Clinical Reaction Time Research Articles

ANXIETY, FEAR, AND MOVEMENT FOLLOWING SPORTS-RELATED CONCUSSION: HOW DOES KINESIOPHOBIA CORRELATE TO SYMPTOMS AND REACTION TIME?

Background:Fear of pain with movement, also known as kinesiophobia, has been widely studied in various musculoskeletal injuries, yet little is known about its relationship to concussion. Given that concussion can negatively affect neuromuscular control and anxiety, re-integration into sports following a concussion may be associated with kinesiophobia.Hypothesis/Purpose:Our primary purpose was to examine kinesiophobia, among youth athletes with concussion compared to uninjured controls. Secondarily, we sought to examine correlations between kinesiophobia with concussion symptom severity and reaction time. We hypothesized adolescents with concussion would demonstrate greater kinesiophobia compared to controls. Additionally, we hypothesized that greater kinesiophobia would be correlated with higher symptom severity and slower reaction times.Methods:We conducted a repeated measures study of 48 youth athletes. Participants were evaluated at two time points. The concussion group was assessed within 14 days of injury and once cleared for return to play (RTP) by physician. The control group was tested initially and again approximately 28 days later. Participants completed Tampa Scale of Kinesiophobia (TSK), Post-Concussion Symptom Inventory (PCSI), and clinical reaction time (CRT) assessments. We compared mean group differences and assessed the correlation of TSK with PCSI and CRT, at each assessment.Results:We included 26 participants with a concussion and 16 controls (Table 1). The concussion group reported significantly greater TSK scores at the initial assessment (38.0±5.6 vs. 29.3±6.9; p<0.001; Figure 1) and a significantly greater proportion of “high” TSK scores (>36) compared to controls (69% vs. 19%; p = 0.004; Table 1). At the follow-up assessment, there were no significant between group differences in TSK scores (32.8±7.0 vs. 30.4±7.5; p=0.35; Figure 1), or the proportion of “high” TSK scores (38% vs. 25%; p=0.51; Figure 1). TSK scores were significantly and moderately correlated with PCSI for the concussion group at both assessments (r=0.53; p=0.006 at visit 1, r=0.47; p=0.01 at visit 2; Figure 2), but not for controls (Figure 2). Furthermore, TSK scores were significantly and moderately correlated with CRT for the concussion group (r=0.50; p=0.01; Figure 2), but not controls (r= -0.26; p=0.37; Figure 2) at the follow-up assessment.Conclusion:Adolescents recovering from concussion commonly reported high kinesiophobia at initial concussion assessment, while many no longer reported high kinesiophobia when given RTP clearance. Furthermore, kinesiophobia was significantly correlated with self-reported concussion symptoms and clinical reaction time scores. The correlation between kinesiophobia and reaction time suggests a perception-behavior relationship with post-concussion movement deficits may exist.Tables/Figures:Figure 1.Individual data points describing the distribution of TSK scores for concussion and control groups at the initial and follow-up (return-to-play) assessments. The line within the plot defines the median value for each group.Figure 2.Scatterplots and lines of best fit describing the relationship between fear of movement (TSK) ratings with concussion symptom severity (A and B), and with clinical reaction time (C and D).

THE RELIABILITY OF CLINICAL BALANCE TESTS UNDER SINGLE-TASK AND DUAL-TASK TESTING PARADIGMS IN UNINJURED ACTIVE YOUTH AND YOUNG ADULTS

Previous researchers have suggested that balance control deficits are detected more accurately with dual-task testing than single-task testing. However, it is necessary to examine the clinimetric properties of dual-task testing before employing it in clinical and research settings. To examine and compare the relative and absolute reliability of the Balance Error Scoring System (BESS), Tandem Gait Test (TGT), and Clinical Reaction Time (CRT) under single and dual-task conditions in uninjured active youth and young adults.Study Design: Single-group, repeated-measures study. Twenty-three individuals [9 female; median age 17 years] completed three trials of the BESS, TGT, and CRT under single and dual-task testing conditions during testing session one. Two raters assessed participants to assess inter-rater reliability. Either later on the same day or the following day, the protocol was repeated by one rater to assess intra-rater reliability. The average of three trials was used to calculate intra-rater (between-session) and inter-rater (within-session) intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and Cohen's Kappa coefficient for tests as appropriate under both conditions. Bland-Altman plots (mean difference and 95% limits of agreement) were used to assess for a systematic error associated with a learning effect. Only one participant attended the second session on the following day, while 22 participants (95%) attended the second session within four hours after testing session one. Under single-task testing, estimated ICCs, SEMs, MDCs, and Kappa coefficients ranged from 0.24 to 0.99, 0.3 to 23, 0.8 to 64, and 0.03 to 0.64, respectively. Under dual-task testing, estimated ICCs, SEMs, MDCs, and Kappa coefficients ranged from 0.70 to 0.99, 0.4 to 17, 1.1 to 47, and 0.39 to 0.83, respectively. A learning effect was identified for all tests under all conditions. The BESS is the only clinical test that demonstrated acceptable reliability for clinical use under single-task testing conditions. The BESS, TGT, and CRT all demonstrated acceptable reliability for clinical use under dual-task testing conditions. A practice session should be used to reduce the possible learning effect seen. Further studies examining sources of the systematic error observed are needed. 2b.

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

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.

Clinical Reaction Time Performance in a Concussed Pediatric Population

PURPOSE: The puck-drop (PD) test has been used to assess clinical reaction time (CRT) and has been proposed as a tool to aid in the diagnosis and management of sports concussion. The simplicity of the test and low cost make it an attractive tool in the management of these injuries; however, it is not known whether the test discriminates between concussed and non-concussed patients. The purpose of this study is to determine the discriminatory utility of the PD test to differentiate acutely concussed pediatric athletes relative to an uninjured cohort. METHODS: Patients (ages 8-18) who remained symptomatic on presentation to a sports medicine clinic and diagnosed with a concussion were eligible for study inclusion. Patients with concomitant injuries that precluded completion of the PD test were excluded. Testing was conducted in accordance with protocols established in the literature. Two practice trials were conducted. The distance of stick transversal was recorded as well as the number of drops and failed attempts. Eight successful trials were completed for each hand. Children with hands too small to circumvent the puck diameter were accommodated by starting at 10 cm above the puck base. RESULTS: 196 concussed (m-103, f-93) and 463 healthy (m-178, f-285) subjects were included in this study. The average CRT for right/left hands for healthy and injured subjects were 229.7+21.6ms/229.6+21.8ms, and 243.4+29.4ms/242.3+29.8ms, respectively. Injured patients were categorized by age and compared to healthy controls. Although significant associations were noted between age and CRT among healthy and concussed subjects overall (both hands), no statistical difference was found between control and concussed groups by age. CONCLUSION: This study demonstrated the association of age on CRT in both concussed and healthy subjects; however, the CRT of injured subjects did not differ from age matched healthy controls for either hand. Thus, CRT measured at the time of clinic presentation did not appear to have a discriminatory effect for diagnostic purposes. Future studies will need to examine the time point of CRT measurement, larger sample size, and longitudinal follow up to evaluate associations with recovery.

Establishment of Normative Clinical Reaction Times in a Pediatric Population

INTRODUCTION: The puck-drop (PD) test has been utilized to assess clinical reaction time (CRT) and has been proposed as a tool to aid in the management of sports related concussion. The simplicity of the test and low cost make it an attractive tool in the management of these injuries; however, no normative data has been established in children, making post-concussion testing in this population difficult to interpret. PURPOSE: The purpose of this study is to examine the use of the PD test in the pediatric and adolescent population: 1) to develop age specific normative values and 2) to examine the effect of sex and handedness on test performance. METHODS: Patients (ages 8-18) who presented to sports medicine clinics for evaluation and treatment of non-concussive injuries and whose presenting complaint would not confound completion of the PD test (LE injury, recovered injury, etc.) were recruited for baseline assessment. Testing was conducted in accordance to protocols previously described in the literature. Two practice trials were conducted. The distance of stick transversal was recorded to the nearest 0.5 cm, as well as the number of drops and failed attempts. The test was completed when 8 successful trials for each hand were recorded. Children with hands too small to circumvent the puck diameter were accommodated by starting at 10 cm above the puck base at the discretion of the test administrator. RESULTS: 463 subjects completed the study (n = 178 male, n = 285 female, average age 13.04 +/- 2.57 years). Regression analysis of baseline CRT indicated a strong effect of age on overall CRT for both right and left hands (R2 = 0.21, p < 0.001, Figure 1). The estimates (SE) of right hand CRT ranged between 255.51 (4.66) to 216.15 (4.97) ms, and those of left hand ranged from 257.41 (4.71) to 219.08 (5.02) ms across 8-18 years of age. There were no differences in performance on CRT based on handedness (p = 0.78) or sex. (p = 0.84). CONCLUSION: As a result of this study, normative values for the PD test were established for the pediatric population. Test performance varied with age. Test performance did not vary based on hand, preliminarily indicating hand dominance does not affect performance during this evaluation, Future studies should evaluate the effect of concussion on performance.