The Importance of Proper Administration and Interpretation of Neuropsychological Baseline and Postconcussion Computerized Testing (original) (raw)
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Is neuropsychological testing useful in the management of sport-related concussion?
Journal of athletic training
Neuropsychological (NP) testing has been used for several years as a way of detecting the effects of sport-related concussion in order to aid in return-to-play determinations. In addition to standard pencil-and-paper tests, computerized NP tests are being commercially marketed for this purpose to professional, collegiate, high school, and elementary school programs. However, a number of important questions regarding the clinical validity and utility of these tests remain unanswered, and these questions present serious challenges to the applicability of NP testing for the management of sport-related concussion. Our purpose is to outline the criteria that should be met in order to establish the utility of NP instruments as a tool in the management of sport-related concussion and to review the degree to which existing tests have met these criteria. A comprehensive literature review of MEDLINE and PsychLit from 1990 to 2004, including all prospective, controlled studies of NP testing in...
Journal of the International Neuropsychological Society : JINS, 2016
Limited data exist comparing the performance of computerized neurocognitive tests (CNTs) for assessing sport-related concussion. We evaluated the reliability and validity of three CNTs-ANAM, Axon Sports/Cogstate Sport, and ImPACT-in a common sample. High school and collegiate athletes completed two CNTs each at baseline. Concussed (n=165) and matched non-injured control (n=166) subjects repeated testing within 24 hr and at 8, 15, and 45 days post-injury. Roughly a quarter of each CNT's indices had stability coefficients (M=198 day interval) over .70. Group differences in performance were mostly moderate to large at 24 hr and small by day 8. The sensitivity of reliable change indices (RCIs) was best at 24 hr (67.8%, 60.3%, and 47.6% with one or more significant RCIs for ImPACT, Axon, and ANAM, respectively) but diminished to near the false positive rates thereafter. Across time, the CNTs' sensitivities were highest in those athletes who became asymptomatic within 1 day before...
Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists, 2017
The use of normative data is a hallmark of the neuropsychological assessment process. Within the context of sports-related concussion, utilizing normative data is especially essential when individualized baseline data are unavailable for comparison. The primary purpose of this study was to establish normative data for a comprehensive neuropsychological test battery used in the assessment of sports-related concussion. A secondary aim was to provide normative data for pertinent demographic variables relevant to the assessment of college athletes, including sex, previous head injuries (PHI), and history of attention deficit hyperactivity disorder (ADHD)/learning disability (LD). Participants included male and female college athletes (N = 794) who were involved in a concussion management program at an NCAA Division I university between 2002 and 2015. Athletes were administered a comprehensive neuropsychological test battery at baseline designed to assess the following cognitive domains:...
The psychometric properties of concussion assessment tools in high school athletics
2006
Sports-related concussion assessment has not examined an individual's effort level during baseline testing. This research examined the level of effort in an athletic population and determined if sub-optimal effort effects neuropsychological test scores. Design: 199 high school athletes, mean age (15.54+ 1.17 years) were administered a brief neuropsychological test battery including the Dot Counting Test (DCT) and the Rey 15-item test with recognition trial. Measurement: One-way analyses of variance were calculated for each outcome measure to examine differences between effort groups. Results: 177 athletes exerted optimal effort while 22 exerted sub-optimal effort. Significant differences existed between effort groups on several of the neuropsychological tests. Conclusions: Sub-optimal effort does exist in the athletic population during baseline testing with statistically significant differences between groups on neuropsychological test scores. Adding an objective effort test is necessary to improve interpretations of scores within concussion assessment.
Advances in neuropsychological assessment of sport-related concussion
British Journal of Sports Medicine, 2013
Objective To critically review the literature from the past 12 years regarding the following key issues in sports-related neuropsychological assessment: (1) the advantages and disadvantages of different neuropsychological assessment modalities; (2) the evidence for and against the current paradigm of baseline/postinjury testing; (3) the role of psychological factors in the evaluation and management of concussion; (4) advances in the neuropsychological assessment of children; (5) multi-modal assessment paradigms; (6) the role of the neuropsychologist as part of the sports healthcare team and (6) the appropriate administration and interpretation of neuropsychological tests. Design Targeted computerised literature review (MEDLINE, PubMed, CINAHL and PsychInfo) from 2000 to the present using key words: neuropsychological, neurocognitive, assessment, testing, concussion and sports. Results More than 2600 articles were identified using key word searches of the databases, including many duplicates. Several books were also reviewed. The articles were pared down for review if they specifically addressed the key areas noted above. Conclusions Traditional and computerised neuropsychological tests are useful in the evaluation and management of concussion. Brief cognitive evaluation tools are not substitutes for formal neuropsychological assessment. At present, there is insufficient evidence to recommend the widespread routine use of baseline neuropsychological testing. Although scant, research suggests that psychological factors may complicate and prolong recovery from concussion in some athletes. Ageappropriate symptom scales for children have been developed but research into age-appropriate tests of cognitive functions lags behind. Neuropsychologists are uniquely qualified to interpret neuropsychological tests and can play an important role within the context of a multifaceted-multimodal approach to manage sportsrelated concussions.
Concussion Baseline Testing: Preexisting Factors, Symptoms, and Neurocognitive Performance
Journal of athletic training, 2017
Neurocognitive test scores are often considered an important aspect of concussion management. To best use these data, clinicians must understand potential factors that may influence baseline performance on these tests. To determine preexisting factors that may influence performance on the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). Cross-sectional study. Research laboratory. A total of 486 National Collegiate Athletic Association Division I collegiate student-athletes. To determine neurocognitive functioning and total symptom score at baseline, ImPACT was administered. Outcomes were verbal memory, visual memory, visual motor speed, reaction time, and total symptom score. A self-report demographic section at the beginning of ImPACT was used to gather information concerning previous treatment for headaches, migraines, and psychiatric conditions; diagnosis of attention-deficit/hyperactivity disorder; and exposure to previous strenuous exercise. We conducted ...
Review of Assessment Scales for Diagnosing and Monitoring Sports-related Concussion
Cureus
Sports-related concussion has emerged as a public health crisis due to increased diagnosis of the condition and increased participation in organized and recreational athletics worldwide. Under-recognition of concussions can lead to premature clearance for athletic participation, leaving athletes vulnerable to repeat injury and subsequent short-and long-term complications. There is overwhelming evidence that assessment and management of sportsrelated concussions should involve a multifaceted approach. A number of assessment criteria have been developed for this purpose. It is important to understand the available and emerging diagnostic testing modalities for sports-related concussions. The most commonly used tools for evaluating individuals with concussion are the Post-Concussion Symptom Scale (PCSS), Standard Assessment of Concussion (SAC), Standard Concussion Assessment Tool (SCAT3), and the most recognized computerized neurocognitive test, the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). The strengths and limitations of each of these tools, and the Concussion Resolution Index (CRI), CogSport, and King-Devick tests were evaluated. Based on the data, it appears that the most sensitive and specific of these is the ImPACT test. Additionally, the King-Devick test is an effective adjunct due to its ability to test eye movements and brainstem function.
Neuropsychological evaluation in the diagnosis and management of sports-related concussion☆
Archives of Clinical Neuropsychology, 2007
A mild traumatic brain injury in sports is typically referred to as a concussion. This is a common injury in amateur and professional athletics, particularly in contact sports. This injury can be very distressing for the athlete, his or her family, coaches, and school personnel. Fortunately, most athletes recover quickly and fully from this injury. However, some athletes have a slow ଝ The working group of authors for this paper was comprised of neuropsychologists who are expert in this field, some of whom have researched and/or developed particular tests for use in sports concussion testing. The National Academy of Neuropsychology (NAN) and the authors of this position paper advocate the use of neuropsychological evaluation in the management of sports concussion. This paper, however, is not meant to advocate or recommend any particular neuropsychological test or vendor of neuropsychological testing. This paper has been peer-reviewed and edited by members of the NAN Policy and Planning Committee. The Policy and Planning Committee of the National Academy of Neuropsychology (NAN) is charged with writing position papers regarding important issues that impact the profession of Neuropsychology. Possible topics for the Position Papers are suggested by the NAN Board of Directors, members of the NAN Policy and Planning Committee, or individual Academy members. Primary authors are identified and approved by the NAN Policy and Planning Committee. These authors typically are experts on the topic and can come from within or outside the Policy and Planning Committee. Primary authors, Policy and Planning Committee members, and selected outside reviewers provide extensive peer review for all papers. All topics and the final paper submissions are reviewed and approved by the NAN Board of Directors.
The American Journal of Sports Medicine, 2011
Background: Concussions affect an estimated 136 000 high school athletes yearly. Computerized neurocognitive testing has been shown to be appropriately sensitive and specific in diagnosing concussions, but no studies have assessed its utility to predict length of recovery. Determining prognosis during subacute recovery after sports concussion will help clinicians more confidently address return-to-play and academic decisions. Purpose: To quantify the prognostic ability of computerized neurocognitive testing in combination with symptoms during the subacute recovery phase from sports-related concussion. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: In sum, 108 male high school football athletes completed a computer-based neurocognitive test battery within 2.23 days of injury and were followed until returned to play as set by international guidelines. Athletes were grouped into protracted recovery (>14 days; n = 50) or short-recovery (≤14 days; n = 58). Sepa...