Performance of the Immediate Post-Concussion Assessment and Cognitive Testing Protocol Validity Indices

Performance of the Immediate Post-Concussion Assessment and Cognitive Testing Protocol Validity Indices
Author: Lisa M. Manderino
Publisher:
Total Pages: 0
Release: 2017
Genre:
ISBN:

Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a widely used, computerized neuropsychological test battery for the diagnosis and management of sport-related concussions (SRC). As SRC is known to affect neurocognitive performance, athletes provide pre-injury, baseline ImPACT scores, to which post-injury scores can be compared in the event of SRC. However, if an athlete's baseline scores are not fully representative of his abilities, the utility of post-injury score comparison is diminished. Return-to-play release may be granted prematurely, putting the athlete at risk for second injury or long-term consequences. For this reason, the ImPACT includes low score thresholds on five validity indices to identify insufficient effort, though evidence of these indices' performance is limited. The present study compares existing ImPACT validity indices, as well as three proposed indices not currently being used to inform protocol validity, to external validity measures. The ImPACT, Word Memory Test (WMT) and Minnesota Multiphasic Personality Inventory - 2- Restructured Form (MMPI-2-RF) were administered to 242 undergraduate students. Participants were instructed to either give full effort on testing or to simulate SRC. The ImPACT demonstrated significantly higher specificity (0.94) and lower sensitivity (0.42) as compared to the WMT and MMPI-2-RF. Alternative score thresholds for the existing ImPACT validity indices may maintain high specificity while improving sensitivity. The three proposed indices showed higher sensitivities than the existing ImPACT indices, though lower specificities. The existing ImPACT indices' high specificity at the expense of lower sensitivity compared to external validity measures raises concern, as unidentified poor-effort may result in premature return-to-play decisions for athletes with SRC. Improvements or additions to the existing indices may raise sensitivity while maintaining acceptable specificity, aiding in the protection of athletes and safe athletic participation.

Determining the False Positive Rate of a Concussion Battery in Healthy Division I Collegiate Athletes

Determining the False Positive Rate of a Concussion Battery in Healthy Division I Collegiate Athletes
Author: Caitlynn S. Hellwig
Publisher:
Total Pages: 81
Release: 2015
Genre: Electronic dissertations
ISBN:

Author's abstract: Context: Athletic participation accounts for 1.6-3.8 million concussions, or mild traumatic brain injuries (mTBI) every year in the United States. Accurate assessment and diagnosis of concussions is critical to protect athletes from further injury. The Fourth International Conference on Concussion in Sport Consensus Statement recommends a multifaceted concussion assessment which includes symptom inventories, postural stability assessment, and neurocognitive testing. The accuracy of each test is vital in correctly diagnosing concussions. The Balance Error Scoring System (BESS), Standardized Assessment of Concussion (SAC), and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) are among the most commonly used assessment tools by NCAA athletic trainers. Objectives: (1) evaluate the false positive rate of a clinical concussion assessment battery (BESS, SAC, ImPACT) in a healthy Division I collegiate athlete population and (2) identify trends in pass/fail rates based on months elapsed from baseline testing. Design: Prospective longitudinal study. Setting: A large university in southeast Georgia. Participants: Fifty Division I collegiate athletes were recruited as participants. Forty-eight participants fulfilled the study requirements. Main Outcome Measure(s): Descriptive statistics were run for all demographic variables, along with scores on the various dependent variables. Failure rates for each test were then determined. Any increase in BESS score, decrease in SAC score, or change in an ImPACT composite score exceeding the reliable change index was classified as a false positive for the concussion battery. A one-way repeated measures ANOVA was run to determine changes in scores by testing time (baseline vs. current) and time elapsed from baseline. Tukey post-hoc testing and planned simple contrasts were evaluated as needed. Results: The concussion battery produced an 81% false positive rate. BESS produced the most false positives (62.5%), followed by ImPACT (33.3%), and SAC (27.1%). No significant interactions were found between the time from baseline testing and differences in scores from baseline to current testing. There was a significant main effect across time between BESS baseline scores and testing scores. Conclusions: Eighty-one percent athletes demonstrated a deficit from their baseline scores on one or more of the assessments, thus failing the concussion battery and giving objective evidence of a possible concussion. When a patient fails an objective assessment used to identify and diagnose a concussion, they are at risk of being removed from all participation. To return to participation, the current recommendation is a symptom free graduated return to play protocol taking about seven days to complete. This may result in significant playing time lost for the athlete.

Concussion Management for Wheelchair Athletes

Concussion Management for Wheelchair Athletes
Author: Kenneth Lee
Publisher: Springer Nature
Total Pages: 238
Release: 2021-11-18
Genre: Medical
ISBN: 3030830047

This book arises from the challenges and difficulties involved in the evaluation and management of concussions in wheelchair athletes. Concussions are most readily identified in the ambulatory population via identifying gross motor instability or when athletes lose their balance and stumble after a blow to the head or neck region. Because wheelchair athletes participate in sport while sitting down and using a wheelchair, clinicians must be extra attentive to identify a potential concussion. Once a potential concussion is identified, there are many challenges in evaluation of the wheelchair athlete population due to their comorbidities. At baseline, they may have signs and symptoms that mimic a concussion, and their impairments can also alter their cognitive and balance assessments. Therefore, it is critical to make a distinction between these athletes’ baseline comorbid impairments and potential new exam findings in a concussion. Filling in a critical gap in the literature, this is a concise pocket guide for any clinician, trainer, or rehabilitation specialist who is involved in wheelchair sports. It focuses on the unique challenges in evaluating a concussion in the wheelchair athlete, including baseline testing, the process of evaluating the signs and symptoms of a concussion, cognitive and vestibular examination, new clinical techniques specific to wheelchair athletes, and the return to play process. A Concussion Management Program (CMP) for use on the sideline as well as in the office is included. Practical and timely, Concussion Management for Wheelchair Athletes is a valuable resource to increase awareness, provide guidance on the unique challenges within this population, and generate interest in future research and investigation.

Concussion Risk Factors Identified at Baseline Testing

Concussion Risk Factors Identified at Baseline Testing
Author: Chelsea Anne Page
Publisher:
Total Pages: 154
Release: 2016
Genre:
ISBN:

Background: Research remains limited in examining potential risk factors that predispose athletes to sustaining a concussion during play. Identifying premorbid risk factors that can influence a concussive injury would provide athletic trainers, physicians, and other health care professionals with information about markers that might increase an athlete's vulnerability to suffering a concussion on the field. Such an approach is in keeping with primary prevention efforts and proper clinical management of head injuries. Objective: The purpose of this study was to identify the extent of known or suspected risk factors for concussion measured during pre-season baseline testing. Method: Participants in this study included approximately 600 student athletes, men and women, 18-22 years of age, and representing students from the United States as well as international students. All student athletes completed the Concussion Resolution Index (CRI) and Standardized Concussion Assessment Tool, edition three (SCAT3) as part of pre-competition medical evaluation. Results: A MANOVA revealed no differences between concussion history and the CRI indices as a group. Univariate comparisons for the three CRI indices revealed a significant difference due to the number of concussions for the Processing Speed (PS) index but not for the Simple Reaction Time (SRT) or Complex Reaction Time (CRT). A correction revealed that within the Processing Speed Index, the "none" concussion group was significantly different from the "more than one" concussion group. To determine whether athletes with a history of a concussion would endorse a greater number of concussion related symptoms than those without a concussion, an ANOVA comparison revealed a significant difference in the concussion groups. A post hoc Bonferroni test indicated that there was a significant difference between the "none" concussion group and "one" concussion group in the total number of symptoms. A Chi Square test compared the ratio of "yes/no" concussion history for male athletes and female athletes at baseline and post-trauma and revealed that non-football male athletes were no more likely to report having had a concussion than female athletes. A total of 19.6% of the male athletes endorsed having a concussion history, whereas, 17.3% of the female athletes reported a concussion history. A t-test compared the total number of symptoms and ratings of symptom severity in male and female athletes and revealed no difference in total symptom report, but females reported significantly more severe symptoms. A MANOVA compared the emotional concussion-related symptoms - emotional, irritability, sadness, nervousness/anxious were compared for males and females, and a univariate analysis revealed there was a significant difference between sexes for items- emotional, irritability, and sadness but not for nervousness/anxious. Finally, a cross-tabulation of history of concussion (yes/no) for all teams showed that football and men's lacrosse had a considerably higher percentage of team members who reported at least one previous concussion when contrasted to all other teams. Discussion and Conclusions: There were no significant differences for concussion history and the CRl across groups. However, athletes with one or more concussions demonstrated a decreased performance on the Processing Speed Index. Findings highlight the importance of administering neurocognitive assessments to athletes to recognize whether a previous concussion is affecting their cognitive functioning. Athletes reporting one or more concussions were found to report a higher symptom total than those without a concussion history. This suggests the importance of assessing an athlete's experienced physical and emotional symptoms if concussion history is reported to ensure an athlete is completely recovered before returning to play. Although inconsistent with prior literature, female athletes were no more likely to sustain a concussion than male athletes. Differences in finding may be due to a smaller sample size compared to previous studies. There were no sex differences in symptom reporting, but female athletes were found to have a higher symptom severity level than male athletes. Female athletes were also found to endorse a greater number of emotional symptoms than male athletes. As such, assessing an athlete's mental health is important, as it can impact symptom reporting on baseline measures. Finally, there were a higher percentage of concussions in football and men's lacrosse than the other men's and women's teams. As such, given that certain sports and positions increase an athlete's vulnerability to incurring a concussion, it is critical that athletic trainers, athletes, and physicians are aware of inherent dangers within the sport.

Visual Disturbance and Post-concussion Testing

Visual Disturbance and Post-concussion Testing
Author: Adam C. Bennati
Publisher:
Total Pages: 59
Release: 2014
Genre: Post-concussion syndrome
ISBN:

Over the last decade, there has been significant growth in occurrence and/or recognition of sport-related concussion and post-concussion syndrome. This has been accompanied by increasing media attention, growth in research dollars, and public health policy related changes to address the issue. Tools such as the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) have been increasingly utilized to evaluate players' symptoms and assist in making return-to-play decisions. A variety of post-concussion symptoms have been reported; however, there has been a lack of research addressing the effects of visual disturbance on ImPACT scores. The present study attempted to identify any effects of a post-concussion visual disturbance on the ImPACT composite scores. The participants included junior high school, high school and college athletes from southeastern Pennsylvania who were divided into groups based on self-reported visual symptoms. This study utilized a quasi-experimental, nonequivalent groups design. One-way MANOVA was used to analyze the data and examine group differences. Tests of between-subjects effects yielded significant differences between the High Sensitivity to Light (HSL) and Low Sensitivity to Light (LSL) groups, as well as the High Visual Problems (HVP) and Low Sensitivity to Light (LSL) groups, in the Verbal Memory, Visual Memory, and Reaction Time composites. Significant differences between the Low Sensitivity to Light (LSL) and the Low Visual Problems (LVP) groups were found for the Reaction Time composite. Identifying effects of visual problems and sensitivity to light on the ImPACT composite scores would have implications for alternative approaches to the assessment of concussions with these presenting symptoms.

Baseline Concussion Assessment in Varsity Athletes

Baseline Concussion Assessment in Varsity Athletes
Author: Nicole I. Lemke
Publisher:
Total Pages: 91
Release: 2014
Genre: Brain
ISBN:

Objectives: To compare the self-report of symptoms on two commonly used tools: Sideline Concussion Assessment Tool 2 (SCAT2), and Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). To identify potential variables on ImPACT and a preseason questionnaire that might predict concussion. Results: Eighteen "matched" symptoms were analyzed for 349 athletes. There were significant differences between 10 symptoms. Athletes who scored in the lowest 10th percentile at baseline on ImPACT for the visual memory composite score were 2.5 (95% CI 1.09 - 5.46) times more likely to suffer a concussion. Male athletes with a family history of concussion were 0.4 (95% CI 0.17-0.93) times less likely to suffer a concussion. Conclusions: Athletes' self-report of post-concussion symptoms differed, depending on the type of concussion evaluation tool used. ImPACT may be able to identify athletes at increased risk for concussion. More research is needed on preseason screening questionnaires.