Concussion in Sports: Postconcussive Activity Levels, Symptoms, and Neurocognitive Performance

Abstract Context: Evidence suggests that athletes engaging in high-intensity activities after concussion have more difficulties with cognitive recovery. Objective: To examine the role postinjury activity level plays in postconcussive symptoms and performance on neurocognitive tests in a population of student-athletes. Design: Retrospective cohort study with repeated measures of neurocognitive performance and symptom reporting. Setting: University-based sports concussion clinic. Patients or Other Participants: Ninety-five student-athletes (80 males, 15 females: age = 15.88 ± 1.35 years) were retrospectively assigned to 1 of 5 groups based on a postinjury activity intensity scale. Main Outcome Measure(s): We employed a regression analysis for repeated measures to evaluate the relationship of activity intensity to symptoms and neurocognitive outcome up to 33 days after concussion. Postconcussion symptom scores and neurocognitive (verbal memory, visual memory, visual motor speed, and reaction time) scores served as the primary outcome measures. Results: Level of exertion was significantly related to all outcome variables (P < .02 for all comparisons). With multivariate analysis, activity intensity remained significant with respect to visual memory (P = .003) and reaction time (P < .001). Conclusions: Activity level after concussion affected symptoms and neurocognitive recovery. Athletes engaging in high levels of activity after concussion demonstrated worse neurocognitive performance. For these tasks, those engaging in moderate levels of activity demonstrated the best performance.

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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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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 stability of ImPACT baseline test performance over a 3-year period in high school athletes

Neurology ◽

10.1212/01.wnl.0000550636.18771.12 ◽

2018 ◽

Vol 91 (23 Supplement 1) ◽

pp. S7.2-S7

Author(s):

Nicholas Erdman ◽

Samuel Walton ◽

Jeremy Eith ◽

Lizzie Leitch ◽

Joanna Shutzer ◽

...

Keyword(s):

High School ◽

Verbal Memory ◽

Repeated Measures ◽

Visual Memory ◽

Intraclass Correlation ◽

Baseline Assessment ◽

Motor Speed ◽

Group Setting ◽

The Stability ◽

Subject Differences

PurposeAnnual baseline assessment using computerized neurocognitive tests have been recommended by governing healthcare bodies for the management of sport-related concussion but is supported by limited evidence. The current study examined the stability of ImPACT performance across three-successive years in adolescent athletes.MethodThis prospective cohort included 229 (117 male, 112 female) high school student-athletes from 2 private high schools. ImPACT was administered in a controlled group setting (1–17 participants) at years 1 (T1; n = 229), 2 (T2; n = 101) and 3 (T3; n = 47). Repeated measures analyses of variance (ANOVA 4 × 3) were used to examine performance on ImPACT's Verbal Memory (VEM), Visual Memory (VIS), Visual Motor Speed (VMS), and Reaction Time (RT) composite scores. Paired t-tests were used for post-hoc analyses. Two-way mixed intraclass correlation coefficients (ICC [3,1]) with 95% confidence intervals (CI) were calculated between time points. Group mean and within-subject differences between each time point for ImPACT scores were analyzed using manufacturer provided reliable change indices (RCI). All analyses were performed with alpha = 0.05.ResultsA significant main effect was observed for VMS (F [2,92] = 27.90, p = 0.001) across time. Participants significantly improved on VMS between T2 and T1 (t [100] = 4.15, p = 0.001), T3 and T2 (t [46] = 7.19, p = 0.001), and T3 and T1 (t [46] = 3.85, p < 0 .001). Weak (VEM: ICC = 0.37, CI = 0.19, 0.55) to strong (VMS: ICC = 0.83, CI = 0.74, 0.90) ICCs were observed for ImPACT scores. No group mean differences exceeded the 80% CI for ImPACT's RCI, although within-subject differences for at least 1 score exceeded the 80% CI between T2 and T1 (24%–39%), T3 and T2 (26%–45%), and T3 and T1 (32%–51%).ConclusionsOverall, statistically significant improvement was observed for VMS, however, the magnitude of the change may not be clinically meaningful. Similar to previous research, reliability of ImPACT scores ranged from weak to strong. Our results support annual baseline assessment of young athletes for progression of neurocognitive functioning.

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A - 08 Within Subjects Comparison of Clinical Outcomes After First, Second, and Third Concussions in Adolescents*

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acab035.08 ◽

2021 ◽

Vol 36 (4) ◽

pp. 648-648

Author(s):

Feder AH ◽

French J ◽

Blaney N ◽

Eagle SR ◽

Kontos AP

Keyword(s):

Clinical Outcomes ◽

Verbal Memory ◽

Visual Memory ◽

Recovery Time ◽

Cognitive Test ◽

Motor Speed ◽

Neurocognitive Performance ◽

Symptom Scale ◽

Visual Motor ◽

Improved Performance

Abstract Objective The objective of the current study was to examine differences in clinical outcomes between adolescents’ first, second, and third concussions. Methods We conducted a retrospective medical chart review of adolescents (n = 40) aged 10–19 years-old (M = 13.0;SD = 1.9;56% male) who presented for evaluation of concussion at a specialty clinic for their first (Concussion 1 = C1), second (C2), and third (C3) concussions. Clinical outcomes included Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Post-Concussion Symptom Scale (PCSS), Vestibular/Ocular-Motor Screening (VOMS) scores from the first clinic visit for each injury, recovery time, and days between injuries. Paired samples t-tests were conducted to compare outcomes between concussions. Results When comparing initial presentation between C1 and C2, participants demonstrated no significant differences in ImPACT, PCSS (t[38] = 0.85, p = 0.402) or VOMS (t[34] = −0.75, p = 0.461), with the exception of faster Visual Motor Speed for C2 (t[38] = −3.45, p = 0.001). Participants demonstrated improved performance from C1 to C3 on ImPACT composites of Verbal Memory (t[38] = −4.22, p < 0.001), Visual Memory (t[38] = −2.99, p = 0.005), Visual Motor Speed (t[38] = −5.14, p < 0.001) and Reaction Time (t[38] = 0.11, p = 0.001). Symptom report was consistent on PCSS (t[38] = 1.80, p = 0.081) and VOMS (t[30] = −0.12, p = 0.903) between C1 and C3. Recovery time was similar comparing C1 to C2 (t[36] = −0.35,p = 0.725) and C1 to C3 (t[34] = 1.74,p = 0.090). Conclusions The results suggest adolescents demonstrate similar levels of symptoms, VOMS, and recovery time after first, second, and third concussions. Neurocognitive performance improved across C1 to C3, suggesting possible learning effect or improved performance with cognitive development. These results provide additional support for similarity between an athlete’s first and second concussion with further initial evidence that a third concussion does not result in worse outcomes.

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Acute Stimulant Ingestion and Neurocognitive Performance in Healthy Participants

Journal of Athletic Training ◽

10.4085/1062-6050-50.1.07 ◽

2015 ◽

Vol 50 (5) ◽

pp. 453-459 ◽

Cited By ~ 2

Author(s):

Michael E. Powers

Keyword(s):

Reaction Time ◽

Attention Deficit Disorder ◽

Visual Processing ◽

Visual Memory ◽

Efficiency Index ◽

Cognitive Testing ◽

Motor Speed ◽

Neurocognitive Performance ◽

Cognitive Efficiency ◽

And Control

Context Concussion management has become an area of great concern in athletics, and neurocognitive tests, such as Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), are commonly used as management tools. Given the restrictive nature of current management plans, anecdotal concerns have been raised about athletes trying to cheat the assessments and return to participation sooner. Stimulants have been shown to improve neurocognitive measures similar to those used in ImPACT. Therefore, they could possibly improve performance during baseline and postinjury testing. Objective To examine the effects of a supplement containing stimulants on ImPACT performance. Design Crossover study. Setting Research laboratory. Patients or Other Participants A total of 5 men (age = 20.6 ± 1.5 years, height = 176.3 ± 9.6 cm, mass = 76.9 ± 18.6 kg) and 7 women (age = 20.6 ± 1.1 years, height = 162.9 ± 7.8 cm, mass = 60.9 ± 8.2 kg) with no histories of physician-diagnosed head injury, learning disability, or attention-deficit disorder. Intervention(s) Participants were assessed under supplement (5.5 g of Jacked 3D, which contains caffeine and 1,3-dimethylamylamine), placebo, and control conditions separated by 1 week. Main Outcome Measure(s) I compared ImPACT composite scores for verbal and visual memory, visual motor speed, reaction time, impulse control, and a cognitive-efficiency index under each of the 3 conditions and assessed them 30 minutes after ingestion. Results I observed a difference when comparing reaction times, as the participants reacted faster during the supplement condition (0.53 ± 0.03 seconds) than during the placebo (0.55 ± 0.03 seconds) and control (0.55 ± 0.03 seconds) conditions (F2,22 = 4.31, P = .03). A difference also was observed for the cognitive-efficiency index, as participants scored higher during the supplement condition (0.49 ± 0.09) than during the placebo (0.41 ± 0.10) and control (0.41 ± 0.12) conditions (F2,22 = 4.07, P = .03). Conclusions Stimulant ingestion 30 minutes before testing resulted in improved memory, visual processing speed, and reaction time. However, the improvements were relatively nominal, and the question of clinical importance remains. Thus, it is unclear if stimulant ingestion would affect the return-to-participation progression.

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Does the Concussion Clinican Examination Predict Post-Concussion Subsequent Musculoskeletal Injury?

Neurology ◽

10.1212/01.wnl.0000581100.52572.15 ◽

2019 ◽

Vol 93 (14 Supplement 1) ◽

pp. S27.3-S28

Author(s):

Thomas Buckley ◽

Jessie Oldham ◽

Nancy Getchell ◽

Buz Swanik ◽

Rob Lynall ◽

...

Keyword(s):

Reaction Time ◽

Verbal Memory ◽

Visual Memory ◽

Injury Risk ◽

Injury Rate ◽

Musculoskeletal Injury ◽

Elevated Risk ◽

Future Research ◽

Motor Speed ◽

Change Scores

ObjectiveTo identify post-concussion subsequent lower extermity musculoskeletal injury predictors from a clinical concussion assessment.BackgroundEmerging evidence has identified an elevated risk of subsequent lower extremity musculoskeletal injury (LE-MSK) in the year post-concussion. This approximately 2-fold elevated risk has been identified in diverse populations including high school, college, professional sports and military populations. While persistent impairments in postural control are a speculated mechanism, these assessments require instrumented biomechanical measures; thus, there are currently no clinically feasible predictors which have been identified.Design/MethodsEighty three NCAA Division I student-athletes (51.8% female, ht: 1.75 +/− 0.12 m, wt: 76.2 +/− 20.1 kg) who had suffered a sports related concussion (LOC: 7.5%, PTA: 12.2%) with baseline data were assessed within 72 hours post-concussion were included in this retrospectic study. The clinical examination consisted of the Balance Error Scoring System (BESS), Standard Assessment of Concussion (SAC), Clinical Reaction Time (CRT), King-Devick (KD) and the Immediate Post-Concussion Assessment and Cognitve Test (ImPACT) composite values. Change scores (Δ) from baseline to acute post-concussion served as predictors to identify subsequent LE-MSK with a step wise binary logistic regression.ResultsThe subsequent LE-MSK rate was 72.3% (60/83). The overall model failed to identify a predictive relationship between change scores and subsequent injury risk (r2 = 0.242, p = 0.458). Exploratory testing failed to identify any significant individual predictors of subsequent LE-MSK: BESS: Δ = −0.35 errs, p = 0.964; SAC: Δ = −0.55, p = 0.239; ImPACT Verbal Memory: Δ = −0.53, p = 0.324; ImPACT Visual Memory: Δ = −5.6, p = 0.750; ImPACT Motor Speed: Δ = −2.81, p = 0.070; ImPACT Reaction Time: Δ = 0.042 sec, p = 0.164; CRT: Δ = 12.2 ms, p = 0.564; and KD: Δ = 2.8 sec, p = 0.607.ConclusionsNone of the common clinical concussion assessments were a significant predictor of subsequent LE-MSK potentially due to a high injury rate (72.3%). Future research should continue attempts to idenify clinically feasible predictors to allow clinicians to identify at-risk athletes to engage injury prevention strategies to reduce subsequent LE-MSK.

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Concussion History and Postconcussion Neurocognitive Performance and Symptoms in Collegiate Athletes

Journal of Athletic Training ◽

10.4085/1062-6050-43.2.119 ◽

2008 ◽

Vol 43 (2) ◽

pp. 119-124 ◽

Cited By ~ 78

Author(s):

Tracey Covassin ◽

David Stearne ◽

Robert Elbin

Keyword(s):

Reaction Time ◽

Processing Speed ◽

Verbal Memory ◽

Visual Memory ◽

Collegiate Athletes ◽

Neurocognitive Performance ◽

Significant Group ◽

Repeated Measures Design ◽

History Of ◽

Concussion History

Abstract Context: Athletes are at an inherent risk for sustaining concussions. Research examining the long-term consequences of sport-related concussion has been inconsistent in demonstrating lingering neurocognitive decrements that may be associated with a previous history of concussion. Objective: To determine the relationship between concussion history and postconcussion neurocognitive performance and symptoms in collegiate athletes. Design: Repeated-measures design. Setting: Multi-center analysis of collegiate athletes. Patients or Other Participants: Fifty-seven concussed collegiate athletes (36 without concussion history, 21 with a history of 2 or more concussions). Intervention(s): All subjects were administered an Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) neurocognitive test battery, which measures verbal memory, visual memory, reaction time, and visual processing speed and 22 concussion symptoms. Main Outcome Measure(s): Subjects who sustained a concussion were administered 2 follow-up tests at days 1 and 5 postinjury. Independent variables were history of concussion (no history of concussion, 2 or more concussions) and time (baseline, day 1 postconcussion, or day 5 postconcussion). Results: A within-subjects effect (time) on ImPACT performance (P < .001), a between-subjects multivariate effect of group (P < .001), and a group-by-time interaction (P = .034) were noted. Athletes with a concussion history performed significantly worse on verbal memory (P = .01) and reaction time (P = .023) at day 5 postconcussion compared with athletes who did not report a previous concussion. No significant group differences were seen at day 5 postinjury on visual memory (P = .167), processing speed (P = .179), or total concussion symptoms (P = .87). Conclusions: Concussed collegiate athletes with a history of 2 or more concussions took longer to recover verbal memory and reaction time than athletes without a history of concussion.

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Signs of cognitive dysfunction in adult players of club level rugby

South African Journal of Psychology ◽

10.1177/0081246319826816 ◽

2019 ◽

Vol 50 (1) ◽

pp. 128-140 ◽

Cited By ~ 1

Author(s):

Diana Zoccola ◽

Ann B Shuttleworth-Edwards ◽

Sarah E Radloff

Keyword(s):

Reaction Time ◽

Cognitive Dysfunction ◽

Verbal Memory ◽

Visual Memory ◽

Rugby Union ◽

Motor Speed ◽

Visual Motor ◽

The Impact ◽

Rugby Players

The objective of this study was to investigate players of club level Rugby Union (hereafter rugby) over one rugby season, for signs of residual cognitive dysfunction due to repeated concussive events incurred during long-term participation in the sport. Adult male players of club level rugby, without a diagnosis of a concussion during the season ( n = 20), were compared with non-contact club level sports participants ( n = 22) of equivalent sex, age, education, and estimated IQ at pre-, mid-, and post-season intervals. Measures included the ImPACT Verbal Memory, Visual Memory, Visual Motor Speed and Reaction Time composites, and the Purdue Pegboard test. Statistical group comparisons revealed consistently poorer performance for rugby players compared with controls for ImPACT Visual Motor Speed and Reaction Time composites at all test intervals, and for the Purdue Pegboard tasks at the first two test intervals. Repeat measures comparisons across the three test intervals demonstrated differential learning patterns between groups on ImPACT Visual Memory, ImPACT Reaction Time, and Purdue Both tasks, suggestive of cognitive vulnerability in the rugby group. Overall, the results reveal deleterious cognitive performance in adult club level rugby players relative to equivalent non-contact sports controls. The finding serves to endorse indications from other studies that demonstrate persistent brain injury effects in association with long-term participation in a contact sport. Recommendations for further research and management of concussion in rugby players are discussed.

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A-38 A Different Approach for Examining Gender Differences on Computerized Neurocognitive Testing: Percentile Ranks Versus Composite Scores

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa036.38 ◽

2020 ◽

Vol 35 (5) ◽

pp. 634-634

Author(s):

P Schatz ◽

K Slicer ◽

R J Elbin

Keyword(s):

Gender Differences ◽

Reaction Time ◽

Verbal Memory ◽

Visual Memory ◽

Motor Speed ◽

Age And Gender ◽

Visual Motor ◽

Gender Based ◽

And Gender ◽

Composite Scores

Abstract Objective ImPACT is a popular tool used to assess neurocognitive function after concussion. Age- and gender-based percentile ranks are provided as part of the ImPACT clinical report, but only raw composite scores are provided for research. Percentile ranks may provide an alternate look at gender differences on neurocognitive testing. We sought to compare the use of percentile ranks versus composite scores when comparing neurocognitive performance between male and females. Method Pre-season baseline data from 3,238 collegiate athletes were exported from a larger multi-site database, 1,714 male (53%) and 1,524 female (47%), ages 18–22 (Mean = 19.3, SD = 1.2). ImPACT composite scores were extracted (Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time) and Percentile Ranks were calculated using age- and gender-based reference tables in the ImPACT 2017–2012 Technical Manual. One-way analyses of variance (ANOVA) were conducted with gender as the IV and the four composite scores and their associated percentile ranks as the DVs. Bonferroni correction for 8 comparisons set the alpha level to p < .006. Results ANOVAs revealed a significant effect of gender on ImPACT Verbal Memory [F(1,3236) = 16.32, p < .001], Visual Memory [F(1,3236) = 66.06, p < .001], Visual Motor Speed [F(1,3236) = 15.61,p < .001] but not Reaction Time [F(1,3236) = 2.59, p = .11]. When using percentile ranks, ANOVAs revealed a significant effect of gender on only Visual Motor Speed [F(1,3236) = 31.07, p < .001], but not Verbal Memory [F(1,3236) = 2.43, p = .12], Visual Memory [F(1,3236) = 0.48, p = .49], or Reaction Time [F(1,3236) = 0.61, p = .44]. Conclusions Use of ImPACT Composite Scores in concussion research may exaggerate or inappropriately promote gender differences on computerized neurocognitive testing. Given that age- and gender-based normative data are available, use of percentile ranks is recommended.

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Testing the Hybrid Battery Approach to Evaluating Sports-Related Concussion in the National Hockey League: A Factor Analytic Study

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz026.52 ◽

2019 ◽

Vol 34 (5) ◽

pp. 782-782

Author(s):

R J Echemendia ◽

J M Bruce ◽

J Thelen ◽

M Hutchison ◽

P Comper ◽

...

Keyword(s):

Reaction Time ◽

Verbal Memory ◽

Visual Memory ◽

Neuropsychological Test ◽

Verbal Learning ◽

Motor Speed ◽

Post Injury ◽

Neuropsychological Measures ◽

Factor Analytic ◽

Computerized Measures

Abstract Purpose Traditional “paper and pencil” neuropsychological tests and computerized test batteries have been employed in the assessment of sports-related concussion (SRC). Each type of test has inherent strengths and weaknesses. The NHL has constructed a “hybrid” battery of tests that uses both traditional and computerized measures in the evaluation of its players suspected of SRC. The purpose of this paper is to use factor analytic techniques to examine the relationships among the measures that comprise this battery. Methods Post-injury neuropsychological test data using the hybrid battery were obtained from 343 NHL players following their first concussion while playing in the league. ImPACT was used as the computer test battery. The traditional battery included: Hopkins Verbal Learning Test, Brief Visuospatial Memory Test, Color Trails, PSU Cancellation, Symbol Digits Modalities Test (including incidental memory), and Verbal Fluency. Results Five factors were extracted explaining 64.55% of the variance. The factor labels and the measures principally loading on each factor were as follows: Factor 1, Verbal Learning and Memory (HVLT Total and Delayed Recall); Factor 2, Processing Speed (Color Trails A/B, PSU Cancellation, and SDMT-Total); Factor 3, Visual Memory (BVMT- Total and Delayed); Factor 4, Cued Memory (ImPACT-Visual and Verbal Memory Composites); and Factor 5, Reaction Time (ImPACT Reaction Time and Visual Motor Speed composites). Conclusion These data underscore the unique contributions of traditional and ImPACT neuropsychological measures to the evaluation SRC in a sample of professional hockey players. It appears that both approaches measure different aspects of cognitive functioning. The next logical step is to use these data in evaluating the diagnostic utility of these measures as part of a combined battery.

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