Computerized neuropsycognitive testing for concussions has become increasingly popular in recent years and have been shown to have value in making the all-important return to play decision.
Because they can detect subtle signs of cognitive impairment indicating that an athlete's brain has not fully healed, even where the athlete claims his symptoms have cleared [1], the tests are designed to help to protect young athletes against the risk of suffering a second concussion by returning too soon, which can lead to short- and long-term cognitive problems, and catastrophic injury or even death from second impact syndrome. [2]
The current international consensus of experts (Zurich consensus statement),[1] views computerized neuropsychological or neurocognitive (NP) testing as having clincal value in evaluation for concussion and as an aid in determining when it is safe for an athlete to return to play after a concussion, and recommends formal baseline NP screening of athletes in all organized sports in which there is a high risk of concussion (e.g. football, hockey, lacrosse, soccer, basketball), regardless of the age or level of performance. The National Athletic Trainers' Association 2014 position statement on the management of sport-related concussion[14] says all athletes should "ideally" undergo a preseason baseline assessment, but, that, at a minimum, athletes who are at a high risk of concussion based on their sport should be included in any baseline testing program, with athletes with a significant concussion history, or other relevant pre-existing condition, such as attention-deficit hyperactivity disorder, tested on an individual basis.
Baseline pre-injury and post-injury computerized neurocognitive testing is now commonplace at the professional and collegiate level, and is increasingly used at the high school level as well.
A recent study[2] found that computerized neuropsychological testing was used to assess fully four in ten concussions suffered by high school athletes during the 2009-2010 school year (albeit at high schools with an athletic trainer on staff), up from one-fourth (25.7%) in the short space of just one year.[3]
In the absence of NP and other testing (e.g. formal balance assessment [3]), the Zurich statement says a more conservative approach to return to play approach may be appropriate, especially for children and adolescents.For years the only way to test cognitive function was with so-called "paper and pencil tests [4]".
More recently, computer-generated neuropsychological test programs have been developed and are currently being validated in the sports setting. They include:
Computerized tests have four significant advantages over traditional pencil and paper neuropsychological tests:
A 2011 study [12] [7] shows for the first time the important role computerized neuropsychological testing is playing in concussion assessment and return to play decisions. Athletes who had undergone pre-season, baseline computerized neuropsychological testing, and were then re-tested after suspected concussion, were less likely to return to play on the same day, and less likely to return to play within a week of their injury, than the three out of four injured athletes who did not undergo such testing.
The authors suggested three possible reasons:
Despite their increasingly widespread use, computerized tests faces many of the same challenges as with use of traditional paper-and-pencil [4] neuropsychological tests, and, because they do not test all the cognitive domains that some specific pencil-and-paper tests measure, have other limitations, including:
The Zurich consensus statement recognizes that in the "majority of cases, NP testing will be used to assist return to play decisions and will not be done until [the] patient is symptom free."
For children and adolescents, however, different testing rules may apply:
1. McCrory P, et al. Concussion statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 2013; 47:250-258.
2. Meehan WP, d'Hemecourt P, Collins C, Comstock RD, Assessment and Management of Sport-Related Concussions in United States High Schools. Am. J. Sports Med. 2011;20(10)(published online on October 3, 2011 ahead of print) as dol:10.1177/0363546511423503 (accessed October 3, 2011).
3. Meehan W, d'Hemecourt P, ComstockD, "High School Concussions in the 2008-2009 Academic Year: Mechanism, Symptoms, and Management" Am. J. Sports. Med. 2010; 38(12): 2405-2409 (accessed December 2, 2010 at http://ajs.sagepub.com/content/38/12/2405.abstract?etoc [17]).
4. Halstead, M, Walter, K. Clinical Report - Sport-Related Concussion in Children and Adolescents. Pediatrics. 2010;126(3):597-615.
5. Lau BC, Collins MW, Lovell MR. Sensitivity and Specificity of Subacute Computerized Neurocognitive Testing and Symptoms Evaluation in Predicting Outcomes After Sports-Related Concussion. Am. J. Sports Med. 2011; 20(10).
6. Broglio SP, Ferrara MS, Macciocchi SN, Baumgartner TA. Test-Retest Reliability of Computerized Concussion Assessment Programs. J. Athl. Tr. 2007; 42(4): 509-514.
7. Lincoln A, Caswell S, Almquist J, Dunn R, Norris J, Hinton R. "Trends in Concussion Incidence in High School Sports: A Prospective 11-Year Study" Am. J. Sports Med. 30(10) (2011), accessed January 31, 2011 @ http://ajs.sagepub.com/content/early/2011/01/29/0363546510392326.full.pd... [18]
8. Zwerdling D, Sapien J, Miller TC. Military's Brain-Testing Program A Debacle (http://www.npr.org/2011/11/28/142662840/militarys-brain-testing-program-... [7])(accessed November 30, 2011).
9. Centers for Disease Control and Prevention. FAQs about Baseline Testing among Young Athletes (http://www.cdc.gov/concussion/pdf/baseline_testing_FAQs-a.pdf [19])(accessed April 16, 2012)
10. Resch J, et al. ImPact Test-Retest Reliability: Reliably Unreliable? J Athl Tr. 2013;48(3):000-000 doi: 10.4085/1062-6050-48.3.09 (ePub in advance of print)
11. Randolph C, McCrea M, Barr WB. Is neuropsychological testing useful in the management of sport-related concussion? J Athl Train.
2005;40(3):139-152.
12. Child SCAT3. Br J Sports Med 2013;47:263.
13. Gualteri CT, Johnson LG. Reliability and validity of a computerized neurocognitive test battery, CNS Vital Signs. Arch Clin Neuropsychol. 2006;21:623-643.
14. Broglio SP, Cantu RC, Gioia GA, Guskiewicz KM, Kutcher J, Valovich McLeod TC. National Athletic Trainers' Association Position Statement: Management of Sport Concussion. J Ath Tr. 2014;49:245-265.
Most recently revised April 6, 2015
Links:
[1] https://mail.momsteam.com/node/4924
[2] https://mail.momsteam.com/node/208
[3] https://mail.momsteam.com/node/221
[4] https://mail.momsteam.com/node/3384
[5] http://www.xlntbrain.com/
[6] http://www.axonsports.com/
[7] http://www.npr.org/2011/11/28/142662840/militarys-brain-testing-program-a-debacle
[8] http://www.pearsoned.com/pearson-launches-concussion-management-assessment-to-protect-the-future-of-student-athletes/#.URQa6h27ORg
[9] https://mail.momsteam.com/node/114
[10] https://mail.momsteam.com/node/149
[11] https://mail.momsteam.com/node/142
[12] https://mail.momsteam.com/node/3227
[13] https://mail.momsteam.com/node/3471
[14] https://mail.momsteam.com/node/2987
[15] https://mail.momsteam.com/node/6026
[16] https://mail.momsteam.com/node/156
[17] http://ajs.sagepub.com/content/38/12/2405.abstract?etoc
[18] http://ajs.sagepub.com/content/early/2011/01/29/0363546510392326.full.pdf html
[19] http://www.cdc.gov/concussion/pdf/baseline_testing_FAQs-a.pdf
[20] https://mail.momsteam.com/health-safety/pencil-paper-neuropsychological-testing-concussions-valuable-but-come-with-limitations
[21] https://mail.momsteam.com/health-safety/concussion-safety/recognition-evaluation/neuropsychological-testing-for-concussions
[22] https://mail.momsteam.com/concussion/concussions-in-high-school-sports-study-provides-new-insights-into-causes-symptoms-manage
[23] https://mail.momsteam.com/baseline/baseline-neuropsychological-tests-getting-valid-results-poses-challenge
[24] https://mail.momsteam.com/scat2/baseline-scores-vary-by-youth-athletes-gender-concussion-history-says-study
[25] https://mail.momsteam.com/baseline-neurocognitive-concussion-testing-getting-enough-sleep-may-affect-results