ABSTRACT
Binocular vision disorders are commonly found postconcussion and associated with high symptom burden. We investigated the relationship between binocular vision symptoms and neurocognitive test performance. Thirty-four adolescents with concussion and 18 without concussion were assessed for cognitive performance using the CogState Brief Battery. Binocular vision disorders were determined using clinical examination and vision symptoms with the Convergence Insufficiency Symptoms Survey (CISS). A cutoff CISS score of 13 had high predictive accuracy for identifying individuals with a binocular vision disorder. CogState scores for processing speed and attention were significantly lower in the concussion group compared with the control group. Within the concussion group, scores for attention, learning, and working memory were significantly lower in those with vision symptoms. The presence of vision symptoms did not significantly affect CogState scores within the control group. The presence of vision symptoms in individuals with concussion is associated with significantly reduced scores on individual components of the CogState.
Subject(s)
Athletic Injuries/diagnosis , Brain Concussion/diagnosis , Post-Concussion Syndrome/diagnosis , Vision Disorders/diagnosis , Vision, Binocular , Adolescent , Athletic Injuries/complications , Brain Concussion/complications , Case-Control Studies , Diagnosis, Computer-Assisted/statistics & numerical data , Female , Humans , Male , Neurologic Examination/methods , Neuropsychological Tests , Vision Disorders/etiologyABSTRACT
INTRODUCTION: Concussion is a common injury in adolescent athletes, many of whom also drive. Counseling athletes and their families about driving risks post concussion is a potentially significant intervention. The aim of this quality improvement project was to increase driving recommendations for concussed athletes in a pediatric sports medicine clinic. METHODS: Patients in this quality improvement project were seen in the sports medicine concussion clinic between February 2014 and August 2015. We determined how often driving recommendations were documented through a retrospective chart review. Once the "return to drive" project was introduced to the sports medicine staff, multiple interventions were completed including handing out flyers to remind families about driving and creating changes to the electronic medical record. RESULTS: At baseline, 9.3% of visits had driving recommendations documented. After an intervention requiring clinical documentation in the electronic medical record, 97% of patients received driving recommendations. CONCLUSIONS: The quality improvement effort was successful at increasing the frequency of delivery of appropriate driving recommendations provided to concussed athletes.
ABSTRACT
OBJECTIVE: Baseline assessments using computerized neurocognitive tests are frequently used in the management of sport-related concussions. Such testing is often done on an annual basis in a community setting. Reliability is a fundamental test characteristic that should be established for such tests. Our study examined the test-retest reliability of a computerized neurocognitive test in high school athletes over 1 year. DESIGN: Repeated measures design. SETTING: Two American high schools. PARTICIPANTS: High school athletes (N = 117) participating in American football or soccer during the 2011-2012 and 2012-2013 academic years. INTERVENTIONS: All study participants completed 2 baseline computerized neurocognitive tests taken 1 year apart at their respective schools. The test measures performance on 4 cognitive tasks: identification speed (Attention), detection speed (Processing Speed), one card learning accuracy (Learning), and one back speed (Working Memory). MAIN OUTCOME MEASURES: Reliability was assessed by measuring the intraclass correlation coefficient (ICC) between the repeated measures of the 4 cognitive tasks. Pearson and Spearman correlation coefficients were calculated as a secondary outcome measure. RESULTS: The measure for identification speed performed best (ICC = 0.672; 95% confidence interval, 0.559-0.760) and the measure for one card learning accuracy performed worst (ICC = 0.401; 95% confidence interval, 0.237-0.542). All tests had marginal or low reliability. CONCLUSIONS: In a population of high school athletes, computerized neurocognitive testing performed in a community setting demonstrated low to marginal test-retest reliability on baseline assessments 1 year apart. Further investigation should focus on (1) improving the reliability of individual tasks tested, (2) controlling for external factors that might affect test performance, and (3) identifying the ideal time interval to repeat baseline testing in high school athletes. CLINICAL RELEVANCE: Computerized neurocognitive tests are used frequently in high school athletes, often within a model of baseline testing of asymptomatic individuals before the start of a sporting season. This study adds to the evidence that suggests in this population such testing may lack sufficient reliability to support clinical decision making.
Subject(s)
Athletes/psychology , Athletic Injuries/diagnosis , Brain Concussion/diagnosis , Diagnosis, Computer-Assisted , Neuropsychological Tests , Adolescent , Athletic Injuries/psychology , Attention , Brain Concussion/psychology , Female , Football , Humans , Learning , Male , Memory, Short-Term , Reference Values , Reproducibility of Results , SoccerABSTRACT
OBJECTIVE: A common sequela of concussions is impaired reaction time. Computerized neurocognitive tests commonly measure reaction time. A simple clinical test for reaction time has been studied previously in college athletes; whether this test is valid and reliable when assessing younger athletes remains unknown. Our study examines the reliability and validity of this test in a population of high school athletes. DESIGN: Cross-sectional study. SETTING: Two American High Schools. PARTICIPANTS: High school athletes (N = 448) participating in American football or soccer during the academic years 2011 to 2012 and 2012 to 2013. INTERVENTIONS: All study participants completed a computerized baseline neurocognitive assessment that included a measure of reaction time (RT comp), in addition to a clinical measure of reaction time that assessed how far a standard measuring device would fall prior to the athlete catching it (RT clin). MAIN OUTCOME MEASURES: Validity was assessed by determining the correlation between RT clin and RT comp. Reliability was assessed by measuring the intraclass correlation coefficients (ICCs) between the repeated measures of RT clin and RT comp taken 1 year apart. RESULTS: In the first year of study, RT clin and RT comp were positively but weakly correlated (rs = 0.229, P < 0.001). In the second year, there was no significant correlation between RT clin and RT comp (rs = 0.084, P = 0.084). Both RT clin [ICC = 0.608; 95% confidence interval (CI), 0.434-0.728] and RT comp (ICC = 0.691; 95% CI, 0.554-0.786) had marginal reliability. CONCLUSIONS: In a population of high school athletes, RT clin had poor validity when compared with RT comp as a standard. Both RT clin and RT comp had marginal test-retest reliability. Before considering the clinical use of RT clin in the assessment of sport-related concussions sustained by high school athletes, the factors affecting reliability and validity should be investigated further. CLINICAL RELEVANCE: Reaction time impairment commonly results from concussion and is among the most clinically important measures of the condition. The device evaluated in this study has previously been investigated as a reaction time measure in college athletes. This study investigates the clinical generalizability of the device in a younger population. VIDEO ABSTRACT: A video abstract showing how the RT clin device is used in practice is available as Supplemental Digital Content 1, http://links.lww.com/JSM/A43.
