Thomas Kinsora - Academia.edu (original) (raw)
Papers by Thomas Kinsora
Archives of Clinical Neuropsychology, Sep 1, 2018
Objective: The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computeri... more Objective: The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computerized assessment that evaluates cognitive abilities before and after sports concussions. Baseline scores can be used determine premorbid cognitive functioning for injured athletes, but this becomes difficult when invalid baselines are produced. The current study examined the rates of invalid baselines among various demographic variables on the ImPACT, among athletes in Nevada. Method: Participants included 32,800 athletes (Mage = 15.26; Meducation = 9.05; 40.90% female) from across Nevada who were assessed pre-or post-concussion from 2008-2012. Test validity was determined by the standard output available from the ImPACT report. Chi square analysis and independent-samples t-tests were conducted to examine between-group differences in valid and invalid baselines on demographic variables including age, education, sex, and sport. Results: Overall, 6.3% of athletes produced invalid profiles. Males produced a significantly greater proportion of invalid baselines (6.5%) than females (5.9%; χ2 = 6.193, p < .05). Football had a higher proportion of invalid baselines (7.6%) than tennis (4%), and all other sports were relatively equal (4.3%-7.2%, excluding football and tennis; χ2 = 44.89, p < .01). There were no significant differences in age (t = 1.53, p > .05); however, education was significantly different (t = −2.8, p > .05), with younger athletes having more invalid baselines. Conclusions: Results from the current study demonstrate that rates of invalid baselines can vary based on demographics. Further research should address potential predictors of invalid baselines among athletes to help in identifying effective strategies to reduce the prevalence of invalid baselines in the future.
Journal of the International Neuropsychological Society
Objective:The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is commonly use... more Objective:The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is commonly used to assist with post-concussion return-to-play decisions for athletes. Additional investigation is needed to determine whether embedded indicators used to determine the validity of scores are influenced by the presence of neurodevelopmental disorders (NDs).Method:This study examined standard and novel ImPACT validity indicators in a large sample of high school athletes (n = 33,772) with or without self-reported ND.Results:Overall, 7.1% of athletes’ baselines were judged invalid based on standard ImPACT validity criteria. When analyzed by group (healthy, ND), there were significantly more invalid ImPACT baselines for athletes with an ND diagnosis or special education history (between 9.7% and 54.3% for standard and novel embedded validity criteria) when compared to athletes without NDs. ND history was a significant predictor of invalid baseline performance above and beyond other demograp...
Brain Sciences
Objective: High school athletes are administered ImPACT at the start of the academic year or spor... more Objective: High school athletes are administered ImPACT at the start of the academic year or sport season and again after suspected concussion. Concussion management involves the comparison of baseline and post-injury cognitive scores with declines in scores providing evidence for concussive injury. A network framework may provide additional information about post-concussive cognitive changes and expand characterization of sport-related concussion (SRC) recovery. Design: Retrospective cohort study. Setting: High school. Participants: High school athletes (n = 1553) were administered ImPACT at baseline (T1), post-SRC (T2 = 72 h of injury), and prior to return to play (T3 = within two weeks post-injury). Independent Variables: ImPACT cognitive subtest scores. Main Outcome Measures: Cognitive networks were calculated and compared over three time points. Centrality indices were calculated to determine the relative importance of cognitive variables within networks. Results: Network conne...
Archives of Clinical Neuropsychology
Objective Assessment of post-concussion symptoms is implemented at secondary, post-secondary, and... more Objective Assessment of post-concussion symptoms is implemented at secondary, post-secondary, and professional levels of athletics. Network theory suggests that disorders can be viewed as a set of interacting symptoms that amplify, reinforce, and maintain one another. Examining the network structure of post-concussion symptoms may provide new insights into symptom comorbidity and may inform targeted treatment. We used network analysis to examine the topology of post-concussion symptoms using the Post-Concussion Symptom Scale (PCSS) in high school athletes with recent suspected sport-related concussion. Method Using a cross-sectional design, the network was estimated from Post Concussion Symptom Scale scores from 3,292 high school athletes, where nodes represented symptoms and edges represented the association between symptoms. Node centrality was calculated to determine the relative importance of each symptom in the network. Results The network consisted of edges within and across s...
Archives of Clinical Neuropsychology
Objective: Assessment of post-concussion symptoms (PCS) has become a standard part of athletics a... more Objective: Assessment of post-concussion symptoms (PCS) has become a standard part of athletics at secondary, post-secondary, and professional levels. Network theory suggests that disorders can be viewed as a set of interacting symptoms that amplify, reinforce, and maintain one another. Examining the network structure of PCS may provide new insights into symptom comorbidity to inform targeted treatment and rehabilitation. We used network analysis to examine the topology of the Post-Concussion Symptom Scale (PCSS) in high school athletes with recent sport-related concussion (SRC). Method: High school athletes (n = 3292) with suspected SRC completed the PCSS. PCSS items were entered into network analysis, where nodes represented symptoms and edges represented association between symptoms. Centrality indices were calculated to determine relative importance of each symptom in the network. Results: Edge weights, node strength, and expected influence were stable and interpretable. The net...
Archives of Clinical Neuropsychology, 2021
Objective The presence of neurodevelopmental disorders (ND) such as attention-deficit/hyperactivi... more Objective The presence of neurodevelopmental disorders (ND) such as attention-deficit/hyperactivity disorder (ADHD) and learning disorders (LD) have demonstrated effects on Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) performance. No current research has directly examined whether autism spectrum disorder (ASD) has similar effects. The current study compared ImPACT cognitive and symptom profiles in athletes with self-reported ASD to other NDs and healthy controls using case-control matching. Method The current study compared ImPACT baselines of high school athletes with ASD to athletes with other NDs (ADHD, LD, and co-occurring ADHD/LD) and healthy controls on cognitive composites and symptom reporting. Participants included 435 athletes (87 controls, 87 with ASD, 87 with ADHD, 87 with LD, and 87 with ADHD/LD) selected from a larger naturalistic sample. Athletes were matched to the ASD group based on age, sex, and sport using randomized case-matched selection f...
Psychological Assessment, 2021
ImPACT is the most commonly utilized computerized neurocognitive assessment for the clinical mana... more ImPACT is the most commonly utilized computerized neurocognitive assessment for the clinical management of sport concussion. The cognitive composite scores that ImPACT currently reports include Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time, and Impulse Control. However, exploratory factor analytic studies report that two or more factors may better represent ImPACT's latent structure, suggesting that the current cognitive composites may not adequately represent the cognitive constructs ImPACT assesses. The latent structure of ImPACT cognitive baseline scores was examined using exploratory (EFA) and confirmatory factor analysis (CFA) of valid baseline ImPACT scores for 36,091 high school athletes. These athletes were randomly divided into two samples. The first sample was a calibration sample used for EFA and the second sample was a cross-validation sample used for CFA to estimate the best model identified in the calibration phase, along with other models that were reported in the literature or based on theoretical considerations, including hierarchical and bifactor models. EFA identified a first-order four-factor solution consisting of Visual Memory, Visual Reaction Time, Verbal Memory, and Working Memory constructs. CFA indicated that this four-factor model provided superior fit for the data, while the current five-composite structure of ImPACT provided a poor fit for the data. The latent constructs identified in this study using CFA do not map well onto the composite scores that are currently used to interpret ImPACT performance. Future research should investigate whether interpretation of ImPACT based on the constructs identified here will be more useful for clinical decision making than current approaches. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Neuropsychology, 2021
OBJECTIVE Heterogeneity is common following traumatic brain injury (TBI) with important implicati... more OBJECTIVE Heterogeneity is common following traumatic brain injury (TBI) with important implications for clinical outcome. Research in moderate to severe TBI identifies differentiated cognitive profiles. There is little research investigating potential clusters following sport concussion. METHODS Cluster analysis was used to determine patterns of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) performance at three time points (72 hr, 4-7 days, and 8-30 days postconcussion). Participants included 1,817 high-school athletes (Mage = 15.5; 37.9% female) who completed ImPACT following concussion. RESULTS Separate cluster analyses of cognitive scores were conducted at each postconcussion timepoint. Results indicated three clusters of cognitive performance within 1 week postinjury, while a two-cluster solution was identified at longer intervals (8-30 days). Clusters differed primarily by level of performance and also exhibited stratified differences in symptom severity and magnitude of change in cognitive function and symptom-reporting from pre- to postconcussion. The lowest performing cluster in each PC group was Mildly-to-Moderately Impaired and exhibited the highest rates of complicated recovery, suggesting an association between the current clusters and protracted recovery. CONCLUSIONS Results provide preliminary evidence that ImPACT can identify clusters of athletes based on cognitive performance postconcussion that differ in clinically meaningful ways, including symptoms, magnitude of change from baseline, and concussion recovery outcomes. Discriminant functions can classify athletes into clusters based on postconcussion scores and a supplemental excel calculator is provided for such purposes. Absence of full demographic data regarding race/ethnicity and socioeconomic status may limit generalizability. Future work should investigate whether these clusters may assist in return-to-play decision-making by identifying at-risk athletes who may benefit from targeted intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Archives of Clinical Neuropsychology, 2021
Research comparing English and Spanish administrations of Immediate Post-Concussion Assessment an... more Research comparing English and Spanish administrations of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) have consistently found differences in performance on various cognitive composites. Few studies have examined the effect of bilingualism on baseline and post-concussion assessments. This study examined whether monolingual English-speakers (MO) and bilingual Spanish/English speakers (BI) differed in cognitive performance at baseline (BL) and post-concussion (PC). Participants were selected from a larger database of high school athletes administered ImPACT in English at BL and PC. Participants included 86 BI athletes (Mage = 14.53; 65.10% male) and 86 MO athletes matched on age, gender, sport type, and probable concussion as defined by number of PC follow-up assessments (PCF; 0 vs. ≥1). To examine group differences and changes over time in cognitive composites, a general linear modeling approach was used with language and PCF as between-subjects factors and tim...
Archives of Clinical Neuropsychology, 2021
ImPACT is commonly used for sport-concussion management. Baseline and post-concussion tests serve... more ImPACT is commonly used for sport-concussion management. Baseline and post-concussion tests serve as within-athlete comparisons for return-to-play decision-making. Previous literature has questioned whether ImPACT’s five composites accurately represent the internal structure of its cognitive scores. A recent alternative four-factor structure has strong confirmatory evidence for baseline scores (Maietta et al., doi:10.1037/pas0001014). The present study examined the stability of these constructs post-concussion. The current study utilized a case-matched design (age, sex, sport category) to select a sample of 3560 high school athletes’ baseline (n = 1780) and post-concussion (n = 1780) assessments. Multi-group CFA of first-order, hierarchical, and bifactor models was conducted to assess measurement invariance (configural, metric, scalar, and residual invariance) between baseline and post-concussion samples. Change in comparative fit indices was interpreted as the primary indicator of ...
Journal of Pediatric Neuropsychology, 2021
Differences in performance on the Immediate Post-Concussion Assessment and Cognitive Testing (ImP... more Differences in performance on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) have been reported between Spanish and English-speaking individuals. The current study addressed whether these differences could be accounted for by primary language preference, language of ImPACT administration, or a combination of the two. Differences in cognitive and symptom domain scores from ImPACT baseline testing were compared for 264 high school athletes. These high school athletes were either monolingual English speakers who were tested in English ( EE ; n = 88), bilingual Spanish/English speakers who were tested in English ( SE ; n = 88), or monolingual and bilingual Spanish speakers who were tested in Spanish ( SS ; n = 88). These participants were selected from a larger sample and individually matched on variables that could contribute to differences in baseline ImPACT performance. Results indicated the EE group performed better on the Visual Motor Speed and Reaction Time cognitive composites than the SE and SS groups. The SS and SE groups also reported significantly more affective symptoms than the EE group, although group differences in the PCSS total score and other domain scores were not significant. These results provide confirmation of differences between language groups’ cognitive and symptom reporting on ImPACT, and further suggest that these differences are not primarily accounted for by confounding factors, language of test administration, or primary language preference. Additional research is needed to determine whether these ImPACT cognitive and symptom differences result from test bias, linguistic influences, cultural considerations, or a combination of these and other factors.
Archives of Clinical Neuropsychology, 2018
Objective: Over 300,000 sport concussions occur every year and rates continue to increase as part... more Objective: Over 300,000 sport concussions occur every year and rates continue to increase as participation increases (Gessel, Fields, Collins, Dick, & Comstock, 2007). Given that even limited contact sports can result in concussion, evaluation of contact in sport is beneficial to inform prevention efforts (Rice, 2008). The purpose of the current study was to investigate the difference in concussion rates in sports with differing amounts of contact during play. Method: Participants included 3,319 athletes (Mage = 16.0; Meducation = 9.4; 65.7% male; concussed n = 1,812) from Nevada who were assessed pre-or post-concussion from 2008 to 2012. Athletes used for analyses had head injury that required ImPACT assessment, and athletes for comparison were limited to those with valid baselines and no self-reported concussion history. Sport types were divided: collision (C), contact (CN), limited contact (LC), and non-contact sports (NC; Brett & Solomon, 2017; Rice, 2008). Chi-square test of homogeneity was performed to evaluate the difference in concussion rates across sport types. Results: A significant difference in concussion rates across groups was observed (χ2 = 820.92; p < .01). Post hoc analysis involved pairwise comparison using the z-test of two proportions with a Bonferroni correction. All sport types differed significantly in concussion rates with C showing the highest proportion of concussion (74.8%), followed by CN (53.1%), LC (22.1%), and NC with no concussions, p < .05. Conclusions: Results indicate that athletes involved in collision or contact sports have the highest rate of concussion. Future research is needed to further evaluate the rules or techniques for play to minimize these concussion rates.
Archives of Clinical Neuropsychology, 2018
Objective: The Immediate Post-Concussion and Assessment and Cognitive Testing (ImPACT) assesses c... more Objective: The Immediate Post-Concussion and Assessment and Cognitive Testing (ImPACT) assesses cognitive abilities before and after sport concussion. Research suggests that demographic factors such as education, sex, and sport affect the frequency of concussions in athletes (Daneshvar, Nowinski, McKee, & Cantu, 2011). Specifically, Covassin, Swanik, and Sachs (2003) demonstrated that among collegiate athletes, men's lacrosse and women's soccer have the highest injury rate of concussion. The current study assessed whether demographic variables such as education level, sex, and sport predicted group membership between concussed (C) and non-concussed (NC) samples. Method: Participants included 3,507 athletes (Mage = 15.4; Meducation = 9.2; 33.9% female; concussed n = 1809) from across the state of Nevada who were assessed pre-or post-concussion. A binomial logistic regression was performed to determine the effects of demographic factors (education, sex, and sport) on the likelihood that an athlete had received a concussion. Results: The logistic regression was statistically significant (χ2(26) = 593.89, p < .001). The model explained 22.2% (Naglkerke R2) of the variance in concussion and correctly classified 67.6% of cases. Sensitivity was 56.7% and specificity was 78.3%. Females were 1.47 times more likely to experience concussions than males. Conclusions: Results from the current study demonstrate that rates of concussion can be predicted based on demographic variables (education level, gender, and sport), which is consistent with past research showing demographic differences in concussion rates. Interestingly, females were more likely to experience concussion than males. Further research is needed to determine what demographic factors help to predict sport concussion rates, which can inform prevention efforts.
Archives of Clinical Neuropsychology, 2020
Objective The Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) is a commonly u... more Objective The Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) is a commonly utilized sport concussion assessment. Previous literature examined differences in concussion rates, symptom scores, and invalid baselines between healthy athletes and athletes with neurodevelopmental disorders. There are no current studies that investigate cognitive profiles of athletes with autism. The present study explores possible differences in ImPACT performance for these athletes. Method Participants included 31,368 high school athletes (mean age = 15.0, SD = 1.2; mean education = 9.0; SD = 1.4; 43.9% female) selected from a larger database who completed baseline ImPACT testing from 2008–2016. Self-reported neurodevelopmental history consisted of these distinct groups: attention-deficit/hyperactivity disorder (ADHD; 3.6%), learning disorders (LD; 1.3%), Autism (0.3%), ADHD/LD (0.6%). ImPACT Composite Scores were analyzed using Mixed-model ANCOVA (age and gender covariates)-Verbal M...
Archives of Clinical Neuropsychology, 2019
Objective Research demonstrates that athletes with neurodevelopmental diagnoses may have a higher... more Objective Research demonstrates that athletes with neurodevelopmental diagnoses may have a higher frequency of lifetime concussions (Iverson et al., 2016; Alosco, Fedor…
Archives of Clinical Neuropsychology, 2019
Objective Research demonstrates neurodevelopmental diagnoses may increase likelihood of failing s... more Objective Research demonstrates neurodevelopmental diagnoses may increase likelihood of failing scores on ImPACT embedded validity indicators that flag questionable effort. New criteria have been proposed to enhance sensitivity of these indicators although their utility in athletes with neurodevelopmental diagnosis have not been thoroughly examined. This study investigates the effect of neurodevelopmental history on frequency of invalid performance on the standard and three proposed validity indicators. Methods Participants included 41,214 high school athletes (Mage = 15.1; 44.2% female; Meducation = 9.1) who completed baseline ImPACT testing. Athletes included these groups: ADHD (3.7%), Learning Disability (LD; 1.5%), Autism (0.2%), ADHD+LD (0.6%), Autism+ADHD/LD (0.1%), athletes with special education history but no diagnosis reported (SpEd; 2.8%), and healthy athletes (91.1%). Odds ratios were calculated to determine differences in invalid performance by both standard and propose...
Archives of Clinical Neuropsychology, 2017
Objective: The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) assesses cogni... more Objective: The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) assesses cognitive abilities before and after traumatic brain injury. Research shows that Spanish-speaking individuals perform more poorly on Spanish versions than on English versions of the ImPACT. The current study explores this hypothesis in a statewide sample. Method: Participants included 166 (mean age = 16.3) individuals who were selected from a consecutive series of 9,000 cases that were assessed to measure baseline functioning before sport participation. Of these, 59 were Spanish-speakers (SS) who were administered the ImPACT in Spanish. Random selection was used to develop comparable groups of Spanish-speakers administered the ImPACT in English (n = 52; SE), and English-speakers administered the ImPACT in English (n = 55; EE). No significant differences were present between groups on age, education, or sex. ImPACT composite scores were compared using mixed-model ANOVA. Results: Results indicated that the SS group performed significantly worse than the SE and EE groups on the Visual Memory (p < .01) and Visual Motor Processing Speed Composites (p < .01). SE and EE groups did not differ from each other on these two composites. No differences between groups were seen for Verbal Memory, Reaction Time, or Impulse Control Composites. Conclusion: Results provide preliminary evidence that performance of Spanishspeakers is similar across Verbal Memory, Reaction Time, and Impulse Control Composites regardless of administration language. If native Spanish-speakers choose to take ImPACT in Spanish, interpretation of Verbal Memory, Reaction Time, and Impulse Control composites may yield a more precise estimate of performance.
Archives of Clinical Neuropsychology, Sep 1, 2018
Objective: The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computeri... more Objective: The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computerized assessment that evaluates cognitive abilities before and after sports concussions. Baseline scores can be used determine premorbid cognitive functioning for injured athletes, but this becomes difficult when invalid baselines are produced. The current study examined the rates of invalid baselines among various demographic variables on the ImPACT, among athletes in Nevada. Method: Participants included 32,800 athletes (Mage = 15.26; Meducation = 9.05; 40.90% female) from across Nevada who were assessed pre-or post-concussion from 2008-2012. Test validity was determined by the standard output available from the ImPACT report. Chi square analysis and independent-samples t-tests were conducted to examine between-group differences in valid and invalid baselines on demographic variables including age, education, sex, and sport. Results: Overall, 6.3% of athletes produced invalid profiles. Males produced a significantly greater proportion of invalid baselines (6.5%) than females (5.9%; χ2 = 6.193, p < .05). Football had a higher proportion of invalid baselines (7.6%) than tennis (4%), and all other sports were relatively equal (4.3%-7.2%, excluding football and tennis; χ2 = 44.89, p < .01). There were no significant differences in age (t = 1.53, p > .05); however, education was significantly different (t = −2.8, p > .05), with younger athletes having more invalid baselines. Conclusions: Results from the current study demonstrate that rates of invalid baselines can vary based on demographics. Further research should address potential predictors of invalid baselines among athletes to help in identifying effective strategies to reduce the prevalence of invalid baselines in the future.
Journal of the International Neuropsychological Society
Objective:The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is commonly use... more Objective:The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is commonly used to assist with post-concussion return-to-play decisions for athletes. Additional investigation is needed to determine whether embedded indicators used to determine the validity of scores are influenced by the presence of neurodevelopmental disorders (NDs).Method:This study examined standard and novel ImPACT validity indicators in a large sample of high school athletes (n = 33,772) with or without self-reported ND.Results:Overall, 7.1% of athletes’ baselines were judged invalid based on standard ImPACT validity criteria. When analyzed by group (healthy, ND), there were significantly more invalid ImPACT baselines for athletes with an ND diagnosis or special education history (between 9.7% and 54.3% for standard and novel embedded validity criteria) when compared to athletes without NDs. ND history was a significant predictor of invalid baseline performance above and beyond other demograp...
Brain Sciences
Objective: High school athletes are administered ImPACT at the start of the academic year or spor... more Objective: High school athletes are administered ImPACT at the start of the academic year or sport season and again after suspected concussion. Concussion management involves the comparison of baseline and post-injury cognitive scores with declines in scores providing evidence for concussive injury. A network framework may provide additional information about post-concussive cognitive changes and expand characterization of sport-related concussion (SRC) recovery. Design: Retrospective cohort study. Setting: High school. Participants: High school athletes (n = 1553) were administered ImPACT at baseline (T1), post-SRC (T2 = 72 h of injury), and prior to return to play (T3 = within two weeks post-injury). Independent Variables: ImPACT cognitive subtest scores. Main Outcome Measures: Cognitive networks were calculated and compared over three time points. Centrality indices were calculated to determine the relative importance of cognitive variables within networks. Results: Network conne...
Archives of Clinical Neuropsychology
Objective Assessment of post-concussion symptoms is implemented at secondary, post-secondary, and... more Objective Assessment of post-concussion symptoms is implemented at secondary, post-secondary, and professional levels of athletics. Network theory suggests that disorders can be viewed as a set of interacting symptoms that amplify, reinforce, and maintain one another. Examining the network structure of post-concussion symptoms may provide new insights into symptom comorbidity and may inform targeted treatment. We used network analysis to examine the topology of post-concussion symptoms using the Post-Concussion Symptom Scale (PCSS) in high school athletes with recent suspected sport-related concussion. Method Using a cross-sectional design, the network was estimated from Post Concussion Symptom Scale scores from 3,292 high school athletes, where nodes represented symptoms and edges represented the association between symptoms. Node centrality was calculated to determine the relative importance of each symptom in the network. Results The network consisted of edges within and across s...
Archives of Clinical Neuropsychology
Objective: Assessment of post-concussion symptoms (PCS) has become a standard part of athletics a... more Objective: Assessment of post-concussion symptoms (PCS) has become a standard part of athletics at secondary, post-secondary, and professional levels. Network theory suggests that disorders can be viewed as a set of interacting symptoms that amplify, reinforce, and maintain one another. Examining the network structure of PCS may provide new insights into symptom comorbidity to inform targeted treatment and rehabilitation. We used network analysis to examine the topology of the Post-Concussion Symptom Scale (PCSS) in high school athletes with recent sport-related concussion (SRC). Method: High school athletes (n = 3292) with suspected SRC completed the PCSS. PCSS items were entered into network analysis, where nodes represented symptoms and edges represented association between symptoms. Centrality indices were calculated to determine relative importance of each symptom in the network. Results: Edge weights, node strength, and expected influence were stable and interpretable. The net...
Archives of Clinical Neuropsychology, 2021
Objective The presence of neurodevelopmental disorders (ND) such as attention-deficit/hyperactivi... more Objective The presence of neurodevelopmental disorders (ND) such as attention-deficit/hyperactivity disorder (ADHD) and learning disorders (LD) have demonstrated effects on Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) performance. No current research has directly examined whether autism spectrum disorder (ASD) has similar effects. The current study compared ImPACT cognitive and symptom profiles in athletes with self-reported ASD to other NDs and healthy controls using case-control matching. Method The current study compared ImPACT baselines of high school athletes with ASD to athletes with other NDs (ADHD, LD, and co-occurring ADHD/LD) and healthy controls on cognitive composites and symptom reporting. Participants included 435 athletes (87 controls, 87 with ASD, 87 with ADHD, 87 with LD, and 87 with ADHD/LD) selected from a larger naturalistic sample. Athletes were matched to the ASD group based on age, sex, and sport using randomized case-matched selection f...
Psychological Assessment, 2021
ImPACT is the most commonly utilized computerized neurocognitive assessment for the clinical mana... more ImPACT is the most commonly utilized computerized neurocognitive assessment for the clinical management of sport concussion. The cognitive composite scores that ImPACT currently reports include Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time, and Impulse Control. However, exploratory factor analytic studies report that two or more factors may better represent ImPACT's latent structure, suggesting that the current cognitive composites may not adequately represent the cognitive constructs ImPACT assesses. The latent structure of ImPACT cognitive baseline scores was examined using exploratory (EFA) and confirmatory factor analysis (CFA) of valid baseline ImPACT scores for 36,091 high school athletes. These athletes were randomly divided into two samples. The first sample was a calibration sample used for EFA and the second sample was a cross-validation sample used for CFA to estimate the best model identified in the calibration phase, along with other models that were reported in the literature or based on theoretical considerations, including hierarchical and bifactor models. EFA identified a first-order four-factor solution consisting of Visual Memory, Visual Reaction Time, Verbal Memory, and Working Memory constructs. CFA indicated that this four-factor model provided superior fit for the data, while the current five-composite structure of ImPACT provided a poor fit for the data. The latent constructs identified in this study using CFA do not map well onto the composite scores that are currently used to interpret ImPACT performance. Future research should investigate whether interpretation of ImPACT based on the constructs identified here will be more useful for clinical decision making than current approaches. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Neuropsychology, 2021
OBJECTIVE Heterogeneity is common following traumatic brain injury (TBI) with important implicati... more OBJECTIVE Heterogeneity is common following traumatic brain injury (TBI) with important implications for clinical outcome. Research in moderate to severe TBI identifies differentiated cognitive profiles. There is little research investigating potential clusters following sport concussion. METHODS Cluster analysis was used to determine patterns of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) performance at three time points (72 hr, 4-7 days, and 8-30 days postconcussion). Participants included 1,817 high-school athletes (Mage = 15.5; 37.9% female) who completed ImPACT following concussion. RESULTS Separate cluster analyses of cognitive scores were conducted at each postconcussion timepoint. Results indicated three clusters of cognitive performance within 1 week postinjury, while a two-cluster solution was identified at longer intervals (8-30 days). Clusters differed primarily by level of performance and also exhibited stratified differences in symptom severity and magnitude of change in cognitive function and symptom-reporting from pre- to postconcussion. The lowest performing cluster in each PC group was Mildly-to-Moderately Impaired and exhibited the highest rates of complicated recovery, suggesting an association between the current clusters and protracted recovery. CONCLUSIONS Results provide preliminary evidence that ImPACT can identify clusters of athletes based on cognitive performance postconcussion that differ in clinically meaningful ways, including symptoms, magnitude of change from baseline, and concussion recovery outcomes. Discriminant functions can classify athletes into clusters based on postconcussion scores and a supplemental excel calculator is provided for such purposes. Absence of full demographic data regarding race/ethnicity and socioeconomic status may limit generalizability. Future work should investigate whether these clusters may assist in return-to-play decision-making by identifying at-risk athletes who may benefit from targeted intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Archives of Clinical Neuropsychology, 2021
Research comparing English and Spanish administrations of Immediate Post-Concussion Assessment an... more Research comparing English and Spanish administrations of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) have consistently found differences in performance on various cognitive composites. Few studies have examined the effect of bilingualism on baseline and post-concussion assessments. This study examined whether monolingual English-speakers (MO) and bilingual Spanish/English speakers (BI) differed in cognitive performance at baseline (BL) and post-concussion (PC). Participants were selected from a larger database of high school athletes administered ImPACT in English at BL and PC. Participants included 86 BI athletes (Mage = 14.53; 65.10% male) and 86 MO athletes matched on age, gender, sport type, and probable concussion as defined by number of PC follow-up assessments (PCF; 0 vs. ≥1). To examine group differences and changes over time in cognitive composites, a general linear modeling approach was used with language and PCF as between-subjects factors and tim...
Archives of Clinical Neuropsychology, 2021
ImPACT is commonly used for sport-concussion management. Baseline and post-concussion tests serve... more ImPACT is commonly used for sport-concussion management. Baseline and post-concussion tests serve as within-athlete comparisons for return-to-play decision-making. Previous literature has questioned whether ImPACT’s five composites accurately represent the internal structure of its cognitive scores. A recent alternative four-factor structure has strong confirmatory evidence for baseline scores (Maietta et al., doi:10.1037/pas0001014). The present study examined the stability of these constructs post-concussion. The current study utilized a case-matched design (age, sex, sport category) to select a sample of 3560 high school athletes’ baseline (n = 1780) and post-concussion (n = 1780) assessments. Multi-group CFA of first-order, hierarchical, and bifactor models was conducted to assess measurement invariance (configural, metric, scalar, and residual invariance) between baseline and post-concussion samples. Change in comparative fit indices was interpreted as the primary indicator of ...
Journal of Pediatric Neuropsychology, 2021
Differences in performance on the Immediate Post-Concussion Assessment and Cognitive Testing (ImP... more Differences in performance on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) have been reported between Spanish and English-speaking individuals. The current study addressed whether these differences could be accounted for by primary language preference, language of ImPACT administration, or a combination of the two. Differences in cognitive and symptom domain scores from ImPACT baseline testing were compared for 264 high school athletes. These high school athletes were either monolingual English speakers who were tested in English ( EE ; n = 88), bilingual Spanish/English speakers who were tested in English ( SE ; n = 88), or monolingual and bilingual Spanish speakers who were tested in Spanish ( SS ; n = 88). These participants were selected from a larger sample and individually matched on variables that could contribute to differences in baseline ImPACT performance. Results indicated the EE group performed better on the Visual Motor Speed and Reaction Time cognitive composites than the SE and SS groups. The SS and SE groups also reported significantly more affective symptoms than the EE group, although group differences in the PCSS total score and other domain scores were not significant. These results provide confirmation of differences between language groups’ cognitive and symptom reporting on ImPACT, and further suggest that these differences are not primarily accounted for by confounding factors, language of test administration, or primary language preference. Additional research is needed to determine whether these ImPACT cognitive and symptom differences result from test bias, linguistic influences, cultural considerations, or a combination of these and other factors.
Archives of Clinical Neuropsychology, 2018
Objective: Over 300,000 sport concussions occur every year and rates continue to increase as part... more Objective: Over 300,000 sport concussions occur every year and rates continue to increase as participation increases (Gessel, Fields, Collins, Dick, & Comstock, 2007). Given that even limited contact sports can result in concussion, evaluation of contact in sport is beneficial to inform prevention efforts (Rice, 2008). The purpose of the current study was to investigate the difference in concussion rates in sports with differing amounts of contact during play. Method: Participants included 3,319 athletes (Mage = 16.0; Meducation = 9.4; 65.7% male; concussed n = 1,812) from Nevada who were assessed pre-or post-concussion from 2008 to 2012. Athletes used for analyses had head injury that required ImPACT assessment, and athletes for comparison were limited to those with valid baselines and no self-reported concussion history. Sport types were divided: collision (C), contact (CN), limited contact (LC), and non-contact sports (NC; Brett & Solomon, 2017; Rice, 2008). Chi-square test of homogeneity was performed to evaluate the difference in concussion rates across sport types. Results: A significant difference in concussion rates across groups was observed (χ2 = 820.92; p < .01). Post hoc analysis involved pairwise comparison using the z-test of two proportions with a Bonferroni correction. All sport types differed significantly in concussion rates with C showing the highest proportion of concussion (74.8%), followed by CN (53.1%), LC (22.1%), and NC with no concussions, p < .05. Conclusions: Results indicate that athletes involved in collision or contact sports have the highest rate of concussion. Future research is needed to further evaluate the rules or techniques for play to minimize these concussion rates.
Archives of Clinical Neuropsychology, 2018
Objective: The Immediate Post-Concussion and Assessment and Cognitive Testing (ImPACT) assesses c... more Objective: The Immediate Post-Concussion and Assessment and Cognitive Testing (ImPACT) assesses cognitive abilities before and after sport concussion. Research suggests that demographic factors such as education, sex, and sport affect the frequency of concussions in athletes (Daneshvar, Nowinski, McKee, & Cantu, 2011). Specifically, Covassin, Swanik, and Sachs (2003) demonstrated that among collegiate athletes, men's lacrosse and women's soccer have the highest injury rate of concussion. The current study assessed whether demographic variables such as education level, sex, and sport predicted group membership between concussed (C) and non-concussed (NC) samples. Method: Participants included 3,507 athletes (Mage = 15.4; Meducation = 9.2; 33.9% female; concussed n = 1809) from across the state of Nevada who were assessed pre-or post-concussion. A binomial logistic regression was performed to determine the effects of demographic factors (education, sex, and sport) on the likelihood that an athlete had received a concussion. Results: The logistic regression was statistically significant (χ2(26) = 593.89, p < .001). The model explained 22.2% (Naglkerke R2) of the variance in concussion and correctly classified 67.6% of cases. Sensitivity was 56.7% and specificity was 78.3%. Females were 1.47 times more likely to experience concussions than males. Conclusions: Results from the current study demonstrate that rates of concussion can be predicted based on demographic variables (education level, gender, and sport), which is consistent with past research showing demographic differences in concussion rates. Interestingly, females were more likely to experience concussion than males. Further research is needed to determine what demographic factors help to predict sport concussion rates, which can inform prevention efforts.
Archives of Clinical Neuropsychology, 2020
Objective The Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) is a commonly u... more Objective The Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) is a commonly utilized sport concussion assessment. Previous literature examined differences in concussion rates, symptom scores, and invalid baselines between healthy athletes and athletes with neurodevelopmental disorders. There are no current studies that investigate cognitive profiles of athletes with autism. The present study explores possible differences in ImPACT performance for these athletes. Method Participants included 31,368 high school athletes (mean age = 15.0, SD = 1.2; mean education = 9.0; SD = 1.4; 43.9% female) selected from a larger database who completed baseline ImPACT testing from 2008–2016. Self-reported neurodevelopmental history consisted of these distinct groups: attention-deficit/hyperactivity disorder (ADHD; 3.6%), learning disorders (LD; 1.3%), Autism (0.3%), ADHD/LD (0.6%). ImPACT Composite Scores were analyzed using Mixed-model ANCOVA (age and gender covariates)-Verbal M...
Archives of Clinical Neuropsychology, 2019
Objective Research demonstrates that athletes with neurodevelopmental diagnoses may have a higher... more Objective Research demonstrates that athletes with neurodevelopmental diagnoses may have a higher frequency of lifetime concussions (Iverson et al., 2016; Alosco, Fedor…
Archives of Clinical Neuropsychology, 2019
Objective Research demonstrates neurodevelopmental diagnoses may increase likelihood of failing s... more Objective Research demonstrates neurodevelopmental diagnoses may increase likelihood of failing scores on ImPACT embedded validity indicators that flag questionable effort. New criteria have been proposed to enhance sensitivity of these indicators although their utility in athletes with neurodevelopmental diagnosis have not been thoroughly examined. This study investigates the effect of neurodevelopmental history on frequency of invalid performance on the standard and three proposed validity indicators. Methods Participants included 41,214 high school athletes (Mage = 15.1; 44.2% female; Meducation = 9.1) who completed baseline ImPACT testing. Athletes included these groups: ADHD (3.7%), Learning Disability (LD; 1.5%), Autism (0.2%), ADHD+LD (0.6%), Autism+ADHD/LD (0.1%), athletes with special education history but no diagnosis reported (SpEd; 2.8%), and healthy athletes (91.1%). Odds ratios were calculated to determine differences in invalid performance by both standard and propose...
Archives of Clinical Neuropsychology, 2017
Objective: The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) assesses cogni... more Objective: The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) assesses cognitive abilities before and after traumatic brain injury. Research shows that Spanish-speaking individuals perform more poorly on Spanish versions than on English versions of the ImPACT. The current study explores this hypothesis in a statewide sample. Method: Participants included 166 (mean age = 16.3) individuals who were selected from a consecutive series of 9,000 cases that were assessed to measure baseline functioning before sport participation. Of these, 59 were Spanish-speakers (SS) who were administered the ImPACT in Spanish. Random selection was used to develop comparable groups of Spanish-speakers administered the ImPACT in English (n = 52; SE), and English-speakers administered the ImPACT in English (n = 55; EE). No significant differences were present between groups on age, education, or sex. ImPACT composite scores were compared using mixed-model ANOVA. Results: Results indicated that the SS group performed significantly worse than the SE and EE groups on the Visual Memory (p < .01) and Visual Motor Processing Speed Composites (p < .01). SE and EE groups did not differ from each other on these two composites. No differences between groups were seen for Verbal Memory, Reaction Time, or Impulse Control Composites. Conclusion: Results provide preliminary evidence that performance of Spanishspeakers is similar across Verbal Memory, Reaction Time, and Impulse Control Composites regardless of administration language. If native Spanish-speakers choose to take ImPACT in Spanish, interpretation of Verbal Memory, Reaction Time, and Impulse Control composites may yield a more precise estimate of performance.