The use of baseline and postconcussion computerized neurocognitive testing has become an increasingly common practice in the assessment and management of concussions at the college, high school, and even youth level. But, as three new studies show, obtaining baseline test results reflecting a valid assessment of an athlete's "true" baseline ability needed for comparison to postinjury performance is fraught with challenges.
Baseline testing of youth athletes
In a first-of-its-kind study of baseline testing among younger athletes,[1] researchers at the Sports Concussion Center of New Jersey (SCCNJ) report a greater proportion of invalid test results for pre-high school athletes ages 10 to 12 years of age than for older athletes aged 13 to 18 years.
Researchers, led by Rosemarie Scolaro Moser, PhD, a MomsTEAM concussion expert, and SCCNJ's Director, found that invalid rates increased when testing was conducted in a large group and nonclinical setting. Even when theywere subject to strict supervision in the Center younger athletes still delivered more invalid baseline scores than did their adolescent counterparts.
Higher rates of invalid test results among younger athletes, particularly when tested in a large group setting (10 per room), which introduced distractions as well as decreased individualized attention, were likely the result, the study says, of a combination of factors, including the fact that younger, pre-high school athletes are developmentally less mature and independent than adolescents, may require more attention and supervision when completing tasks, may not intellectually grasp the importance and utility of baseline testing because of their less mature cognitive development, and because their reading skills are less advanced.
The findings, writes Moser "support the need for standardized, better controlled administration procedures by trained professionals who understand neurocognitive testing" and also "provide a warning to those who may contemplate implementing computerized baseline testing programs for younger athletes [that they] will require even greater vigilance, caution, individualized attention, and resources for administration."
Lack of sleep can invalidate baselineIn the second study,[2] researchers at Vanderbilt University found that athletes who didn't get enough sleep the night before undergoing baseline neurocognitive concussion testing didn't perform as well as expected,
"Our results indicate athletes sleeping less than 7 hours the night prior to baseline concussion testing did not do as well on 3 out of 4 ImPACT scores and showed more symptoms" said lead author, Jake McClure, MD, of Vanderbilt University.
"Because return-to-play decisions often hinge on the comparison of post-concussion to baseline concussion scores, our research indicates that healthcare providers should consider the sleep duration prior to baseline neurocognitive testing as a potential factor in assessing recovery."
The study was originally presented as a researcher paper at the American Orthopaedic Society for Sports Medicine's Annual Meeting in Chicago, Illinois in July 2013 and reported by MomsTEAM at that time.
Wake-up call
In the third study,[3] Moser and her colleagues outline factors affecting the validity of baseline test results, provide examples of misuse and misinterpretation of the results, and strongly urge adoption and implementation by schools of best testing practices emphasizing the importance of a standardized, controlled and tightly supervised testing environment and the use of qualified trained professionals to review the test results for validity and interpretation.
"There are no shortcuts to providing sports concussion services," writes Moser. "It is time for a wake-up call: there should be no excuses (e.g. lack of resources, funding, or staff) for the current level of computerized, neurocognitive test misuse," she says. "These concussion tests should be administered with the same care and consideration afforded all standardized neuropsychological and educational tests."
"Baseline and postconcussion testing programs, test developers, and test vendors must be required to demonstrate proper concern and respect for testing standards, such as those already promulgated by the [American Psychological Association], which provide for reliable, valid, interpretable test results that protect, benefit, and respect the welfare of the patient and in this case the athlete," the study concludes.
1. Lichtenstein JD, Moser RS, Schatz P. Age and Test Setting Affect the Prevalence of Invalid Baseline Scores on Neurocognitive Tests. Am J Sports Med. 2013;20(10):DOI:10.1177/0363546513509225 (epub November 15, 2013)
2. McClure DJ, Zuckerman SL, Kutscher SJ, Gregory A, Solomon GS. Baseline Neurocognitive Testing in Sports-Related Concussions: The Importance of a Prior Night's Sleep. Am J Sports Med. 2013;20(10):DOI:10.177/0363546513510389 (epub November 20, 2013).
3. Moser RS, Schatz P, Lichtenstein JD. The Importance of Proper Administration and Interpretation of Neuropsychological Baseline and Postconcussion Computerized Testing. Applied Neuropsychology: Child. 2013;DOI:10.1080/21622965.2013.791825 (epub November 16, 2013).
Posted November 21, 2013
