Objective To evaluate the performance and test–retest reliability obtained when administering a computerized baseline neurocognitive exam to NCAA Division I student-athletes in a controlled laboratory setting versus an uncontrolled remote location. Method A sample of 129 (female = 100) Division I student-athletes completed Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) pre-season assessments for two distinct and respective sports seasons in a controlled laboratory environment and an uncontrolled remote environment. Depending on the environment, participants were given verbal (controlled) or written (uncontrolled) guidelines for taking the test. Results Multivariate repeated-measures ANOVA’s determined that there were no within-subject differences between testing environments on ImPACT composite scores and cognitive efficiency index (CEI). The Chi-square test did not find any significant differences in impulse control or the number of invalid test scores, as determined by ImPACT, between environments. Intraclass correlations found the ImPACT subtest scores to range in test–retest reliability across testing environments, demonstrating moderate (verbal memory composite, r = 0.46; visual memory composite, r = 0.64; reaction time, r = 0.61; impulse control, r = 0.52; and CEI, r = 0.61) and good (visual motor composite, r = 0.77) test–retest reliability. Conclusions Results indicate that ImPACT is reliable between controlled and uncontrolled testing environments. This further suggests that ImPACT can be administered in a remote environment, pending specific adherence to testing instructions, or in the event of social distancing or isolation policies.
Repetitive head impacts (RHI), independent of concussion, can lead to alterations in brain activity and function, specifically within the midbrain, which can manifest as abnormal eye movements. PURPOSE: To evaluate the effect of repetitive head impacts on eye movements during a head stationary dynamic visual acuity (sDVA) task. METHODS: 11 NCAA Division I athletes [5 FB: all males; average age 21 years; 6 cross country (XC) athletes (3 females, 3 males; average age 20 years] participated in this study. Any athlete was excluded due to any existing non-corrected vision impairment, self-reported prior concussion history, and withdrawal from their sport due to injury or sickness. FB players had to sustain 20 impacts per week ≥10gs for inclusion. Student-athletes were assessed prior (PRE) to the start, in the middle (MID) and within 2-weeks of the conclusion of the season (POST) on an adaptive sDVA task. FB players wore instrumented mouthguards to track head impacts that were independently video verified. At each testing time point, participants completed 60 randomized trials of smooth pursuit (SPEM) (30°/s) and saccadic (90°/s) eye movements. Participants' eye movements were monitored (500Hz; Eyelink SR research, Ottawa, CN) while their heads were stabilized in a chin rest at a distance of 154cm from the 26° visual field monitor. Participants' task was to track the gap location (left, right, up, down) in a Landolt-C that moved across the screen (horizontally left to right). Using a 2-up-1-down staircase method the size of the stimulus and the gap varied based on the correct/incorrect responses during both smooth pursuit and saccadic trials. The primary measures were SPEM gain and saccadic mean velocity.
Context The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is one of the most widely used computerized neurocognitive assessment batteries in athletics, serving as both a baseline and post-injury assessment. It has become increasingly popular to administer the ImPACT baseline test in an un-supervised remote environment, however, it is unknown if the lack of supervision affects the test-retest reliability. Objective To establish the minimal detectable change (MDC) of composite scores from the ImPACT test when administered to National Collegiate Athletic Association (NCAA) Division I student-athletes in an un-supervised remote environment before two consecutive athletic seasons. Design Cross-Sectional Setting Participants were provided with a unique link and detailed written instructions on how to complete the ImPACT test at home. Patients or Other Participants NCAA Division I student-athletes Main Outcome Measure(s) Remote ImPACT baseline test results from the 2020–2021 and 2021–2022 athletic seasons were analyzed. The MDC was calculated at the 95%, 90%, and 80% confidence intervals for each of the ImPACT composite scores, as well as the average and standard deviation. Results The MDC at the 95% confidence interval was found to be 18.6 for the verbal memory composite score, 24.44 for visual memory, 8.76 for visual motor, 0.14 for reaction time, and 6.13 for impulse control. One-way repeated measures MANOVA, repeated measures ANOVA, and Wilcoxon signed-ranks test all suggest no significant difference between the composite scores and impulse control between time points. Conclusions The ImPACT test composite scores and impulse control did not significantly change between the two remote testing time points when administered approximately a year between testing. Our study suggests the MDC serve as a clinician's guide for evaluating changes in ImPACT baseline scores and in making clinical judgments on sports-related concussion when the test is administered at home.
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