Test Order Does Not Affect Vestibular/Ocular Motor Screening Item Scores in High School Athletes.

OBJECTIVE: To compare VOMS item scores between a fixed and randomized administration order in a sample of nonconcussed high school athletes. DESIGN: Post-test only, quasi-experimental design. SETTING: Local high schools in a mid-west region of the United States. PATIENTS: Fifty nonconcussed high school athletes (M = 15.64; SD = 1.12 years) completed the VOMS in a randomized testing order (RANDOM), and 49 (M = 15.64; SD = 1.12 years) completed the VOMS in the fixed testing order (FIXED). The groups were matched on age, sex, learning disorder, attention-deficit/hyperactivity disorder, concussion history, and baseline concussion symptoms. INTERVENTIONS: The Vestibular/Ocular Motor Screening (VOMS) tool comprises pretest symptoms, smooth pursuit (SP), horizontal/vertical saccade (HSAC/VSAC), average near-point of convergence (NPC) distance, convergence symptoms, horizontal/vertical vestibular ocular reflex (HVOR/VVOR), and visual motion sensitivity (VMS). MAIN OUTCOME MEASURES: Mann-Whitney U tests were performed to examine differences between FIXED and RANDOM groups on VOMS items. RANDOM scores were rearranged in order of administration and combined with the FIXED group scores, and a Freidman test was performed for repeated measures. RESULTS: There were no significant differences between FIXED and RANDOM groups on VOMS pretest symptoms (U = 1171, P = 0.57), SP (U = 1122.5, P = 0.35), HSAC (U = 1128.5, P = 0.44), VSAC (U = 1055.5, P = 0.16), convergence symptoms (U = 1129.0, P = 0.41), average NPC distance (U = 979.0, P = 0.06), HVOR (U = 1085.0, P = 0.25), VVOR (U = 1126.0, P = 0.41), and VMS scores (U = 1101.0, P = 0.32). When VOMS items were rearranged and the sample was combined, there were no differences for repeated measures [χ2 (6) = 9.92, P = 0.13]. CONCLUSIONS: There were no significant differences on VOMS items between FIXED and RANDOM groups for repeated measures. The testing order of VOMS items does not affect VOMS scores in nonconcussed high school athletes.

How Do ImPACT Quick Test Scores Compare with ImPACT Online Scores in Non-Concussed Adolescent Athletes?

OBJECTIVE: To compare neurocognitive scores between the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) Quick Test (QT) and Online Versions in non-concussed high school athletes. METHODS: A sample of 47 high school athletes completed the ImPACT Online Version pre-season and the ImPACT QT approximately 3 months later. Paired sample t-tests and Pearson's correlations examined differences and relationships between the ImPACT batteries. RESULTS: The ImPACT QT scores were significantly higher for performance on the Three Letters: Average Counted (p < .001, d = .88), Three Letters: Average Counted Correctly (p < .001, d = .80), and Symbol Match: Correct RT Visible (p < .001, d = .72), and Symbol Match: Correct RT Hidden (p = .002, d = .50) subtests. There were significant relationships for Three Letters: Average Counted (r = .85, p < .001), Three Letters: Average Counted Correctly (r = .82, p < .001), and Symbol Match: Total Correct Hidden (r = .40, p = .006) subtests. CONCLUSIONS: Post-injury evaluation data using ImPACT QT should be compared to normative referenced data, and not to pre-season data from the ImPACT Online Version.

Preliminary Evidence of a Dose-Response for Continuing to Play on Recovery Time After Concussion.

OBJECTIVE: To investigate a dose-response relationship between continuing to play following concussion and outcomes. PARTICIPANTS: A total of 130 athletes (age 11-19 years). DESIGN: Repeated-measures design comparing symptoms, neurocognitive performance, and recovery time between 52 athletes immediately removed from play (Removed), 24 who continued to play for 15 minutes or less (Short-Play), and 32 who continued to play for more than 15 minutes (Long-Play). MAIN MEASURES: Recovery was the number of days from injury to clearance. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) measured neurocognitive outcomes and the Post-Concussion Symptom Scale (PCSS) measured symptom severity. RESULTS: Long-Play (44.09 ± 27.01 days) took longer to recover than Short-Play (28.42±12.74 days) and Removed (18.98 ± 13.76 days). Short-Play was 5.43 times more likely, and Long-Play 11.76 times more likely, to experience protracted recovery relative to Removed. Both Play groups had worse neurocognitive performance and higher symptom scores than Removed at days 1 to 7, with Long-Play demonstrating worse reaction time than Short-Play. At days 8 to 30, both Play groups performed worse than Removed on visual memory and visual motor speed, while only Long-Play performed worse on verbal memory and reaction time. CONCLUSIONS: Results provide initial evidence of a dose-response effect for continuing to play on recovery from concussion, highlighting the importance of removal from play.

Motion Sickness Susceptibility and Baseline Vestibular and Ocular-Motor Performance in Adolescent Athletes.

CONTEXT: High school athletes with a history of motion sickness susceptibility exhibit higher baseline vestibular and ocular-motor scores than those without a history of motion sickness susceptibility. OBJECTIVE: To examine the effects of motion sickness susceptibility on baseline vestibular and ocular-motor functioning, neurocognitive performance, and symptom scores. DESIGN: Cross-sectional study. SETTING: Preseason concussion testing. PATIENTS OR OTHER PARTICIPANTS: A convenience sample of high school athletes (N = 308, age = 15.13 ± 1.21 years) involved in a variety of sports. MAIN OUTCOME MEASURE(S): Vestibular/Ocular Motor Screening, computerized neurocognitive assessment, symptom scale, and Motion Sickness Susceptibility Questionnaire-Short Form (MSSQ-S). RESULTS: Participants were categorized into 3 groups based on a median split of the scores (eg, NONE, LOW, and HIGH). The LOW (n = 95) and HIGH (n = 92) groups (ie, MSSQ-S score > 0) were 2.64 times more likely (χ21,257 = 7.94, P = .01, 95% confidence interval = 1.32, 5.26) to have baseline Vestibular/Ocular Motor Screening scores larger than the clinical cutoffs for the NONE group (n = 70). No between-groups main effects were present for the NONE (n = 52), LOW (n = 89), and HIGH (n = 90) MSSQ-S groups for verbal (F2,230 = .09, P = .91, η2 = .001) and visual (F2,230 = .15, P = .86, η2 = .001) memory, processing speed (F2,230 = .78, P = .46, η2 = .007), or reaction time (F2,230 = 2.21, P = .11, η2 = .002). The HIGH group exhibited higher total baseline symptom scores than the LOW (U = 3325.50, z = -1.99, P = .05, r = .15) and NONE (U = 1647.50, z = -2.83, P = .005, r = .24) groups. CONCLUSIONS: Motion sickness should be considered a preexisting risk factor that might influence specific domains of the baseline concussion assessment and postinjury management.

Evaluating the suitability of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computerized neurocognitive battery for short-term, serial assessment of neurocognitive functioning.

BACKGROUND: Computerized Neurocognitive Testing (CNT) is frequently used for serial assessment of athletes following concussion. The Immediate Post-Concussion Assessment for Cognitive Testing (ImPACT) is a commonly used CNT with well-documented test-retest reliability in healthy samples for intervals ranging from one month to two years. However, previous research has not explored use of ImPACT for other serial testing methodologies such as immediately before and after an experimental trial/intervention where administration on the same day may be necessary. PURPOSE: To examine the suitability of ImPACT for short-term, serial assessment of neurocognitive functioning. STUDY DESIGN: Prospective, repeated measures research design. METHODS: Forty-two healthy, college-aged individuals completed ImPACT twice, with a one-hour break between assessments. Reliability was assessed using Pearson correlation coefficients, intraclass correlation coefficients (ICCs), reliable change indices (RCIs) and regression-based methods (RBM). RESULTS: No significant increases in mean ImPACT composite or symptom scores were observed between assessments. ICCs ranged from 0.34 to 0.74 (single)/0.51 to 0.85 (average). Across two test administrations, 92-100% and 93-98% of participants' change scores fell within cutoffs when utilizing the RCI and RBM, respectively. CONCLUSION: The ICCs for ImPACT composite and factor scores across the one-hour administration were consistent with previous studies. Only a small percentage of scores fell outside of RCI and RBM cutoffs. These statistical metrics suggest that ImPACT has sufficient reliability when repeating administration within one-hour.

Repetitive head impacts do not affect postural control following a competitive athletic season.

Evidence suggests that Repetitive Head Impacts (RHI) directly influence the brain over the course of a single contact collision season yet do not significantly impact a player's performance on the standard clinical concussion assessment battery. The purpose of this study was to investigate changes in static postural control after a season of RHI in Division I football athletes using more sensitive measures of postural control as compared to a non-head contact sports. Fourteen Division I football players (CON) (age=20.4±1.12years) and fourteen non-contact athletes (NON) (2 male, 11 female; age=19.85±1.21years) completed a single trial of two minutes of eyes open quiet upright stance on a force platform (1000Hz) prior to athletic participation (PRE) and at the end of the athletic season (POST). All CON athletes wore helmets outfitted with Head Impact Telemetry (HIT) sensors and total number of RHI and linear accelerations forces of each RHI were recorded. Center of pressure root mean square (RMS), peak excursion velocity (PEV), and sample entropy (SampEn) in the anteroposterior (AP) and mediolateral (ML) directions were calculated. CON group experienced 649.5±496.8 mean number of impacts, 27.1±3.0 mean linear accelerations, with ≈1% of total player impacts exceeded 98g over the course of the season. There were no significant interactions for group x time RMS in the AP (p=0.434) and ML (p=0.114) directions, PEV in the AP (p=0.262) and ML (p=0.977) directions, and SampEn in the AP (p=0.499) and ML (p=0.984) directions. In addition, no significant interactions for group were observed for RMS in the AP (p=0.105) and ML (p=0.272) directions, PEV in the AP (p=0.081) and ML (p=0.143) directions, and SampEn in the AP (p=0.583) and ML (p=0.129) directions. These results suggest that over the course of a single competitive season, RHI do not negatively impact postural control even when measured with sensitive non-linear metrics.

ASB clinical biomechanics award winner 2016: Assessment of gaze stability within 24-48hours post-concussion.

BACKGROUND: Approximately 90% of athletes with concussion experience a certain degree of visual system dysfunction immediately post-concussion. Of these abnormalities, gaze stability deficits are denoted as among the most common. Little research quantitatively explores these variables post-concussion. As such, the purpose of this study was to investigate and compare gaze stability between a control group of healthy non-injured athletes and a group of athletes with concussions 24-48hours post-injury. METHODS: Ten collegiate NCAA Division I athletes with concussions and ten healthy control collegiate athletes completed two trials of a sport-like antisaccade postural control task, the Wii Fit Soccer Heading Game. During play all participants were instructed to minimize gaze deviations away from a central fixed area. Athletes with concussions were assessed within 24-48 post-concussion while healthy control data were collected during pre-season athletic screening. Raw ocular point of gaze coordinates were tracked with a monocular eye tracking device (240Hz) and motion capture during the postural task to determine the instantaneous gaze coordinates. This data was exported and analyzed using a custom algorithm. Independent t-tests analyzed gaze resultant distance, prosaccade errors, mean vertical velocity, and mean horizontal velocity. FINDINGS: Athletes with concussions had significantly greater gaze resultant distance (p=0.006), prosaccade errors (p<0.001), and horizontal velocity (p=0.029) when compared to healthy controls. INTERPRETATION: These data suggest that athletes with concussions had less control of gaze during play of the Wii Fit Soccer Heading Game. This could indicate a gaze stability deficit via potentially reduced cortical inhibition that is present within 24-48hours post-concussion.