Utility Of A Pediatric Computerized Cognitive Tool In Children Aged 5-9 Following Concussion

Abstract

PURPOSE: Computerized neurocognitive testing is commonly used as part of a comprehensive evaluation of sport-related concussion (SRC) in adolescents and adults. However, these tools are not designed for use in children. There is a need for a valid, computerized tool to assess cognitive function in pediatric athletes following SRC. The aim is to evaluate a pediatric version of the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) neurocognitive battery by examining the measure’s clinical utility in the evaluation and management of concussion in a pediatric population. METHODS: A total of 63 children (female-42.2%) aged 5-9 years (7.5 ± 1.0 years) were enrolled within 30 (8.5 ± 5.9) days of concussion upon presentation to a sports medicine concussion specialty clinic. Participants were administered the ImPACT Pediatric at all clinic visits. ImPACT Pediatric is a brief (25 min) computerized neurocognitive test with composite scores for sequential memory, word memory, visual memory, and rapid processing. An omnibus F-test was used to evaluate ImPACT Pediatric performance from initial clinic visit (V1) to medical clearance visit. Paired t-tests were used to compare ImPACT Pediatric composite and subtest scores at V1 and clearance with statistical significance set at p < .05. RESULTS: On average, participants recovered in 34.1 ± 23.5 days. Participants demonstrated improved performance on all ImPACT Pediatric composite scores from V1 to clearance (p = .001, ηp2 = .152), with particular improvement in speeded domains (rapid processing: p = .008, d = .29). At both V1 and clearance, older participants demonstrated faster performance (rapid processing: p = .021, d = .58) and higher accuracy scores on subtests measuring word learning/memory (word learning correct: p = .008, d = .67) and working memory (memory touch sequences correct: p = .005, d = .72). CONCLUSIONS: The findings indicate that ImPACT Pediatric composites and subtests, particularly speeded domains, are able to detect changes in cognitive function from initial to medical clearance visits following concussion. This study suggests that the ImPACT Pediatric tool can be used by sports medicine professionals as one component of a comprehensive assessment to evaluate injury, monitor recovery, and inform return-to-play decisions following SRC.