Assessing Preseason Baseline Cognitive Functioning in High School Student Athletes: A “Hybrid” Approach

Abstract

Objective International consensus statements highlight the value of neuropsychological testing for sport-related concussion. Computerized measures are the most frequently administered assessments of pre-injury baseline and post-injury cognitive functioning, despite known measurement limitations. To our knowledge, no studies have explored the convergent validity of computerized Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and traditional, well-validated paper and pencil (P&P) neuropsychological tests in high school student athletes. This study aimed to assess a “hybrid” adolescent test battery composed of ImPACT and P&P measures to determine the extent of shared variance among ImPACT and P&P tests to inform comprehensive yet streamlined assessment. Method Participants included male and female high school student athletes in the Southeastern United States participating in American football, hockey, and soccer who completed a battery of ImPACT and P&P tests (N = 69). Results We performed principal component analysis with ProMax rotation to determine components of the hybrid battery that maximally accounted for observed variance of the data (Kaiser–Meyer–Olkin factor adequacy = 0.71). Our analysis revealed four independent factors (Verbal Learning and Memory, ImPACT Memory and Speed, Verbal Processing Speed/Executive Functions, and Nonverbal Processing Speed/Executive Functions) explaining 75% of the variance. Conclusions Findings of this study in adolescent student athletes support those from the adult literature demonstrating the independence of ImPACT and P&P tests. Providers should be aware of limitations in using standalone ImPACT or P&P measures to evaluate cognitive functioning after concussion. If confirmed in a larger, clinical sample, our findings suggest that a hybrid battery of computerized and P&P measures provides a broad scope of adolescent cognitive functioning to better inform recovery decisions, including return to play after concussion.

Effects of Cumulative Head Impact Exposure in Adolescent Male Contact and Collision Sport Student Athletes

“…A hybrid neuropsychological test battery was selected by a board-certified neuropsychologist and comprised measures assessing processing speed/executive functions, cued/recognition memory, verbal learning/memory, and reaction time/processing speed, consistent with international consensus guidelines. [24][25][26] The 4 primary composite scores from the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) computerized neurocognitive screening battery were included, including Verbal Memory, Visual Memory, Visual Motor, and Reaction Time. Paper and pencil neuropsychological measures included subtests from the Delis-Kaplan Executive Function System (Trail Making Test, Verbal Fluency, Tower, Color-Word Inhibition, and Design Fluency) and the California Verbal Learning Test (CVLT) (children's version for participants <16; second edition for participants >16), with available alternate forms used in follow-up evaluation.…”

“…Testing was completed during preseason prior to contact play and approximately 1 year later during follow-up preseason testing. A hybrid neuropsychological test battery was selected by a board-certified neuropsychologist and comprised measures assessing processing speed/executive functions, cued/recognition memory, verbal learning/memory, and reaction time/processing speed, consistent with international consensus guidelines 24–26. The 4 primary composite scores from the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) computerized neurocognitive screening battery were included, including Verbal Memory, Visual Memory, Visual Motor, and Reaction Time.…”