scholarly journals A-42 Incremental Utility of Visual Assessment in Predicting Concussion Recovery Time Among Adolescents

2020 ◽  
Vol 35 (5) ◽  
pp. 638-638
Author(s):  
J Sterling ◽  
D Pardini ◽  
J Pardini ◽  
M Docherty ◽  
J Mattis
Keyword(s):  
Test Performance ◽  
Symptom Severity ◽  
Visual Memory ◽  
Recovery Time ◽  
Return To Play ◽  
Prior History ◽  
Post Injury ◽  
Neurocognitive Test ◽  
The Impact ◽  
Vision Function

Abstract Objective Sports-related concussions (SRC) often affect vision function and cognition, two components frequently assessed as part of a multimodal post-injury evaluation. The purpose of the study was to examine contributions of measures of vision function and cognition toward understanding recovery time. Method Participants were 593 (37.6% female) adolescents ages 10–18 (M = 14.7, SD = 1.7) who were evaluated and diagnosed with a concussion within 10 days of injury. Participants were administered the King-Devick (KD) test via KD cards to assess rapid number naming speed and the ImPACT test to assess post-concussion symptoms and neurocognitive test performance. The primary outcome was number of weeks (M = 3.2, SD = 1.9) until participants were cleared to return to play by the treating physician based on a standardized protocol. Results Poorer performance on the King-Devick test was significantly correlated with higher symptom severity (r = .41, p < .001), and poorer performance on ImPACT Verbal Memory (r = −.46, p < .001), Visual Memory (r = −.39, p < .001), Visual Motor Speed (r = −55, p < .001), and Reaction Time (r = .47, p < .001) composites. Poorer KD scores were also significantly correlated with a longer time to recovery (r = .23, p < .001). Importantly, poorer KD scores continued to significantly predict protracted recovery time after controlling for age, gender, time to initial physician evaluation, prior history of concussion, post-concussion symptom severity, and neurocognitive test performance (β = .12, p < .05). Conclusions Performance on King-Devick testing predicted recovery time, even after controlling for important demographic/injury characteristics and cognitive testing. Evaluation of vision function is an important component of post-injury assessment for SRC.

scholarly journals A-30 Symptom Count Versus Symptom Severity: Which is a Better Predictor of Time to Recovery?

2020 ◽  
Vol 35 (5) ◽  
pp. 626-626
Author(s):  
J Pardini ◽  
D Pardini ◽  
J Sterling ◽  
M Docherty ◽  
J Mattis
Keyword(s):  
Regression Model ◽  
Test Performance ◽  
Symptom Severity ◽  
Clinic Visit ◽  
Return To Play ◽  
Prior History ◽  
Linear Regression Models ◽  
Symptom Scale ◽  
Concussion Management ◽  
The Impact

Abstract Objective Evaluation of self-reported symptoms is a key component of concussion management. This study examined whether symptom count, a more parsimonious method to gather symptom information, would predict recovery better than symptom severity. Method Participants were 1267 (39.3% female) adolescents ages 10–18 (M = 14.7, SD = 1.8) who were evaluated and diagnosed with a concussion by a physician within 10 days of injury. At their initial visit, participants completed the ImPACT computerized test and the included post-concussion symptom scale. The primary outcome was number of weeks (M = 3.2, SD = 1.8) until participants were cleared to return to play by the treating physician based on a standardized protocol. Results Symptom count and symptom severity were highly correlated (r = .89, p < .001). When examined in separate linear regression models, both symptom count (β = .28, p < .001) and symptom severity (β = .25, p < .001) predicted weeks until return to play after controlling for age, gender, prior history of concussion, and neurocognitive test performance. However, when symptom count and severity were both included in the same regression model, symptom count continued to predict weeks to recovery (β = .31, p < .001) and the effect of symptom severity was reduced to non-significance (β = −.03, p = .64). Conclusions Symptom count at initial clinic visit predicted recovery time, eliminating the predictive power of symptom severity when both were entered in the same regression model. Thus, symptom count may be a more robust and more parsimonious assessment than traditional severity ratings, which may save clinic time and allow for additional multimodal assessments.

Influence of Test Environment, Age, Sex, and Sport on Baseline Computerized Neurocognitive Test Performance

2019 ◽  
Vol 47 (13) ◽  
pp. 3263-3269 ◽  
Author(s):  
Jonathan French ◽  
Patrick Huber ◽  
Joseph McShane ◽  
Cyndi L. Holland ◽  
Robert J. Elbin ◽  
...  
Keyword(s):  
Test Performance ◽  
Symptom Severity ◽  
Test Validity ◽  
Outreach Program ◽  
Age Group ◽  
Testing Environment ◽  
Severity Scores ◽  
Sport Type ◽  
Neurocognitive Test ◽  
The Individual

Background: Baseline computerized testing is a common component of concussion assessments, and the testing environment has been suggested to influence test performance and validity. Purpose: To compare concussion baseline computerized neurocognitive test performance and validity among adolescent athletes based on testing environment (group, individual), age group (10-12, 13-15, 16-18 years), sex (male, female), and sport type (collision/combat, contact, noncontact). Study Design: Cohort study; Level of evidence, 3. Methods: Through a concussion community outreach program, participants completed baseline computerized neurocognitive testing using Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). A total of 2845 athletes aged 10 to 18 years completed the baseline assessment. A total of 2241 (79%) athletes completed baseline testing in a group environment, and 604 (21%) completed testing in an individual environment. A random subsample of 500 athletes from each group was selected for statistical comparison. Results: No significant differences were supported in baseline computerized neurocognitive test performance between the group and individual administration environments. Test validity was statistically similar across testing environment, age group, and sex. However, patients of older age (16-18 years), female sex, and collision/combat and contact sports performed better on ImPACT. There were differences in total symptom severity scores ( t = 2.19, df = 998, P = .03), with participants in the group testing environment reporting lower total symptom severity scores than those in the individual testing environment. The rates of invalid tests were low across all age groups, averaging from 4.0% in the 10- to 12-year age group to 4.8% in the 13- to 15-year age group. Conclusion: The findings indicated that concussion baseline neurocognitive test performance is similar when administered in group and individual testing environments. However, differences based on age group, sex, and sport type should be considered when interpreting baseline computerized neurocognitive test scores. The finding of higher symptom scores in older adolescents in the individual testing environment suggests that they may be less forthcoming about symptoms in a group setting.

scholarly journals A-31 Association Between Cognitive Activity and Recovery Outcomes in College Students Following Concussion

2020 ◽  
Vol 35 (5) ◽  
pp. 627-627
Author(s):  
K M Petit ◽  
A J Zynda ◽  
M Anderson ◽  
C P Tomczyk ◽  
T Covassin
Keyword(s):  
College Students ◽  
Symptom Severity ◽  
Recovery Time ◽  
Cognitive Activity ◽  
Symptom Reporting ◽  
Future Research ◽  
Symptom Scale ◽  
Post Injury ◽  
Medical Clearance ◽  
The Relationship

Abstract Objective To evaluate the relationship between self-reported cognitive activity and recovery outcomes (symptom reporting, recovery time) in college students following concussion. Method Cognitive activity was defined as self-reported minutes spent in class and studying during the first 5 days following concussion. Self-reported symptoms were reported at day 5 post-injury using the Post-Concussion Symptom Scale (PCSS). The PCSS evaluates 22 symptoms on a 7-point Likert Scale from 0 (none) to 6 (severe). Recovery time was defined as total days from injury to unrestricted medical clearance. Separate Spearman’s rank correlations assessed the relationship between total cognitive activity (minutes in class and studying) and recovery outcomes (symptom total (22), symptom severity (132), and recovery time). Alpha level set a priori at 0.05. Results Twenty-one participants (14 female, 7 male, 19.5 ± 1.3 years) averaged a total of 653[IQR = 348] minutes of cognitive activity during the first 5 days after concussion (334[IQR = 149] minutes in class, 273[IQR = 313] minutes studying). Five days after injury, participants self-reported 3[IQR = 8] total symptoms yielding a severity of 4[IQR = 12]. Participants took 15 [IQR = 8] days to reach unrestricted medical clearance. No associations were found between total cognitive load and any post-concussion recovery outcomes (symptom total: Rs = −.299, p = .19; symptom severity: Rs = −.230, p = .32; recovery time: Rs = −.041, p = .86). Conclusions Preliminary analyses suggest that concussed college students can be encouraged to gradually return to normal levels of cognitive activity, as it may not be associated with future symptom reporting or recovery time. Future research is needed to assess specific cognitive activities immediately influence on post-concussion symptom reporting.

scholarly journals Adolescents With ADHD Do Not Take Longer to Recover From Concussion

2021 ◽  
Vol 8 ◽  
Author(s):  
Nathan E. Cook ◽  
Grant L. Iverson ◽  
Bruce Maxwell ◽  
Ross Zafonte ◽  
Paul D. Berkner
Keyword(s):  
Recovery Time ◽  
Return To Play ◽  
Return To School ◽  
Prior History ◽  
Return To Sports ◽  
Full Time ◽  
Recovery Times ◽  
Concussion History ◽  
Concussion Recovery ◽  
Medication Status

The objective of this study was to determine whether adolescents with attention-deficit/hyperactivity disorder (ADHD) have prolonged return to school and sports following concussion compared to those without ADHD and whether medication status or concussion history is associated with recovery time. We hypothesized that having ADHD would not be associated with longer recovery time. This prospective observational cohort study, conducted between 2014 and 2019, examined concussion recovery among school sponsored athletics throughout Maine, USA. The sample included 623 adolescents, aged 14–19 years (mean = 16.3, standard deviation = 1.3 years), 43.8% girls, and 90 (14.4%) reported having ADHD. Concussions were identified by certified athletic trainers. We computed days to return to school (full time without accommodations) and days to return to sports (completed return to play protocol) following concussion. Adolescents with ADHD [median days = 7, interquartile range (IQR) = 3–13, range = 0–45] did not take longer than those without ADHD (median days = 7, IQR = 3–13, range = 0–231) to return to school (U = 22,642.0, p = 0.81, r = 0.01; log rank: χ12 = 0.059, p = 0.81). Adolescents with ADHD (median days = 14, IQR = 10–20, range = 2–80) did not take longer than those without ADHD (median days = 15, IQR = 10–21, range = 1–210) to return to sports (U = 20,295.0, p = 0.38, r = 0.04; log rank: χ12 = 0.511, p = 0.48). Medication status and concussion history were not associated with longer recovery times. Adolescents with ADHD did not take longer to functionally recover following concussion. Recovery times did not differ based on whether adolescents with ADHD reported taking medication to treat their ADHD or whether they reported a prior history of concussion.

scholarly journals Perceptual-cognitive three-dimensional multiple-object tracking task can help the monitoring of sport-related concussion

2018 ◽  
Vol 4 (1) ◽  
pp. e000384 ◽  
Author(s):  
Jean-François Chermann ◽  
Thomas Romeas ◽  
Flore Marty ◽  
Jocelyn Faubert
Keyword(s):  
Object Tracking ◽  
Test Performance ◽  
Cognitive Task ◽  
Three Dimensional ◽  
Multiple Object Tracking ◽  
Return To Play ◽  
Professional Athletes ◽  
Post Injury ◽  
Multiple Object ◽  
Management Protocol

ObjectivesWhile the rate of sport-related concussion is increasing, more effective tools are needed to help monitor the diagnosis and return to play of athletes. The three-dimensional multiple-object tracking (3D-MOT) exercise is a perceptual-cognitive task that has shown predictive power towards the dynamic requirements of real-world activities such as sport. This study introduced the use of the 3D-MOT task, along with the Standardized Assessment of Concussion (SAC) and Modified Balance Error Scoring System (M-BESS) tests, for diagnosis and return to play in professional sports.MethodsFifty-nine professional athletes were tested with the 3D-MOT, SAC and M-BESS tests at 48 hours following the injury. The same measures were employed to evaluate the return to play following the standard concussion management protocol. The SAC and M-BESS tests were also performed in pre-season (baseline) in 32 out of the 59 athletes.ResultsThe injured athletes exhibited poor performance on 3D-MOT at 48 hours post injury compared with return to play (p<0.001) as well as compared with healthy professionals’ performance scores (p<0.001). Importantly, learning rate, which participants are thought to have an expert advantage on this perceptual-cognitive task, was totally disrupted at 48 hours post injury compared with healthy professionals (p<0.001). The 3D-MOT performance was also correlated to the total number of symptoms (p=0.020), SAC (p=0.031) and M-BESS (p=0.004) scores at 48 hours. Not surprisingly, SAC and M-BESS tests’ usefulness for monitoring concussion was found to be weak, particularly when test performance following the injury was compared to baseline (p=0.056 and 0.349 for SAC and M-BESS, respectively).Conclusion3D-MOT could help monitor sport-related concussion in professional athletes. The discussion also covers the critical importance of perceptual-cognitive assessment following concussion in the athletic population.

scholarly journals Recovery Profiles Following Concussion Among Male Athletes with a Family History of Neurodegenerative Disease: Data from the NCAA-DOD CARE Consortium

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S13.2-S14
Author(s):  
Adam Harrison ◽  
Steven Broglio ◽  
R. Davis Moore ◽  
Andrew Lapointe ◽  
Michael McCrea
Keyword(s):  
Family History ◽  
Neurodegenerative Disease ◽  
Repeated Measures ◽  
Visual Memory ◽  
Memory Performance ◽  
Return To Play ◽  
Post Injury ◽  
Male Athletes ◽  
Time Interaction ◽  
History Of

ObjectiveLongitudinally assess recovery following concussion in male athletes with fhNDD.BackgroundResearch suggests that a family history of neurodegenerative disease (fhNDD) may predispose an athlete to abnormal recovery following brain injury. However, no one has longitudinally assessed recovery following concussion in male athletes with fhNDD.Design/MethodsData from the NCAA-DOD Grand Alliance: Concussion Assessment, Research, and Education (CARE) Consortium were used to compared male athletes with (n = 51) and without (n = 102) a family history of neurodegenerative disease (Parkinson’s, Alzheimer’s, Non-Alzheimer’s Dementia, and Mild Cognitive Impairment). All athletes completed baseline ImPACT assessments prior to the beginning of their sporting season. Athletes that sustained a concussion were then re-evaluated 24-48 hours post-injury, prior to un-restricted return to play (RTP), and again 6 months post-injury. Athletes without fhNDD were double matched based on age, body mass index, sport category, and concussion history.ResultsRepeated measures ANCOVA models were used to evaluate performance at each post-injury timepoint, while controlling for baseline performance. A group × time interaction was observed for visual memory performance. Post-hoc univariate analyses revealed that male athletes with fhNDD demonstrated significantly poorer visual memory performance 24–48 hours post-injury compared to controls (p ≤ 0.005). Additionally, we found a main effect of group for impulse control, indicating that male athletes with fhNDD demonstrated an increase number of impulse errors at all three post-injury evaluations (p ≤ 0.004). We did not to observe any other group differences (p’s > 0.05).ConclusionsOur results suggest that male athletes with a family history of neurodegenerative disease may exhibit greater post-injury cognitive deficits compared to controls. Additionally, some deficits may persist for at least 6 months post-injury. Further research is warranted to investigate the interaction between family history of neurodegenerative disease and concussion.

A-125 The Impact of Bilingualism on Symbol Digit Modalities Test Performance Following Traumatic Brain Injury

2021 ◽  
Vol 36 (6) ◽  
pp. 1175-1175
Author(s):  
Raelynn Munoz ◽  
Daniel W Lopez-Hernandez ◽  
Rachel A Rugh-Fraser ◽  
Jasman Sidhu ◽  
Pavel Y Litvin ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Deficits ◽  
Test Performance ◽  
Oral Performance ◽  
Neurocognitive Performance ◽  
Post Injury ◽  
Cognitive Speed ◽  
The Impact ◽  
Larger Sample

Abstract Objective Traumatic brain injury (TBI) survivors exhibit cognitive deficits. Research suggests that multilingualism can influence neurocognitive performance. We examined the effects of TBI and bilingualism/monolingualism on a test of attention and cognitive speed (i.e., Symbol Digit Modalities Test; SDMT). Method The sample consisted of 55 healthy comparison (27 Spanish-English bilinguals; 28 English-monolinguals), 34 acute TBI (14 Spanish-English bilinguals; 23 English-monolinguals), and 27 chronic TBI (13 Spanish-English bilinguals; 12 English-monolinguals) participants. Acute TBI participants were tested 6 months post-injury; chronic TBI participants were tested 12 months or more post-injury. A series of 3X2 ANOVAs were conducted to determine the effect of TBI and language on SDMT written and oral performance. Results ANOVAs revealed the healthy comparison group outperformed both TBI groups on SDMT written, p = 0.000, ηp2 = 0.21. Also, the healthy comparison and chronic TBI groups outperformed the acute TBI group on SDMT oral, p = 0.000, ηp2 = 0.13. Interaction effects emerged between TBI and bilingualism/monolingualism. On SDMT written and oral, acute TBI English-monolinguals outperformed acute TBI Spanish-English bilinguals; meanwhile, chronic TBI Spanish-English bilinguals outperformed chronic TBI English-monolinguals, p &lt; 0.05, ηp2 = 0.09–0.10. Conclusion The acute TBI group performed worse than healthy comparison adults on both SDMT tasks. Furthermore, the chronic TBI group demonstrated better SDMT oral abilities compared to the acute TBI group. Relative to monolinguals with TBI, our findings suggest better cognitive recovery of attention and cognitive speed in bilingual TBI participants. Future studies with larger sample sizes should examine if learning English first or second impacts Spanish-English bilingual TBI survivors’ SDMT performance compared to English-monolingual TBI survivors.

The impact of visual memory impairment on Victoria Symptom Validity Test performance: A known-groups analysis

2022 ◽  
pp. 1-10
Author(s):  
Jane K. Stocks ◽  
Allison N. Shields ◽  
Adam B. DeBoer ◽  
Brian M. Cerny ◽  
Caitlin M. Ogram Buckley ◽  
...  
Keyword(s):  
Test Performance ◽  
Visual Memory ◽  
Memory Impairment ◽  
Symptom Validity ◽  
Validity Test ◽  
Victoria Symptom Validity Test ◽  
Symptom Validity Test ◽  
The Impact

Recovery from mild concussion in high school athletes

2003 ◽  
Vol 98 (2) ◽  
pp. 296-301 ◽  
Author(s):  
Mark R. Lovell ◽  
Michael W. Collins ◽  
Grant L. Iverson ◽  
Melvin Field ◽  
Joseph C. Maroon ◽  
...  
Keyword(s):  
High School ◽  
Mental Status ◽  
Test Performance ◽  
Neuropsychological Test ◽  
Return To Play ◽  
Control Group ◽  
High School Athletes ◽  
Post Injury ◽  
Content Type ◽  
Fine Print

Object. A computerized neuropsychological test battery was conducted to evaluate memory dysfunction and self-reporting of symptoms in a group of high school athletes who had suffered concussion. Methods. Neuropsychological performance prior to and following concussion was compared with the test performance of an age-matched control group. Potentially important diagnostic markers of concussion severity are discussed and linked to recovery within the 1st week of injury. Conclusions. High school athletes who had suffered mild concussion demonstrated significant declines in memory processes relative to a noninjured control group. Statistically significant differences between preseason and postinjury memory test results were still evident in the concussion group at 4 and 7 days postinjury. Self-reported neurological symptoms such as headache, dizziness, and nausea resolved by Day 4. Duration of on-field mental status changes such as retrograde amnesia and posttraumatic confusion was related to the presence of memory impairment at 36 hours and 4 and 7 days post-injury and was also related to slower resolution of self-reported symptoms. The results of this study suggest that caution should be exercised in returning high school athletes to the playing field following concussion. On-field mental status changes appear to have prognostic utility and should be taken into account when making return-to-play decisions following concussion. Athletes who exhibit on-field mental status changes for more than 5 minutes have longer-lasting postconcussion symptoms and memory decline.

scholarly journals A-19 Utility OF ImPACT Pediatric In Patients Aged 5–9 Following Concussion

2020 ◽  
Vol 35 (5) ◽  
pp. 615-615
Author(s):  
A H Feder ◽  
N Kegel ◽  
S R Eagle ◽  
V Fazio-Sumrok ◽  
A Trbovich ◽  
...  
Keyword(s):  
Visual Processing ◽  
Comprehensive Evaluation ◽  
Pediatric Population ◽  
Empirical Support ◽  
Test Battery ◽  
Initial Visit ◽  
Post Injury ◽  
Stop And Go ◽  
Neurocognitive Test ◽  
The Impact

Abstract Objective Computerized neurocognitive testing has demonstrated sensitivity to the effects of concussion (Kontos et al., 2014). While there have been attempts to develop post-injury assessments for youth concussion, most lack compelling empirical support regarding psychometric properties. The purpose of this study was to expand upon preliminary support for the ImPACT Pediatric neurocognitive test battery (Newman et al., 2013) by examining the clinical utility of this measure in the evaluation of concussion in a pediatric population. Method Children, aged 5–9 years, presented to an outpatient clinic within 30 days of concussion. Participants completed ImPACT Pediatric at all clinic visits. ImPACT Pediatric is a computerized neurocognitive test battery that assesses various aspects of memory and visual processing speed. Paired t-tests were used to compare ImPACT Pediatric subtest scores at initial visit and clinical clearance. Results Participants (n = 63) were predominantly male (57.8%), aged 7.5 ± 1.0 years who presented to the clinic in 8.5 ± 5.9 days from injury and recovered in 34.1 ± 23.5 days. Design Rotation average time (−11.3%; p &lt; 0.001), Stop and Go average correct time (−4.3%; p = 0.030), and Picture Touch immediate memory average time (−11.3%; p &lt; 0.001) significantly improved from initial visit to clearance. Memory subtest scores did not significantly improve from initial visit to clearance. Conclusions Average time was significantly improved at the time of clinical clearance on the Design Rotation, Stop and Go, and Picture Match subtests. The findings indicate that ImPACT Pediatric timed subtests can detect changes between initial and clearance visits. Pediatric ImPACT can be a useful component of the comprehensive evaluation of concussion in younger children.

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