Immediate Post-Concussion Assessment And Cognitive Testing Test Research Articles

NEUROCOGNITIVE PERFORMANCE AT RETURN TO PLAY IN ELITE YOUTH HOCKEY PLAYERS WITH SPORT-RELATED CONCUSSION

BackgroundNeurocognitive recovery following sport-related concussion is important for re-injury risk reduction. In elite youth hockey, it is unknown if neurocognitive function returns to baseline values at the time of medical...

Neurocognitive Performance and Symptom Profiles of Spanish-Speaking Hispanic Athletes on the ImPACT Test

This study documented baseline neurocognitive performance of 23,815 athletes on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test. Specifically, 9,733 Hispanic, Spanish-speaking athletes who completed the ImPACT test in English and 2,087 Hispanic, Spanish-speaking athletes who completed the test in Spanish were compared with 11,955 English-speaking athletes who completed the test in English. Athletes were assigned to age groups (13-15, 16-18). Results revealed a significant effect of language group (p < .001; partial η(2) = 0.06) and age (p < .001; partial η(2) = 0.01) on test performance. Younger athletes performed more poorly than older athletes, and Spanish-speaking athletes completing the test in Spanish scored more poorly than Spanish-speaking and English-speaking athletes completing the test in English, on all Composite scores and Total Symptom scores. Spanish-speaking athletes completing the test in English also performed more poorly than English-speaking athletes completing the test in English on three Composite scores. These differences in performance and reported symptoms highlight the need for caution in interpreting ImPACT test data for Hispanic Americans.

Invalid Performance and the ImPACT in National Collegiate Athletic Association Division I Football Players

Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computerized cognitive test battery commonly used for concussion evaluation. An important aspect of these procedures is baseline testing, but researchers have suggested that many users do not use validity indices to ensure adequate effort during testing. No one has examined the prevalence of invalid performance for college football players. To examine the prevalence of invalid scores on ImPACT testing. Cross-sectional study. National Collegiate Athletic Association Division I university. A total of 159 athletes (age = 20.3 ± 1.41 years; range = 17.8-23.7 years) from a Division I collegiate football team participated. An informational intervention regarding the importance of concussion testing to promote safety was administered before testing for the most recent season. We examined preseason ImPACT testing data across a 3-year period (total assessments = 269). Based on invalid and sandbagging indices denoted by the ImPACT manual, protocols were examined to indicate how many invalid indices each athlete had. A total of 27.9% (n = 75) of assessments were suggestive of invalid scores, with 4.1% (n = 11) suggesting invalid responding only, 17.5% (n = 47) indicating "sandbagging" only, and 6.3% (n = 17) showing both invalid and sandbagging responding. The informational intervention did not reduce the prevalence of invalid responding. These findings highlight the need for further information about the ImPACT validity indices and whether they truly reflect poor effort. Future work is needed to identify practices to reliably target and reduce invalid responding.

Residual alterations of brain electrical activity in clinically asymptomatic concussed individuals: An EEG study

ObjectiveTo examine the neural substrates underlying performance on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and HeadRehab Virtual Reality (VR) balance and spatial modules in a concussed and control group. MethodsThirteen controls and seven concussed participants were fitted with a Geodesic 128-channel EEG cap and completed three assessments: EEG baseline, ImPACT testing, and VR balance and spatial modules. Concussed participants completed were tested within 8 (5±1) days after injury. ResultsEEG power was significantly (p<.05) decreased in the concussed group over all testing modalities. EEG coherence was significantly (p<.05) increased in the concussed group during EEG baseline and ImPACT. For VR testing, two conditions showed significant (p<.05) increases in EEG coherence between ROIs, while two different conditions showed significant (p<.05) decreases in coherence levels. ConclusionsConcussed participants passed all clinical concussion testing tools, but showed pathophysiological dysfunction when evaluating EEG variables. SignificanceConcussed participants are able to compensate and achieve normal functioning due to recruiting additional brain networks. This allows concussed participants to pass clinical tests while still displaying electrophysiological deficits and clinicians must consider this information when making return-to-play decisions.

A Two-Factor Theory for Concussion Assessment Using ImPACT: Memory and Speed

We present the initial validation of a two-factor structure of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) using ImPACT composite scores and document the reliability and validity of this factor structure. Factor analyses were conducted for baseline (N = 21,537) and post-concussion (N = 560) data, yielding "Memory" (Verbal and Visual) and "Speed" (Visual Motor Speed and Reaction Time) Factors; inclusion of Total Symptom Scores resulted in a third discrete factor. Speed and Memory z-scores were calculated, and test-retest reliability (using intra-class correlation coefficients) at 1 month (0.88/0.81), 1 year (0.85/0.75), and 2 years (0.76/0.74) were higher than published data using Composite scores. Speed and Memory scores yielded 89% sensitivity and 70% specificity, which was higher than composites (80%/62%) and comparable with subscales (91%/69%). This emergent two-factor structure has improved test-retest reliability with no loss of sensitivity/specificity and may improve understanding and interpretability of ImPACT test results.

Concussion Symptoms and Neurocognitive Performance of High School and College Athletes Who Incur Multiple Concussions

Background: Multiple concussions have been associated with prolonged symptoms, recovery time, and risk for future concussions. However, very few studies have examined the effect of multiple concussions on neurocognitive performance and the recently revised symptom clusters using a large database. Purpose: To examine concussed athletes with a history of 0, 1, 2, or ≥3 concussions on neurocognitive performance and the recently revised symptom clusters. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: The independent variables were concussion group (0, 1, 2, and ≥3 concussions) and time (baseline, 3 days, and 8 days). The dependent variables were neurocognitive test scores as measured by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) neurocognitive test battery (verbal and visual memory, processing speed, and reaction time) and 4 concussion symptom clusters (migraine-cognitive-fatigue, affective, somatic, and sleep). All concussed athletes (n = 596) were administered the ImPACT test at a mean 2.67 ± 1.98 and 7.95 ± 4.46 days after injury. A series of 4 (concussion group) × 3 (time) repeated-measures analyses of covariance (age = covariate) were performed on ImPACT composite scores and symptom clusters. Results: Concussed athletes with ≥3 concussions were still impaired 8 days after a concussion compared with baseline scores on verbal memory (P < .001), reaction time (P < .001), and migraine-cognitive-fatigue symptoms (P < .001). There were no significant findings on the remaining dependent variables. Conclusion: Concussed athletes with a history of ≥3 concussions take longer to recover than athletes with 1 or no previous concussion. Future research should concentrate on validating the new symptom clusters on multiple concussed athletes, examining longer recovery times (ie, >8 days) among athletes with multiple concussions.

Neurocognitive Test Performance and Symptom Reporting in Cheerleaders with Concussions

To evaluate neurocognitive test results and symptom reporting after sports-related concussion in a group of female cheerleaders. Junior and senior high school female cheerleaders (n = 138) underwent preparticipation baseline testing and repeated the ImPACT (Immediate Postconcussion Assessment and Cognitive Testing) evaluation within 7 days of concussive injury (range, 0-7 days; mean, 3.9 days). Postinjury neurocognitive and symptom scores were compared with preinjury (baseline) scores. "Abnormal" test performance was determined statistically using Reliable Change Index scores and self-reported symptoms. Main outcome variables included the composite scores indices from the ImPACT test, as well as symptoms reported by participants. Preinjury baseline and postinjury test results were compared using MANOVA. As a group, cheerleaders with concussion evaluated within 7 days of injury performed poorly on the ImPACT test battery relative to their own baseline (F = 6.5; P = .00). In addition, 61% of the cheerleaders with concussions reported an increase in symptoms compared with baseline. The groups did not differ significantly by position on the squad (F = 0.37; P = .96). Of the group of cheerleaders who did not report increased symptoms at the time of postinjury evaluation, 37% had at least 1 abnormal ImPACT composite score result, suggesting some residual cognitive decline compared with baseline. The diagnosis and management of concussion in cheerleaders should not consist solely of self-reported symptoms. Neurocognitive test results represent an important component of the evaluation process and may identify athletes with residual neurocognitive deficits who report being clinically asymptomatic.

Practice Effects Reveal Visuomotor Vulnerability in School and University Rugby Players

This article reports on three pre- versus post-season prospective studies in which male university and high school contact sport players predominantly of Rugby Union (hereafter rugby) were compared with age, education, and IQ equivalent non-contact sport controls on the ImPACT (Immediate Postconcussion Assessment and Cognitive Testing) test. All analyses revealed a relative absence of practice effects on the Visual Motor Speed (VMS) composite for contact sport groups compared with controls. The VMS data for rugby players from each study were pooled and subjected to additional analysis (Rugby, n = 145; Controls, n = 106). Controls revealed significant improvement over the season (p < .001), whereas no learning effect was in evidence for rugby players whose performance remained the same (interaction effect, p = .028). It is apparent that practice effects have diagnostic potential in this context, implicating vulnerability on speeded visuomotor processing in association with participation in rugby. Pointers for further research and concussion management in the individual case are explored.

Computerized assessment of cognitive late effects among adolescent brain tumor survivors

Advantages of computerized assessment of neuropsychological functions include improved standardization and increased reliability of response time variables. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computerized battery developed for monitoring recovery following mild brain injuries that assesses attention, memory and processing speed. Despite evidence that core areas of deficit among cancer survivors are those assessed by ImPACT, it has not previously been used with this population. Twenty four childhood brain tumor (BT) survivors treated with conformal radiation therapy (mean age = 15.7 ± 1.6; mean age at irradiation = 9.8 ± 2.5), twenty solid tumor (ST) survivors treated without CNS-directed therapy (mean age = 16.2 ± 1.8) and twenty healthy siblings (mean age = 15.1 ± 1.6 years) were administered an age modified version of ImPACT. Additional computerized measures of working memory and recognition memory were administered. Univariate ANOVAs revealed group differences (p < 0.05) on measures of recognition memory, spatial working memory, processing speed and reaction time, with BT survivors performing significantly worse than ST survivors and siblings. Pearson correlation coefficients revealed significant associations between ImPACT memory tasks and computerized forced choice recognition tasks (rs = 0.30-0.33, p < 0.05). Multiple surgical resections, hydrocephalus and CSF shunt placement most consistently predicted worse ImPACT performance using linear mixed models (p < 0.05). The ImPACT test battery demonstrated sensitivity to cognitive late effects experienced by some BT survivors with clinical predictors of performance consistent with the pediatric oncology literature. Correlations with measures of similar constructs provide evidence for convergent validity. Findings offer initial support for the utility of ImPACT for monitoring of cognitive late effects.

"Sandbagging" Baseline Test Performance on ImPACT, Without Detection, Is More Difficult than It Appears

Participants coached to display poor effort on neuropsychological tests have successfully evaded detection. Recent research has documented that 89% college athletes instructed to perform poorly on a follow-up baseline ImPACT (Immediate Post-concussion Assessment and Cognitive Testing) test were unable to bypass detection, but otherwise, sandbagging on baseline testing has not been directly studied. In an analog study intended to measure participants' ability to successfully sandbag, we compared baseline test performance in three groups of individuals, instructed: (a) to perform their best, (b) to malinger without guidance (e.g., naïve), and (c) how to malinger (e.g., coached), using ImPACT, the Medical Symptom Validity Test (MSVT), and the Balance Error Scoring System. The MSVT identified more participants in the naïve (80%) and coached (90%) groups than those automatically "flagged" by ImPACT (60% and 75%, respectively). Inclusion of additional indicators within ImPACT increased identification to 95% of naïve and 100% of coached malingerers. These results suggest that intentional "sandbagging" on baseline neurocognitive testing can be readily detected.

Sensitivity and Specificity of the Online Version of ImPACT in High School and Collegiate Athletes

Background: The utility of postconcussion neurocognitive testing versus symptom data has been debated. The sensitivity of the desktop version of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) tool has been documented, but psychometric properties of the recently released online version of ImPACT have yet to be fully established. Purpose: To document the sensitivity of the online ImPACT version in samples of (1) symptomatic concussed (high school and collegiate) athletes, and (2) asymptomatic concussed (high school and collegiate) athletes suspected of hiding their concussions. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 81 athletes observed to sustain a concussion by a certified athletic trainer or team physician, a finding that was confirmed with reported postconcussion symptoms, completed the ImPACT test within 3 days of injury. Data were compared with an independent sample of 81 athletes who completed preseason baseline cognitive assessments using ImPACT and who were matched (with concussed athletes) on the basis of sex, age, sport, concussion history, and absence of attention deficit hyperactivity disorder and learning disability. An independent group of 37 athletes who were also observed to sustain a concussion completed ImPACT within 3 days of injury. These athletes reported no postconcussion symptoms but were noted for suspected invalid response patterns on ImPACT (Impulse Control index >30 and Verbal Memory index <69%). The subscale data from the assessments (excluding those contributing to the aforementioned indices) were compared with a matched sample of 37 athletes who completed preseason baseline cognitive assessments in ImPACT (using the same criteria described above). Results: Data from the ImPACT online version yielded 91.4% sensitivity and 69.1% specificity. For asymptomatic athletes suspected of hiding their concussion, data from ImPACT yielded 94.6% sensitivity and 97.3% specificity. Conclusion: The online version of the ImPACT tool is a valid measure of neurocognitive performance at the acute stages of concussion, with high levels of sensitivity and specificity, even when athletes appear to be denying postconcussion symptoms.

Neurocognitive Functioning and Symptom Reporting of High School Athletes Following a Single Concussion

The aim of this research was to evaluate the neurocognitive functioning and symptom reporting of high school athletes with the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery after sustaining a single sports-related concussion. The ImPACT battery was administered to 26 athletes at an average of 6.8 days after their head injury. ImPACT composite scores, including neurocognitive measures of Verbal Memory, Visual Memory, Processing Speed, and Reaction Time, as well as a Total Symptom Score, were also obtained from an equivalent group of 25 nonconcussed football players. The composite scores of the concussed athletes were lower but not statistically different than the nonconcussed athletes. The findings were consistent with previous ImPACT research that reported no differences between concussed and nonconcussed athletes 7 days after a concussion. The symptom scores of the concussed athletes, on the other hand, were significantly higher than those who had no concussion. The similarities and differences in ImPACT test performances of the present sample of concussed high school athletes as compared with previous studies of concussed high school athletes are discussed. This study raises awareness that with high school athletes, symptom complaints may persist, even after cognitive functioning has returned to preinjury levels.

Group Versus Individual Administration Affects Baseline Neurocognitive Test Performance

Background: Computer-based tests are widely used for the purpose of documenting baseline neurocognitive function, and athletes are often tested in groups. At present, there is limited research on the effects of administering these tests in a group versus individual setting. Hypothesis: Athletes assessed with neurocognitive tests in groups would show decreased performance compared with those assessed individually. Study Design: Cohort study; Level of evidence, 3. Methods: High school athletes completed preseason baseline neurocognitive tests either in groups in their school or individually in a private neuropsychological clinic (with no significant between-group differences in sex, history of concussion, and attention deficit disorder/learning disability). All athletes completed the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) test battery on 1 occasion, which yielded scores in the area of verbal memory, visual memory, motor processing speed, reaction time, and symptom scores. Results: Athletes in the group setting scored significantly lower on verbal memory (mean 83.4 vs 86.5; P = .003), visual memory (mean 71.6 vs 76.7; P = .0001), motor processing speed (mean 35.6 vs 38.4; P = .0001), and reaction time (mean 0.61 vs 0.57; P = .001), but not symptom scores (mean 6.1 vs 4.4; P = .11), and exhibited a greater rate of invalid baselines. Similar results were obtained after excluding athletes with attention deficit disorder/learning disability and/or a history of concussion. Conclusion: Administering baseline neurocognitive testing to athletes in a group setting may introduce extraneous error, negatively affecting test performance.

Computerized Neuropsychological Profiles of South African Versus US Athletes: A Basis for Commentary on Cross-Cultural Norming Issues in the Sports Concussion Arena

Computerized programs are widely used as part of the overall medical management of concussion in order to monitor recovery and facilitate safe return-to-play decisions. Typically, neurocognitive profiles of concussed athletes are compared with baseline and/or normative data in the absence of baseline scores. However, the cultural equivalence of performance on neuropsychological tests cannot be assumed and has not been sufficiently researched. The purpose of this study was to investigate the neuropsychological test profiles of the ImPACT (Immediate Postconcussion Assessment and Cognitive Testing) on age-matched South African (SA) rugby and US football players. Participants included 11 257 English-speaking, predominantly white male athletes from multiple SA and US schools and sports organizations in 3 age groups: 11 to 13 years (SA, n = 301; US, n = 775); 14 to 16 years (SA, n = 997; US, n = 4081); and 17 to 21 years (SA, n = 319; US, n = 4784). ImPACT neurocognitive composite scores (verbal and visual memory, visual motor speed, reaction time, impulse control) and the ImPACT total symptom score, derived from the initial baseline testing, were used for comparison purposes between the targeted groups. Independent t-test comparisons revealed overall equivalence between the SA and US athletes on the neurocognitive measures, but they also revealed consistently higher symptom scores for SA athletes in association with clinically relevant effect sizes. It was concluded that US neurocognitive normative data on the ImPACT test are appropriate for use on South African athletes whose first language is English, whereas culture-specific sensitivity for symptom reporting on this same population should be taken into consideration for management purposes. It is argued that neurocognitive equivalence is less likely to apply in educationally disadvantaged populations. The use of registered psychologists is deemed necessary to provide contextualized interpretations of computerized test scores, thereby protecting against misdiagnosis that may occur within the concussion management arena via actuarial approaches that fail to take sociocultural complexities into account.

Comparison of Preseason, Midseason, and Postseason Neurocognitive Scores in Uninjured Collegiate Football Players

Background College football players sustain an average of 3 subconcussive blows to the head per game. Concussions correlate with decreases in standardized neurocognitive test scores. It is not known whether repetitive, subconcussive microtrauma associated with participation in a full season of collision sport affects neurocognitive test scores. Hypothesis No difference exists between preseason, midseason, and postseason Standardized Assessment of Concussion (SAC) and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) scores when collegiate football players sustain subconcussive microtrauma from forceful, repetitive contact activity. Study Design Case series; Level of evidence, 4. Methods Fifty-eight members of a Division III collegiate football team who had no known concussion during the season voluntarily completed the SAC and ImPACT instruments preseason, midseason, and postseason. A repeated measures analysis of variance was used to compare the scores at the 3 time intervals (P < .05). Results No statistically significant decreases were found in overall SAC or ImPACT scores or in any of the domains or composites of the tests (P < .05) when preseason, midseason, and postseason scores were evaluated. Conclusions ImPACT and SAC neurocognitive test scores are not significantly altered by a season of repetitive contact in collegiate football athletes who have not sustained a concussion. Clinical Relevance A diminution in SAC or ImPACT scores in concert with clinical symptoms and findings should be interpreted as evidence of a postconcussive event.

Sensitivity and specificity of the ImPACT Test Battery for concussion in athletes

This study explored the diagnostic utility of the composite scores of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and Post Concussion Symptom Scale scores (PCSS). Recently concussed high school athletes ( N = 72) were tested within 72 h of sustaining a concussion, and data were compared to non-concussed high school athletes with no history of concussion ( N = 66). Between-groups MANOVA revealed a significant multivariate effect of concussion on test performance ( p < .001); univariate ANOVAS revealed all six measures contributed to the between-groups differences. A discriminant function analyses was conducted to measure the ability of the five ImPACT composite scores, as well as the PCSS to classify concussion status. One discriminant function was identified that consisted of the Visual Memory, Processing Speed, and Impulse Control composite scores PCSS, which correctly classified 85.5% of the cases. Approximately 82% of participants in the concussion group and 89% of participants in the control group were correctly classified. Using these data, the sensitivity of ImPACT was 81.9%, and the specificity was 89.4%. As part of a formal concussion management program, ImPACT is a useful tool for the assessment of the neurocognitive and neurobehavioral sequelae of concussion, and can also provide post-injury cognitive and symptom data that can assist a practitioner in making safer return to play decisions.

Test-Retest Reliability of Computerized Neuropsychological Testing in the High School Aged Athlete

0734 INTRODUCTION: Sports related concussions are common in the high school athlete and may have chronic and debilitating effects. Return-to-play considerations can be difficult; however computerized neuropsychological testing may be a useful adjunct in detecting subtle neurocognitive changes resulting from concussions. Reasonably good re-test reliability for such a test should be on the order of r = 0.7 or better. PURPOSE: To determine the test-retest reliability of ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), a computer-based demographic, symptom, and neuropsychological test inventory, in high school athletes. SUBJECTS: 24 nonconcussed high school varsity male football players from two area schools, ranging in age from 16–18 years. METHODS: The athletes completed the ImPACT test battery twice. The second evaluation was conducted an average of 13.5 days (range 13–14 days) post-baseline. Subjects were tested in groups of 4 & 20 athletes in 2 computer labs. One of the investigators provided detailed instructions prior to test administration and was immediately available for questions. RESULTS: Test-retest data was examined in the five ImPACT test battery subscales. We found stronger correlations in the areas of reaction time (correlation coefficients (r) = .669, p < .001) and verbal memory (r = .530, p = .008). Weaker correlations were found in visual memory (r = .442, p = .031), impulse control (r = .202, p = .345), and visual motor speed (r = .178, p = .405). CONCLUSION: Our test-retest data was less strongly correlated than the data originally reported by the developers of the ImPACT software. From our data, we were able to conclude the verbal memory and reaction time subscales posses a higher degree of reliability in high school athletes, while the visual memory, impulse control, and visual motor speed subscales have a lower degree of reliability in this population. These results may be helpful to clinicians in interpreting the results of ImPACT testing in high school athletes.