Psychometric and measurement properties of concussion assessment tools in youth sports.
ABSTRACT Establishing psychometric and measurement properties of concussion assessments is important before these assessments are used by clinicians. To date, data have been limited regarding these issues with respect to neurocognitive and postural stability testing, especially in a younger athletic population.
To determine the test-retest reliability and reliable change indices of concussion assessments in athletes participating in youth sports. A secondary objective was to determine the relationship between the Standardized Assessment of Concussion (SAC) and neuropsychological assessments in young athletes.
We used a repeated-measures design to evaluate the test-retest reliability of the concussion assessments in young athletes. Correlations were calculated to determine the relationship between the measures. All subjects underwent 2 test sessions 60 days apart.
Sports medicine laboratory and school or home environment. Patients or Other Participants: Fifty healthy young athletes between the ages of 9 and 14 years.
Scores from the SAC, Balance Error Scoring System, Buschke Selective Reminding Test, Trail Making Test B, and Coding and Symbol Search subsets of the Wechsler Intelligence Scale for Children were used in the analysis.
Our test-retest indices for each of the 6 scores were poor to good, ranging from r = .46 to .83. Good reliability was found for the Coding and Symbol Search tests. The reliable change scores provided a way of determining a meaningful change in score for each assessment. We found a weak relationship ( r < .36) between the SAC and each of the neuropsychological assessments; however, stronger relationships ( r > .70) were found between certain neuropsychological measures.
We found moderate test-retest reliability on the cognitive tests that assessed attention, concentration, and visual processing and the Balance Error Scoring System. Our results demonstrated only a weak relationship between performance on the SAC and the selected neuropsychological tests, so it is likely that these tests assess somewhat different areas of cognitive function. Our correlational findings provide more evidence for using the SAC along with a more complex neuropsychological assessment battery in the evaluation of concussion in young athletes.
SourceAvailable from: Tamara Valovich McLeod[Show abstract] [Hide abstract]
ABSTRACT: Primary objective: To review relevant literature regarding the effect of concussion on vestibular function, impairments, assessments and management strategies. Reasoning: Dizziness and balance impairments are common following sport-related concussion. Recommendations regarding the management of sport-related concussion suggest including tests of balance within the multifactorial assessment paradigm for concussive injuries. Analysis: The literature was searched for guidelines and original studies related to vestibular impairments following concussion, oculomotor and balance assessments and treatment or rehabilitation of vestibular impairments. The databases searched included Medline, CINAHL, Sport Discus and the Cochrane Database of Systematic Reviews through October 2013. Main outcomes and results: Dizziness following concussion occurs in ∼67–77% of cases and has been implicated as a risk factor for a prolonged recovery. Balance impairments also occur after concussion and last 3–10 days post-injury. Assessments of balance can be done using both clinical and instrumented measures with success. Vestibular rehabilitation has been shown to improve outcomes in patients with vestibular impairments, with one study demonstrating success in decreasing symptoms and increasing function following concussion. Conclusions: Best practices suggest that the assessment of vestibular function through cranial nerve, oculomotor and balance assessments are an important aspect of concussion management. Future studies should evaluate the effectiveness of vestibular rehabilitation for improving patient outcomes.Brain Injury 10/2014; 29(2). DOI:10.3109/02699052.2014.965206 · 1.86 Impact Factor
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ABSTRACT: Concussion, particularly in relation to sports and combat activities, is increasingly recognized as a potential cause of both short- and long-term neurologic sequelae. This review will focus on the neuro-ophthalmologic findings associated with concussion, the current tests for concussion, and the potential for visual performance measures to improve our detection and assessment of concussions. A PubMed search using the specific key words "concussion," "mild traumatic brain injury," "neuro-ophthalmological findings," and "diagnostic and management tests" was performed. An emphasis was placed on articles published during the past 5 years, but additional articles referenced within recent publications were obtained. Concussion is frequently associated with abnormalities of saccades, pursuit eye movements, convergence, accommodation, and the vestibular-ocular reflex. Current sideline testing for athletes includes the Sports Concussion Assessment Tool, Third Edition (SCAT3) incorporates cognitive and balance testing. The King-Devick (K-D) test is a rapid visual performance measures that can be used on sidelines by nonmedical personnel, including parents of youth athletes. The K-D test complements components of the SCAT3 and improves the detection of concussions. Other vision-based tools for diagnosing and for managing concussion include eye movement tracking devices, pupillary assessment, computerized testing, imaging modalities, and eletrophysiologic testing. Many of the imaging modalities and electrophysiological studies have been combined with vision-based tests. Concusssion is associated with many neuro-ophthalmologic signs and symptoms. Visual performance measures enhance the detection and management of concussion, and future studies are under way to further incorporate vision-based testing into sideline diagnosis and long-term clinical assessments.Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 03/2015; 35(1):73-81. DOI:10.1097/WNO.0000000000000223 · 1.81 Impact Factor
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ABSTRACT: During the past two decades the focus on sport concussion has increased significantly. Young athletes represent the most vulnerable population to sustain a sport concussion yet receive the least amount of attention. Specifically, young athletes who sustain a sport concussion can go unrecognized and continue to participate in sport putting them at an increased risk for a more significant injury. The purpose of this review is to provide a clinical framework for the evaluation and management of sport concussion. In addition, this review provides considerations for health care professionals in regard to clinical measures and follow-up strategies during the acute phase following concussion in young concussed athletes following injury. © The Author(s) 2015.Journal of child neurology 04/2015; DOI:10.1177/0883073815574335 · 1.67 Impact Factor