Exploring Baseline Concussion-Assessment Performance in Adapted Wheelchair Sport Athletes

Context With growing awareness of and advocacy for including individuals with disabilities in sport, implementation of concussion-assessment and -management strategies is warranted. Limited research is available on concussion assessment in adapted wheelchair sport athletes. Objective To examine baseline symptom reporting, computerized neurocognitive testing, and a modified balance scoring system in adapted athletes. A secondary objective was to provide preliminary normative data for this population. Design Cross-sectional study. Setting University athletic training room and computer laboratory. Patients or Other Participants Twenty-one athletes (age = 22.1 ± 3.0 years) from 1 institution's collegiate adapted athletics program. Main Outcome Measure(s) Athletes completed baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and the Wheelchair Error Scoring System (WESS) before the start of their respective seasons. Symptom reporting variables consisted of total symptoms, symptom severity scores, and baseline symptom factors (eg, vestibular-somatic, sleep arousal, cognitive-sensory, and affective). We analyzed ImPACT composite scores of verbal memory, visual memory, visual motor processing speed, and reaction time and impulse control to determine neurocognitive function. Balance performance was quantified using the WESS condition and overall errors. Results Compared with normative reference values, 17 (81%) of adapted athletes reported greater symptoms and 20 (95%) performed at or below average on at least 1 neurocognitive composite score. Mean errors on the WESS were 3.14 ± 2.9, with 81% committing ≥1 error. Sex differences were not present for symptoms, neurocognitive testing, or balance measures. Conclusions Our findings provide context for baseline performance in adapted athletes and help to further develop the WESS as an assessment of balance in these athletes.

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Do Sideline Concussion Assessments Predict Subsequent Neurocognitive Impairment After Sport-Related Concussion?

Journal of Athletic Training ◽

10.4085/1062-6050-52.4.01 ◽

2017 ◽

Vol 52 (7) ◽

pp. 676-681 ◽

Cited By ~ 7

Author(s):

Alicia Sufrinko ◽

Jamie McAllister-Deitrick ◽

Melissa Womble ◽

Anthony Kontos

Keyword(s):

High School ◽

Verbal Memory ◽

Visual Memory ◽

Standard Of Care ◽

Cognitive Testing ◽

Assessment Tools ◽

Motor Speed ◽

Neurocognitive Testing ◽

Symptom Scale ◽

The Impact

Context: Comprehensive, multidomain assessment is the standard of care after sport-related concussion. However, the relationship between performance on sideline concussion-assessment tools and in-office computerized neurocognitive testing has received little attention, and the prognostic utility of sideline measures is unknown. Objective: To evaluate concurrent impairment on commonly used concussion measures 24 to 48 hours postinjury while also determining the predictive utility of sideline measures on computerized neurocognitive testing in the acute to subacute recovery periods postinjury. Design: Case-control study. Setting: High school and collegiate athletics. Patients or Other Participants: A total of 125 high school and college-aged athletes (85 males, 40 females) 14 to 23 (16.8 ± 2.21) years old. Main Outcome Measure(s): Participants were administered sideline concussion-assessment measures (ie, Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT], Standardized Assessment of Concussion [SAC], and Balance Error Scoring System [BESS]) 24 to 48 hours postinjury and completed ImPACT and the Post-Concussion Symptom Scale 5 to 7 and 10 to 14 days postinjury. Outcome measures were the ImPACT composite (verbal memory, visual memory, reaction time, visual-motor speed), SAC, and BESS scores and total symptom score on the Post-Concussion Symptom Scale. Results: Participants demonstrated heterogeneous patterns of impairment on measures 24 to 48 hours postinjury, with the most common pattern being impairment on ImPACT and the SAC. Performance on the SAC and BESS at 24 to 48 hours after injury did not distinguish between those with and those without impairment on ImPACT at 5 to 7 days postinjury (χ2 = 5.076, P = .079) or 10 to 14 days postinjury (χ2 = 2.04, P = .361). Conclusions: More than 90% of athletes were impaired on at least 1 sideline or neurocognitive measure 24 to 48 hours after sport-related concussion. Although sideline measures are useful for concussion diagnosis, they are not suitable for prognostication of impairment or the presence of symptoms 1 to 2 weeks postinjury.

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Verbal memory deficits associated with fornix atrophy in carbon monoxide poisoning

Journal of the International Neuropsychological Society ◽

10.1017/s1355617701005112 ◽

2001 ◽

Vol 7 (5) ◽

pp. 640-646 ◽

Cited By ~ 36

Author(s):

SHELLI R. KESLER ◽

RAMONA O. HOPKINS ◽

LINDELL K. WEAVER ◽

DUANE D. BLATTER ◽

HOLLY EDGE-BOOTH ◽

...

Keyword(s):

Carbon Monoxide ◽

Verbal Memory ◽

Visual Memory ◽

Carbon Monoxide Poisoning ◽

Neuropsychological Testing ◽

Mr Images ◽

Cross Sectional ◽

Memory Processing ◽

Within Subjects ◽

And Gender

Magnetic resonance (MR) images and neuropsychological testing data of 69 carbon monoxide (CO) poisoned patients were prospectively obtained within 1 day of CO poisoning, two weeks and six months. CO patients' Day 1 cross-sectional fornix surface area measurements, corrected for head size by using a fornix-to-brain ratio (FBR), were compared to normal age and gender-matched controls. Additionally, a within-subjects analysis was performed comparing the mean areas between CO patients' Day 1, 2 weeks and 6-month FBR. The FBR was correlated with patients' neuropsychological data. There were no significant differences between CO patients' Day 1 fornix measurements compared to normal control subjects. However, significant atrophic changes in the fornix of CO poisoned patients occurred at two weeks with no progressive atrophy at 6 months. By 6 months, CO patients showed significant decline on tests of verbal memory (when practice effects were taken into account), whereas visual memory, processing speed and attention/concentration did not decline. This study indicates that CO results in brain damage and cognitive impairments in the absence of lesions and other neuroanatomic markers. (JINS, 2001, 7, 640–646.)

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Internet-based cognitive testing in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458507077626 ◽

2007 ◽

Vol 13 (8) ◽

pp. 1011-1019 ◽

Cited By ~ 19

Author(s):

M. Younes ◽

J. Hill ◽

J. Quinless ◽

M. Kilduff ◽

B. Peng ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Function ◽

Verbal Memory ◽

Stability Index ◽

Cross Sectional Study ◽

Cognitive Testing ◽

The Internet ◽

Cross Sectional ◽

Multiple Sclerosis Patients

Cognitive impairment in multiple sclerosis is difficult to study because of the heterogeneity and variability of this disease. The gold standard for measurement of cognitive function in multiple sclerosis is a full battery of neurocognitive tests, which is time consuming and expensive. Some cognitive tests like the PASAT, a measure of working verbal memory and processing speed, have been proposed for screening and follow-up of cognitive function in clinical trials. We studied whether we could measure cognitive function in multiple sclerosis over the Internet. For this we used the Cognitive Stability Index (CSI)™, developed for persons with known or suspected primary central nervous system illness. The CSI was compared with formal neurocognitive testing (NPsych) and the PASAT in a cross-sectional study of 40 consecutive multiple sclerosis patients with subjective cognitive complaints. NPsych revealed that only 18 of the 40 patients (46%) were cognitively impaired. Although both the CSI and the PASAT were equalivalent in their specificity (86%), the CSI was significantly more sensitive than the PASAT (83% versus 28%). We conclude that the CSI, because of its availability over the Internet, has great potential as a tool for screening and follow up of cognitive function in multiple sclerosis. Multiple Sclerosis 2007; 13: 1011—1019. http://msj.sagepub.com

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B-44 An Examination of Balance Measurements in Predicting Post-Concussion Neurocognitive Dysfunction

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz034.127 ◽

2019 ◽

Vol 34 (6) ◽

pp. 990-990

Author(s):

A DaCosta ◽

A Crane ◽

M Fasciana ◽

A LoGalbo

Keyword(s):

Reaction Time ◽

Verbal Memory ◽

Visual Memory ◽

Clinical Utility ◽

Collegiate Athletes ◽

Motor Speed ◽

Balance Performance ◽

Neurocognitive Dysfunction ◽

Balance Deficits ◽

Visual Motor

Abstract Objective Previous research indicates that athletes experiencing concussions demonstrate acute balance deficits (Guskiewicz, 2011). Although it is hypothesized that balance performance is related to neurocognitive function in athletes experiencing a concussion (Guskiewicz, Ross, & Marshall, 2001; Broglio, Sosnoff, Ferrara, 2009), limited research exists regarding the clinical utility of baseline measures. Method 68 collegiate athletes (ages 18-23; M = 19.62, SD = 1.44) were evaluated using the Balance error scoring system (BESS) and ImPACT at baseline and post-concussion. Multiple linear regressions were used to determine how BESS performance change across evaluations predicted post-concussion neurocognitive dysfunction compared to post-concussion performance alone. Results BESS performance changes from baseline to post-concussion significantly predicted post-concussion Verbal Memory (R² = .06, p = .05), Visual Memory (R² = .135, p = .002), Visual-Motor Speed (R² = .146, p = .001), Reaction Time (R² = .156, p = .001), and Total Symptom Scores (R² = .112, p = .005); while post-concussion BESS scores predicted Visual Memory (R² = .138, p = .002), Visual-Motor Speed (R² = .137, p = .002), and Reaction Time (R² = .145, p = .001). Therefore, assessing change in BESS performance is a more comprehensive predictor of neurocognitive dysfunction than solely post-concussion BESS performance. Conclusions Changes in BESS performance from baseline to post-concussion was found to be a more comprehensive predictor of neurocognitive dysfunction than post-concussion BESS scores alone. Therefore, our results support the clinical utility of evaluating balance at pre-participation to better understand neurocognitive risk factors.

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THE RELATIONSHIP BETWEEN ACUTE MOOD, SLEEP, AND SEX ON NEUROCOGNITIVE PERFORMANCE POST-CONCUSSION IN ADOLESCENTS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00191 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0019

Author(s):

Sara Stremlau ◽

Richard Cameron Allred ◽

Richard Gerkin ◽

Steven Erickson ◽

Jamie Pardini

Keyword(s):

Reaction Time ◽

Verbal Memory ◽

Visual Memory ◽

Cognitive Testing ◽

Motor Speed ◽

Neurocognitive Performance ◽

Symptom Report ◽

Mood Symptoms ◽

Visual Motor ◽

And Performance

Background: Both sleep disturbance and mood changes are common symptoms post-concussion (Sell & Rubeor, 2017). Studies have found these symptoms are correlated with poorer performance on neurocognitive testing (Kontos et al., 2012 and Kostyun et al., 2015). In addition, Brown et al., (2015) showed that females report more symptoms at both baseline and post-concussion compared to males on the Post-Concussion Scale and the Sport Concussion Assessment Tool 2. Hypothesis/Purpose: The purpose of this study is to investigate how a patient’s sex, as well as self-reported acute mood and sleep symptoms are related to neurocognitive performance in individuals with concussion. Methods: Data were acquired through IRB-approved retrospective chart review. Composite scores from the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computerized evaluation and self-reported symptom scores on the Post-Concussion Symptom Scale were gathered for 1619 adolescents age 12-18 (49.3% female) who presented to a large metropolitan outpatient clinic for treatment of concussion. Results: Females endorsed higher overall symptoms (x=19.52, SD 19.37, median 13.0 for females; x=12.88, SD 15.89, median 7.0 for males; Mann-Whitney U Test p<0.001). This same pattern emerged for the mood and sleep symptom clusters (female mood mean=2.92, SD 4.51; male mood mean=1.64, SD 3.34; female sleep mean=1.59, SD 2.0; male sleep mean=1.11, SD 1.84; both Independent Samples Mann-Whitney U Tests ps<0.001). There were significant but modest negative correlations between mood symptoms and performance on verbal memory (r=-0.174), visual memory (r=-0.213), and visual motor speed (r=-0.146) composites (all ps<0.01). There was positive correlation between reaction time composite and mood symptoms (r=0.191). There were significant but modest negative correlations between sleep symptoms and performance on verbal memory (r=-0.171), visual memory (r=-0.184), and visual motor speed (r=-0.161) composites (all ps<0.01). There was a positive correlation between reaction time composite and sleep symptoms (r=0.196, p<0.01). Conclusion: Consistent with prior research, adolescent females reported more symptoms post-concussion, including total symptom score, mood symptoms, and sleep symptoms. Adolescents presenting with more mood and sleep symptoms demonstrated poorer performance on neurocognitive testing. However, given the modest nature of the correlation, a significant amount of variation in test performance is not explained by symptom report. Results from this study underscore the importance of a multidimensional concussion assessment that includes both symptom report and cognitive testing when working with pediatric athletes. This study also reinforces the importance of understanding potential effects of sleep, mood, and sex on concussion.

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Reduced cognitive resiliency ofattention-deficit/hyperactivity disorder against subconcussive head impacts

Neurology ◽

10.1212/01.wnl.0000581116.83066.44 ◽

2019 ◽

Vol 93 (14 Supplement 1) ◽

pp. S29.1-S29

Author(s):

Madeleine Nowak ◽

Patrick Quinn ◽

Keisuke Ejima ◽

Timothy Mickelborough ◽

Sharlene Newman ◽

...

Keyword(s):

Verbal Memory ◽

Visual Memory ◽

Neurocognitive Function ◽

Significant Decline ◽

Cognitive Testing ◽

Soccer Players ◽

Post Intervention ◽

Significant Group ◽

Head Impacts ◽

Hyperactivity Disorder

ObjectiveThe purpose of this study was to determine the subconcussive head impacts (SHI) effects on neurocognitive function in individuals diagnosed with attention-deficit/hyperactivity disorder (ADHD).BackgroundAthletes diagnosed with ADHD have a heightened risk (2 to 4-fold) for sustaining concussion. However, their response to repetitive SHI remain unclear.Design/MethodsIn this case-control intervention study, 17 soccer players clinically diagnosed with ADHD who take their prescribed medication daily, were assigned a heading intervention (ADHD-Heading group),individuals who met the ADHD criteria but were non-soccer players, were assigned into a kicking group, (ADHD-Kicking group, n = 15). Whereas 34 soccer players without ADHD diagnosis were randomized into either a heading or kicking intervention, yielding Non-ADHD-Heading group (n = 17) or Non-ADHD-Kicking group (n = 17). To implement SHI, the heading groups executed 10 headers with a standard soccer ball projected at a velocity of 25 mph (equivalent to a long throw-in) over 10 minutes by a JUGS soccer machine, while the kicking groups performed 10 kicks. Neurocognitive function was measured via the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) at pre-intervention baseline, 0h, 2h, and 24h post-intervention.ResultsThe vulnerability to SHI was notable in subjects diagnosed with ADHD particularly in memory, as illustrated by a significant group × time interaction, F(6,96) = 3.796, p = 0.002. Both Kicking groups improved verbal memory over time indicating the brain’s ability to learn, whereas the Non-ADHD-Heading group showed no improvement. The ADHD-Heading group showed a significant decline at 0h and 2h post-heading compared to other groups. As for visual memory, the ADHD-Heading group showed a significant decline at 24h post; however, all other groups displayed improvement. There were no group differences in remaining domains.ConclusionsData suggests neurocognitive vulnerability in athletes diagnosed with ADHD after experiencing SHI, specifically in memory performance. These outcomes can better inform clinicians; overall, promoting a better personalized care in athletes diagnosed with ADHD.

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Preseason Symptom Reporting and Cognition in Middle School Athletes with Past Concussions

International Journal of Sports Medicine ◽

10.1055/a-1538-0075 ◽

2022 ◽

Author(s):

Grant L. Iverson ◽

Paul D. Berkner ◽

Ross Zafonte ◽

Bruce Maxwell ◽

Douglas P. Terry

Keyword(s):

Visual Memory ◽

Cognitive Testing ◽

Symptom Reporting ◽

Symptom Scale ◽

Health History ◽

School Sports ◽

History Of ◽

Concussion History ◽

Composite Scores ◽

The Impact

AbstractThis study examined the association between past concussions and current preseason symptom reporting and cognitive performance in 9,257 youth ages 11–13. Participants completed neurocognitive testing prior to participating in a school sports between 2009 and 2019. We stratified the sample by gender and number of prior concussions and assessed group differences on the Post-Concussion Symptom Scale total score and the ImPACT cognitive composite scores. Those with≥2 prior concussions reported more symptoms than those with 0 concussions (d=0.43–0.46). Multiple regressions examining the contribution of concussion history and developmental/health history to symptom reporting showed the most significant predictors of symptoms scores were (in descending order): treatment for a psychiatric condition, treatment for headaches, history of learning disability (in boys only), history of attention-deficit/hyperactivity disorder, and age. Concussion history was the weakest statistically significant predictor in boys and not significant in girls. Cognitively, boys with 1 prior concussion had worse speed those with 0 concussions (d=0.11), and girls with≥2 prior concussions had worse verbal/visual memory than girls with 0 concussions (ds=0.38–0.39). In summary, youth with≥2 prior concussions reported more symptoms than those with no concussions. Boys with multiple concussions performed similarly on cognitive testing, while girls had worse memory scores.

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MEMORY STATUS AMONG CHILDREN WITH EPILEPSY

10.36106/ijsr/7404107 ◽

2021 ◽

pp. 33-35

Author(s):

Arun John ◽

Santanu Deb ◽

Palash R Gogoi ◽

Jasmine Mary Lyngdoh ◽

Prasenjit Paul ◽

...

Keyword(s):

Verbal Memory ◽

Visual Memory ◽

Memory Impairment ◽

Verbal Learning ◽

Cross Sectional Study ◽

Early Screening ◽

Cross Sectional ◽

The Status ◽

Age Appropriate ◽

Memory Status

Objective: To study the status of visual and verbal memory status among children with epilepsy and effects on schooling. Methods:This descriptive cross-sectional study enrolled children aged 5 to 15 years who have been diagnosed to have epilepsy and has been seizure free during last one month. Enrolled children (81) were evaluated by using two sub tests selected from the National Institute of Mental Health and Neuro Sciences(NIMHANS) Neuropsychological Battery for Children, Rey’s Auditory Verbal Learning test and Memory for Designs test, for verbal and visual memory status respectively and the child was graded on the basis of the standard scores. Schooling details were obtained by questioners to care taker. Results: Memory impairment (MI) was identied in 50 (61.7%) Children with Epilepsy (CWE) (predominantly verbal memory impairment). 20 (25%) CWE were not attending age appropriate class. Among these 20 CWE, 17(85%) children had memory impairment. p: 0.01. There were 25 CWE performing poorly, among them 22(88%) children had memory impairment. p <0.0024. A total of 8 children were school dropouts and all 8 had MI (100%).Conclusions:MI was found to be very common in CWE. MI among CWE was found to negatively inuence age appropriate schooling and school performance. Early screening and appropriate support may improve the outcome.

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A-27 APOE & BDNF Polymorphisms Interact to Affect Memory Performance at Baseline in Adolescent Athletes

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa036.27 ◽

2020 ◽

Vol 35 (5) ◽

pp. 623-623

Author(s):

V C Merritt ◽

E Guty ◽

K Riegler ◽

M Brewer ◽

S Fink ◽

...

Keyword(s):

Cognitive Functioning ◽

Visual Memory ◽

Memory Performance ◽

Cognitive Testing ◽

Clinical Samples ◽

Motor Speed ◽

Adolescent Athletes ◽

Cross Sectional ◽

Healthy Adolescent ◽

The Impact

Abstract Objective Although several single-nucleotide polymorphisms have been associated with cognitive functioning in a variety of healthy and clinical samples, the influence of gene x gene interactions on cognition is poorly understood. The purpose of this study was to examine interactive relationships between apolipoprotein E (APOE) and brain-derived neurotrophic factor (BDNF) polymorphisms on cognitive functioning in a sample of healthy adolescent athletes. Method Participants of this cross-sectional study included 82 athletes (53.7% male, age, M = 12.85, SD = 1.13) who completed the Immediate Post-Concussion and Cognitive Testing (ImPACT) computerized battery at baseline as part of a school-based sports-concussion management program. Athletes also provided a buccal sample for determination of their APOE and BDNF genotypes. Two-way analyses of variance (ANOVAs) were used to evaluate the effect of APOE (ε4+ vs. ε4-) and BDNF (Met+ vs. Met-) genotypes on the ImPACT cognitive composites. Results ANOVAs showed non-significant main effects for both APOE and BDNF genotypes across the four cognitive composites. However, there was a significant APOE x BDNF genotype interaction for the verbal (p = .01; ηp2 = .08) and visual (p = .013; ηp2 = .08) memory composites, such that ε4+/Met+ carriers demonstrated poorer performance relative to the other allele combinations (ε4+/Met-, ε4−/Met+, ε4−/Met-). No significant interactions were observed for the visual motor speed (p = .20; ηp2 = .02) or reaction time (p = .87; ηp2 < .001) composites. Conclusions Our findings suggest a meaningful relationship between APOE and BDNF genotypes on verbal and visual memory performance in healthy adolescent athletes. These findings will need to be replicated using much larger samples, and future studies will need to explore these associations following sports-related concussion.

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Balance performance in sedentary and active healthy young individuals – a cross-sectional study

Physical Education of Students ◽

10.15561/20755279.2020.0207 ◽

2020 ◽

Vol 24 (2) ◽

pp. 115-119

Author(s):

Radu Petroman ◽

Andreea Luciana Rata

Keyword(s):

Postural Balance ◽

Scoring System ◽

Cross Sectional Study ◽

Activity Level ◽

Sectional Study ◽

Balance Performance ◽

Cross Sectional ◽

Sedentary Group ◽

Balance Error Scoring System ◽

Balance Error

Background and Study aim. Balance ability has a fundamental role in many activities of daily living, as well in athletic activities. The Balance Error Scoring System is a valid and reliable test used to evaluate postural balance. The aim of this study was to assess the postural balance in active and sedentary healthy young individuals. Material and Methods. A cross-sectional study was carried out to evaluate the balance performance in forty-four healthy young individuals (mean age 21.69±4.87 years), based on their physical activity level. Balance was assessed using the Balance Error Scoring System (BESS), and the total number of errors was scored, for the non-dominant limb (the left leg for both groups). The errors were counted for each of the six situations (double leg stance, single leg stance and tandem stance, on hard and soft surface). Results. Group 1 consisted of twenty-two active subjects (mean age 21.18±2.32 years, 59.09% females), with a BESS score of 9.87±1.6. The sedentary group (group 2), with twenty-two young subjects (mean age 22.22±6.61 years, 59.09% females), scored a significantly higher BESS score for the sedentary group (15.48±2.24) (p<0.001). No gender differences were recorded. Conclusions. Physically active young people have a better postural balance than do the sedentary ones, as scored with the BESS.

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