Validation of the kinarm end-point robot for clinical assessment of acute sport concussion sensory, motor, and neurocognitive impairment in athletes

Abstract

ObjectiveTo determine if there is a significant association between KINARM robotic sensorimotor and neurocognitive measurements at baseline, ≤10 days post-concussion (IPC), and when clinically asymptomatic (CA).DesignDouble-blind, prospective case series.SettingFour athletic seasons (2011–2015).Participants1,214 elite athletes (904 males, 310 females, mean age: 18 and 20 years, respectively).Outcome measuresFifty-seven parameters from five robotic tasks (Visually Guided Reaching (VGR), Position Matching (PM), Object Hit, Object Hit and Avoid, Trail Making B (TMB)) characterising sensorimotor and neurocognitive function. Linear regression was used to determine if there was a significant association between baseline, IPC, and CA measurements, adjusting for potential predictors (age, sex, concussion history, recurrent concussion during study, number of baseline assessments, method (seated versus standing), Post-Concussion Symptom Scale Score (PCSS), days post-concussion at testing) and learning effect.Main results95 athletes sustained 102 concussions. There was a clear reduction in performance in concussed athletes on individual parameters compared to non-concussed repeat performance. Significant predictors of impairment were: 1) higher PCSS for VGR (IPC): Reaction Time (p<0.001), Min-Max Speed Difference (m/s) (p=0.001), Path Length Ratio (p=0.001), and TMB (CA): Test Time (p=0.003), Dwell Time (p=0.003); 2) older athletes for VGR (IPC): Speed Maxima Count (p<0.01); 3) less days post-concussion at IPC testing for PM Contraction/Expansion Ratio XY (p=0.005); and 4) recurrent concussion during study period for non-dominant PM Shift Y (p=0.005).ConclusionsResults of this large prospective study suggest the KINARM robot is a valid, objective tool for quantifying sensorimotor and neurocognitive impairment in concussed athletes.Competing interestsBrian W Benson In the future may receive a small royalty from BKIN Technologies Ltd. in consideration for assisting with development and validation of the KINARM end-point robotic device for use in acute sport concussion assessment and management.None.Co-founder and CSO of BKIN Technologies that commercialises the KINARM robot.