Summer D. Ott

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.

Prevalence of Invalid Computerized Baseline Neurocognitive Test Results in High School and Collegiate Athletes

CONTEXT Limited data are available regarding the prevalence and nature of invalid computerized baseline neurocognitive test data. OBJECTIVE To identify the prevalence of invalid baselines on the desktop and online versions of ImPACT and to document the utility of correcting for left-right (L-R) confusion on the desktop version of ImPACT. DESIGN Cross-sectional study of independent samples of high school (HS) and collegiate athletes who completed the desktop or online versions of ImPACT. Participants or Other Participants: A total of 3769 HS (desktop = 1617, online = 2152) and 2130 collegiate (desktop = 742, online = 1388) athletes completed preseason baseline assessments. MAIN OUTCOME MEASURE(S) Prevalence of = ImPACT validity indicators, with correction for L-R confusion (reversing left and right mouse-click responses) on the desktop version, by test version and group. Chi-square analyses were conducted for sex and attentional or learning disorders. RESULTS At least 1 invalid indicator was present on 11.9% (desktop) versus 6.3% (online) of the HS baselines and 10.2% (desktop) versus 4.1% (online) of collegiate baselines; correcting for L-R confusion (desktop) decreased this overall prevalence to 8.4% (HS) and 7.5% (collegiate). Online Impulse Control scores alone yielded 0.4% (HS) and 0.9% (collegiate) invalid baselines, compared with 9.0% (HS) and 5.4% (collegiate) on the desktop version; correcting for L-R confusion (desktop) decreased the prevalence of invalid Impulse Control scores to 5.4% (HS) and 2.6% (collegiate). Male athletes and HS athletes with attention deficit or learning disorders who took the online version were more likely to have at least 1 invalid indicator. Utility of additional invalidity indicators is reported. CONCLUSIONS The online ImPACT version appeared to yield fewer invalid baseline results than did the desktop version. Identification of L-R confusion reduces the prevalence of invalid baselines (desktop only) and the potency of Impulse Control as a validity indicator. We advise test administrators to be vigilant in identifying invalid baseline results as part of routine concussion management and prevention programs.

Long-term Neurocognitive Dysfunction in Sports: What Is the Evidence?

Although the immediate neurocognitive effects of sports-related concussion are well known, less is known about the intermediate or long-term effects of sports-related concussions. A sample of selected studies of high-school and collegiate athletes is reviewed and the intermediate effects of concussive injuries are discussed, because no long-term empiric data are available with these populations. The evidence for intermediate neurocognitive effects is mixed and not convincing at present in these groups of athletes. Selected studies of professional boxers and American professional football players are also reviewed, and the available data regarding long-term neurocognitive and neuropathologic effects are assessed. The evidence for long-term adverse neurocognitive effects in professional boxers is compelling. Suggestions for future research on relevant biopsychosocial variables affecting response to concussive injury are presented.

Utility of Repeated Assessment After Invalid Baseline Neurocognitive Test Performance

CONTEXT Although the prevalence of invalid baseline neurocognitive testing has been documented, and repeated administration after obtaining invalid results is recommended, no empirical data are available on the utility of repeated assessment after obtaining invalid baseline results. OBJECTIVE To document the utility of readministering neurocognitive testing after an invalid baseline test. DESIGN Case series. SETTING Schools, colleges, and universities. PATIENTS OR OTHER PARTICIPANTS A total of 156 athletes who obtained invalid results on ImPACT baseline neurocognitive testing and were readministered the ImPACT baseline test within a 2-week period (mean = 4 days). MAIN OUTCOME MEASURE(S) Overall prevalence of invalid results on reassessment, specific invalidity indicators at initial and follow-up baseline, dependent-samples analysis of variance, with Bonferroni correction for multiple comparisons. RESULTS Reassessment resulted in valid test results for 87.2% of the sample. Poor performance on the design memory and three-letter subscales were the most common reasons for athletes obtaining an invalid baseline result, on both the initial assessment and the reassessment. Significant improvements were noted on all ImPACT composite scores except for reaction time on reassessment. Of note, 40% of athletes showed slower reaction time scores on reassessment, perhaps reflecting a more cautious approach taken the second time. Invalid results were more likely to be obtained by athletes with a self-reported history of attention-deficit disorder or learning disability on reassessments (35%) than on initial baseline assessments (10%). CONCLUSIONS Repeat assessment after the initial invalid baseline performance yielded valid results in nearly 90% of cases. Invalid results on a follow-up assessment may be influenced by a history of attention-deficit disorder or learning disability, the skills and abilities of the individual, or a particular test-taking approach; in these cases, a third assessment may not be useful.

Functional Connectivity Is Altered in Concussed Adolescent Athletes Despite Medical Clearance to Return to Play: A Preliminary Report

Recovery following sports-related concussion (SRC) is slower and often more complicated in young adolescent athletes than in collegiate players. Further, the clinical decision to return to play is currently based on symptoms and cognitive performance without direct knowledge of brain function. We tested the hypothesis that brain functional connectivity (FC) would be aberrant in recently concussed, asymptomatic athletes who had been cleared to return to play. A seed-based FC analysis measured the FC of the default mode network (DMN) (seeds = anterior cingulate cortex, posterior cingulate cortex (PCC), right lateral parietal cortex, and left lateral parietal cortex) 30 days after SRC in asymptomatic high school athletes cleared to return to play (n = 13) and was compared to the FC of high school athletes with orthopedic injury (OI) (n = 13). The SRC group demonstrated greater FC than the OI group between the PCC and the ventral lateral prefrontal cortex, as well as between the right lateral parietal cortex and lateral temporal cortex (with regions both outside of and within the DMN). Additionally, the OI group demonstrated greater FC than the SRC group between right lateral parietal cortex and supramarginal gyrus. When relating the FC results to verbal memory performance approximately 1 week and 1 month after injury, significantly different between-group relations were found for the posterior cingulate and right lateral parietal cortex seeds. However, the groups did not differ in verbal memory at 1 month. We suggest that changes in FC are apparent 1-month post-SRC despite resolution of post-concussion symptoms and recovery of cognitive performance in adolescent athletes cleared to return to play.

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.

Influence of Language of Administration on ImPACT Performance by Bilingual Spanish–English College Students

Previous research has suggested that there are performance differences on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery related to language of administration, such that scores are higher with the English than the Spanish version of the battery. This study extended those findings in a within-subjects design, evaluating neurocognitive performance of 58 bilingual English-Spanish-speaking individuals who completed ImPACT in both languages. Results revealed a significant multivariate effect of language of test administration, p < .01; partial η(2) = 0.23, with significantly better English language performance on Verbal Memory and Visual Motor Speed composite scores, but not Visual Memory, Reaction Time, or Total Symptom score. Results are discussed in relation to potential linguistic biases of the ImPACT and functional language dominance that may contribute to the lower scores. These results extend previous findings and suggest a need for separate normative data for Spanish-speaking individuals completing the ImPACT battery if baseline data are not present.

Neurocognitive responses to a single session of static squats with whole body vibration

Abstract Amonette, WE, Boyle, M, Psarakis, MB, Barker, J, Dupler, TL, and Ott, SD. Neurocognitive responses to a single session of static squats with whole body vibration. J Strength Cond Res 29(1): 96–100, 2015—The purpose of this study was to determine if the head accelerations using a common whole body vibration (WBV) exercise protocol acutely reduced neurocognition in healthy subjects. Second, we investigated differential responses to WBV plates with 2 different delivery mechanisms: vertical and rotational vibrations. Twelve healthy subjects (N = 12) volunteered and completed a baseline (BASE) neurocognitive assessment: the Immediate Postconcussion Assessment and Cognitive Test (ImPACT). Subjects then participated in 3 randomized exercise sessions separated by no more than 2 weeks. The exercise sessions consisted of five 2-minute sets of static hip-width stance squats, with the knees positioned at a 45° angle of flexion. The squats were performed with no vibration (control [CON]), with a vertically vibrating plate (vertical vibration [VV]), and with a rotational vibrating plate (rotational vibration [RV]) set to 30 Hz with 4 mm of peak-to-peak displacement. The ImPACT assessments were completed immediately after each exercise session and the composite score for 5 cognitive domains was analyzed: verbal memory, visual memory, visual motor speed, reaction time, and impulse control. Verbal memory scores were unaffected by exercise with or without vibration (p = 0.40). Likewise, visual memory was not different (p = 0.14) after CON, VV, or RV. Significant differences were detected for visual motor speed (p = 0.006); VV was elevated compared with BASE (p = 0.01). There were no significant differences (p = 0.26) in reaction time or impulse control (p = 0.16) after exercise with or without vibration. In healthy individuals, 10 minutes of 30 Hz, 4-mm peak-to-peak displacement vibration exposure with a 45° angle of knee flexion did not negatively affect neurocognition.

An Interdisciplinary Approach to Sports Concussion Evaluation and Management: The Role of a Neuropsychologist

Sports neuropsychology is a rapidly emerging field that affords neuropsychologists, the opportunity to work with a diverse group of individuals in terms of age, gender, sports, ethnicity, and language and sports has a way of bringing diverse communities together. Although working with athletes can be associated with unique challenges, neuropsychological assessment with this population and being part of an interdisciplinary sports medicine team is both exciting and rewarding and can merge a passion for sports with professional interests. This paper is intended to highlight the contribution of neuropsychology to the evaluation and management of sport-related concussion as well as describe the neuropsychologists role as an integral member of interdisciplinary sports medicine teams. Clinical model, special considerations, assessment strategy, and administrative aspects of practice are discussed.

Clinical and demographic predictors of concussion resolution in adolescents: A retrospective study

ABSTRACT Concussions in adolescents are a growing public health concern. The aim of this study was to identify clinical (e.g., concussion history, migraine history, learning disabilities/ADHD) and demographic factors (e.g., age, sex, race, health insurance status, mechanism of injury, education) that predict concussion recovery times. In a retrospective cohort study of 118 adolescents 13–19 years old who were evaluated for an acute concussion (≤10 days from injury), recovery times were calculated from the date of concussive injury to the date of clearance to return to play and/or normal activities. The median time to recovery was 17 days. Predictors of longer recovery included ADHD (HR = .221, 95% CI = .095 − .514, p < .001) and prior concussion (HR = .564, 95% CI = .332 − .959, p = .03). Student athletic insurance and public insurance were predictors of shorter recovery times (HR = 3.98, 95% CI = 1.25 − 12.65, p = .02 and HR = 3.33, 95% CI = 1.09 − 10.15, p = .03, respectively). In adolescents with prior concussion or ADHD, clearance to return to play/ normal activities may be delayed. Further research is needed to validate the impact of SES/health insurance on concussion recovery time.