- Department of Psychology, University of Windsor, Windsor, Canada
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12
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Maerlender A, Masterson C, James T, Beckwith J, Brolinson P, Crisco J, Duma S, Flashman L, Greenwald R, Rowson S, Wilcox B. Test-retest, retest, and retest: Growth curve models of repeat testing with Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). J Clin Exp Neuropsychol 2016; 38:869-74. [PMID: 27266563 PMCID: PMC4962874 DOI: 10.1080/13803395.2016.1168781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Computerized neuropsychological testing has become an important tool in the identification and management of sports-related concussions; however, the psychometric effect of repeat testing has not been studied extensively beyond test-retest statistics. The current study analyzed data from Division I collegiate athletes who completed Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) baseline assessments at four sequential time points that varied over the course of their athletic careers. Administrations were part of a larger National Institutes of Health (NIH) study. Growth curve modeling showed that the two memory composite scores increased significantly with successive administrations: Change in Verbal Memory was best represented with a quadratic model, while a linear model best fit Visual Memory. Visual Motor Speed and Reaction Time composites showed no significant linear or quadratic growth. The results demonstrate the effect of repeated test administrations for memory composite scores, while speed composites were not significantly impacted by repeat testing. Acceptable test-retest reliability was demonstrated for all four composites as well.
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Affiliation(s)
- A.C. Maerlender
- University of Nebraska-Lincoln, USA; Center for Brain, Biology and Behavior, 1100 T Street, C89 East Stadium, University of Nebraska-Lincoln, Lincoln, NE 68588-0156
| | | | | | | | | | | | - S. Duma
- Virginia Tech University, USA
| | - L. Flashman
- Dartmouth College Geisel School of Medicine, USA
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13
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Henry LC, Elbin RJ, Collins MW, Marchetti G, Kontos AP. Examining Recovery Trajectories After Sport-Related Concussion With a Multimodal Clinical Assessment Approach. Neurosurgery 2016; 78:232-41. [PMID: 26445375 DOI: 10.1227/neu.0000000000001041] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous research estimates that the majority of athletes with sport-related concussion (SRC) will recover between 7 and 10 days after injury. This short temporal window of recovery is based predominately on symptom resolution and cognitive improvement and does not accurately reflect recent advances in the clinical assessment model. OBJECTIVE To characterize SRC recovery at 1-week postinjury time intervals on symptom, neurocognitive, and vestibular-oculomotor outcomes and to examine sex differences in SRC recovery time. METHODS A prospective, repeated-measures design was used to examine the temporal resolution of neurocognitive, symptom, and vestibular-oculomotor impairment in 66 subjects (age, 16.5 ± 1.9 years; range, 14-23 years; 64% male) with SRC. RESULTS Recovery time across all outcomes was between 21 and 28 days after SRC for most athletes. Symptoms demonstrated the greatest improvement in the first 2 weeks, although neurocognitive impairment lingered across various domains up to 28 days after SRC. Vestibular-oculomotor decrements also resolved between 1 and 3 weeks after injury. There were no sex differences in neurocognitive recovery. Male subjects were more likely to be asymptomatic by the fourth week and reported less vestibular-oculomotor impairment than female subjects at weeks 1 and 2. CONCLUSION When the recommended "comprehensive" approach is used for concussion assessment, recovery time for SRC is approximately 3 to 4 weeks, which is longer than the commonly reported 7 to 14 days. Sports medicine clinicians should use a variety of complementing assessment tools to capture the heterogeneity of SRC.
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Affiliation(s)
- Luke C Henry
- *Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania; ‡Department of Health, Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas, Fayetteville, Arkansas; §Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania
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14
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Measurement Error in the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT): Systematic Review. J Head Trauma Rehabil 2016; 31:242-51. [DOI: 10.1097/htr.0000000000000175] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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De Marco AP, Broshek DK. Computerized Cognitive Testing in the Management of Youth Sports-Related Concussion. J Child Neurol 2016; 31:68-75. [PMID: 25477270 DOI: 10.1177/0883073814559645] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 10/22/2014] [Indexed: 11/17/2022]
Abstract
Computerized neurocognitive testing has become a growing practice across medical populations, but particularly within sports medicine and the management of sports-related concussion. Although traditional neuropsychological measures are solely administered and interpreted by neuropsychologists, computerized cognitive tests are marketed to and utilized by a wide range of professionals involved in the management of sports-related concussions, many of whom lack specialized psychometric training. Although the benefits of computerized testing allow for many youth athletes to be evaluated quickly, professionals implementing their use should be aware of the potential pitfalls and the high potential for misuse. After briefly reviewing the recommended guidelines set forth by the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology, we review the benefits/limitations of computerized testing in the management of sports-related concussion and the basic psychometric properties of some of the more widely used computerized measures. Lastly, we discuss the practical application of these devices.
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Affiliation(s)
- Anthony P De Marco
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - Donna K Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA
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Resch JE, Kutcher JS. The Acute Management of Sport Concussion in Pediatric Athletes. J Child Neurol 2015; 30:1686-94. [PMID: 25834282 DOI: 10.1177/0883073815574335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/28/2015] [Indexed: 11/17/2022]
Abstract
During the past two decades the focus on sport concussion has increased significantly. Young athletes represent the most vulnerable population to sustain a sport concussion yet receive the least amount of attention. Specifically, young athletes who sustain a sport concussion can go unrecognized and continue to participate in sport putting them at an increased risk for a more significant injury. The purpose of this review is to provide a clinical framework for the evaluation and management of sport concussion. In addition, this review provides considerations for health care professionals in regard to clinical measures and follow-up strategies during the acute phase following concussion in young concussed athletes following injury.
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Iverson GL, Schatz P. Advanced topics in neuropsychological assessment following sport-related concussion. Brain Inj 2014; 29:263-75. [PMID: 25313596 DOI: 10.3109/02699052.2014.965214] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study examined seven topics relating to neuropsychological assessment following sport-related concussion: (i) traditional vs. computerized tests; (ii) the value of baseline, pre-season testing; (iii) invalid baseline scores and poor effort; (iv) when to assess following injury; (v) the reliability of neuropsychological tests; (vi) reliable change methodology; and (vii) new methods for identifying cognitive impairment. MAIN RESULTS Baseline testing can be helpful for quantifying cognitive deficits following injury and for assessing recovery. At present, however, there is insufficient evidence to conclude that having baseline test results is clearly superior to not having baseline test results. Although invalid baseline test performance can be detected in some athletes, validity indicators cannot determine the extent to which the results were due to deliberately poor performance, confusion or misunderstanding regarding some aspect of the test, distractions in group testing environments or some combination of factors. When interpreting baseline and post-injury data, sophisticated psychometric methods (e.g. reliable change, multivariate base rates) are available to assist with more accurate identification of cognitive impairment and the serial monitoring of recovery. CONCLUSIONS The value of neuropsychological assessment in the management of sport-related concussion has a strong empirical foundation. Additional research is needed, however, to refine its use.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, MA , USA
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Rahman-Filipiak AAM, Woodard JL. Administration and environment considerations in computer-based sports-concussion assessment. Neuropsychol Rev 2013; 23:314-34. [PMID: 24306286 DOI: 10.1007/s11065-013-9241-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/07/2013] [Indexed: 11/30/2022]
Abstract
Computer-based testing has become a vital tool for the assessment of sport-related concussion (SRC). An increasing number of papers have been published on this topic, focusing on subjects such as the purpose and validity of baseline testing, the performance of special populations on computer-based tests, the psychometric properties of different computerized neurocognitive tools, and considerations for valid and reliable administration of these tools. The current paper describes several considerations regarding computerized test design, input and output devices, and testing environment that should be described explicitly when administering computer-based cognitive testing, regardless of whether the assessment is used for clinical or research purposes. The paper also reviews the conclusions of recent literature (2007-2013) using computer-based testing for the assessment of SRC, with special attention to the methods used in these studies. We also present an appendix checklist for clinicians and researchers that may be helpful in ensuring proper attention to factors that could influence the reliability and validity of computer-based cognitive testing. We believe that explicit attention to these technological factors may lead to the development of standards for the development and implementation of computer-based tests. Such standards have the potential to enhance the accuracy and utility of computer-based tests in SRC.
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