Concussion Baseline Testing: Preexisting Factors, Symptoms, and Neurocognitive Performance

Cottle, Jordan E.; Hall, Eric E.; Patel, Kalpesh; Barnes, Kenneth P.; Ketcham, Caroline J.

doi:10.4085/1062-6050-51.12.21

Cited by 62 publications

(54 citation statements)

References 28 publications

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“…Our findings are inconsistent with those of Covassin et al 4 and Hall et al 11 in that we found that individuals who had engaged in self-reported strenuous exercise prior to ImPACT baseline test administration had significantly lower verbal memory and visual memory scores and significantly higher scores on reaction time, impulse control, and total symptoms. Covassin et al found a decrease in only verbal memory, and Hall et al found no significant difference in neurocognitive scores.…”

Section: Discussioncontrasting

confidence: 99%

“…Such variation in type and amount of exercise may have caused the observed difference in results. One possible explanation for the difference in findings between the current study and Hall et al 11 is the number of covariates controlled. The current study accounted for the covariates of age, education level, concussion history, and hours of sleep prior to testing, while the study by Hall et al did not.…”

Section: Discussioncontrasting

confidence: 91%

“…A more recent study by Hall et al 11 investigated the effect of self-reported strenuous exercise 3 hours prior to baseline ImPACT testing in NCAA Division I collegiate athletes. “Strenuous exercise” is a partly defined parameter assessed in the medical history section of ImPACT; the subject is asked to report whether he or she has engaged in strenuous exercise in the 3 hours prior to taking the ImPACT test.…”

mentioning

confidence: 99%

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The Effect of Pretest Exercise on Baseline Computerized Neurocognitive Test Scores

Pawlukiewicz

Yengo‐Kahn

Solomon

2017

Orthopaedic Journal of Sports Medicine

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Background:Baseline neurocognitive assessment plays a critical role in return-to-play decision making following sport-related concussions. Prior studies have assessed the effect of a variety of modifying factors on neurocognitive baseline test scores. However, relatively little investigation has been conducted regarding the effect of pretest exercise on baseline testing.Purpose/Hypothesis:The aim of our investigation was to determine the effect of pretest exercise on baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) scores in adolescent and young adult athletes. We hypothesized that athletes undergoing self-reported strenuous exercise within 3 hours of baseline testing would perform more poorly on neurocognitive metrics and would report a greater number of symptoms than those who had not completed such exercise.Study Design:Cross-sectional study; Level of evidence, 3.Methods:The ImPACT records of 18,245 adolescent and young adult athletes were retrospectively analyzed. After application of inclusion and exclusion criteria, participants were dichotomized into groups based on a positive (n = 664) or negative (n = 6609) self-reported history of strenuous exercise within 3 hours of the baseline test. Participants with a positive history of exercise were then randomly matched, based on age, sex, education level, concussion history, and hours of sleep prior to testing, on a 1:2 basis with individuals who had reported no pretest exercise. The baseline ImPACT composite scores of the 2 groups were then compared.Results:Significant differences were observed for the ImPACT composite scores of verbal memory, visual memory, reaction time, and impulse control as well as for the total symptom score. No significant between-group difference was detected for the visual motor composite score. Furthermore, pretest exercise was associated with a significant increase in the overall frequency of invalid test results.Conclusion:Our results suggest a statistically significant difference in ImPACT composite scores between individuals who report strenuous exercise prior to baseline testing compared with those who do not. Since return-to-play decision making often involves documentation of return to neurocognitive baseline, the baseline test scores must be valid and accurate. As a result, we recommend standardization of baseline testing such that no strenuous exercise takes place 3 hours prior to test administration.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 91%

mentioning

confidence: 99%

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The Effect of Pretest Exercise on Baseline Computerized Neurocognitive Test Scores

Pawlukiewicz

Yengo‐Kahn

Solomon

2017

Orthopaedic Journal of Sports Medicine

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“…Prior studies assessing cognitive functioning before and after exercise have found mixed results regarding the effect of exercise. [25][26][27] We found that exercise did not have a clinically meaningful effect on EYE-SYNC ® goggles mean dynamic visual performance scores, as indicated by the small effect sizes observed in most of the pre-post practices measures. Despite a statistically significant difference in pre/post exercise scores, we found minimal changes in DVS measures pre-to-post practice, with absolute mean changes ranging from 0.02 (0.05) for horizontal gain to 0.1 (0.5) for SD tangential error.…”

Section: Discussionmentioning

confidence: 79%

Reliable sideline ocular-motor assessment following exercise in healthy student athletes

Sundaram

Ding

Desai

et al. 2019

Journal of Science and Medicine in Sport

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Objectives: To assess the reliability and effect of exercise on sideline dynamic visual performance measures of ocular-motor function using a portable visual assessment system (EYE-SYNC ®). Design: Prospective cohort study. Methods: Healthy student athletes, ages 18-25 years, performed eye-tracking six times-three times consecutively prior to and after practice-using EYE-SYNC ® goggles. Ocular-motor performance was assessed by calculating five gaze error outcomes between target position and actual gaze position to inform dynamic visual synchronization. We assessed reliability by calculating the intraclass correlation coefficient (ICC) for each outcome (we defined the standard deviation of tangential error (SDTE) as our primary outcome) and calculated differences in mean pre-and post-practice scores. Results: ICCs for the SDTE score were 0.86 (95% confidence interval, CI: 0.82-0.9) and 0.88 (0.84-0.91) at pre-and post-practice, respectively. 133 (89%) and 135 (90%) of 150 athletes had at least one measurement at pre-and post-practice, respectively. 117 (78%) and 122 (81%) athletes had more than one SDTE score at pre-and post-practice, respectively. The absolute mean (SD) differences between pre-and post-practice mean scores ranged from 0.02 (0.05) for horizontal gain to 0.1 (0.5) for SDTE. Conclusions: We observed high ICC scores indicating excellent reliability of visual synchronization measurements, suggesting that one measurement would be sufficient. Most athletes had similar scores before and after practice, indicating little change in visual performance following exercise. EYE-SYNC ® goggles have the potential for use in obtaining objective visual performance measures of ocular-motor function for sideline assessment of concussion and return to play decisions.

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“…Studies using the ImPACT test have shown female athletes in middle school, high school, and college exhibited a statistically significant greater aggregate symptom severity and longer reaction time than males [ 9 , 10 , 11 ] at baseline. A study conducted by Cottle and colleagues showed that female collegiate students performed better on ImPACT’s visual memory, visual motor speed, and reaction time than males [ 12 ]. However, no studies were found assessing sex differences using the new tool, ImPACT Pediatric, among 5–11-year-old children.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Baseline Computerized Neurocognitive Testing Results among 5–11-Year-Old Male and Female Children Playing Sports in Recreational Leagues in Florida

Liller

Morris

Fillion

et al. 2017

IJERPH

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There is a paucity of data related to sports injuries, concussions, and computerized neurocognitive testing (CNT) among very young athletes playing sports in recreational settings. The purpose of this study was to report baseline CNT results among male and female children, ages 5–11, playing sports in Hillsborough County, Florida using ImPACT Pediatric, which is specifically designed for this population. Data were collected from 2016 to 2017. The results show that 657 baseline tests were conducted and t-tests and linear regression were used to assess mean significant differences in composite scores with sex and age. Results showed that females scored better on visual memory and in general as age increased, baseline scores improved. The results can be used to build further studies on the use of CNT in recreational settings and their role in concussion treatment, management, and interventions.

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Concussion Baseline Testing: Preexisting Factors, Symptoms, and Neurocognitive Performance

Cited by 62 publications

References 28 publications

The Effect of Pretest Exercise on Baseline Computerized Neurocognitive Test Scores

The Effect of Pretest Exercise on Baseline Computerized Neurocognitive Test Scores

Reliable sideline ocular-motor assessment following exercise in healthy student athletes

Analysis of Baseline Computerized Neurocognitive Testing Results among 5–11-Year-Old Male and Female Children Playing Sports in Recreational Leagues in Florida

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