neurocognitive testing for concussions is widely used in amateur and
professional sports, but little research over the past decade proves its
effectiveness, a paper published this month in the journal Neuropsychology Review says.
Resch, director of the Brain Injury Laboratory at
The University of Texas at Arlington, is lead author on the review, which
updates a 2005 look at the available research on computerized neurocognitive
testing. In 2005, researchers said not enough evidence existed to support
clinical use of the then relatively new assessments.
recent work acknowledges that computerized tests, such as those marketed under
the name ImPACT, HeadMinder, CogState, and ANAM, have become extremely
commonplace across the sports world.
But, the authors still urge caution with their use and point out a need
for more peer-reviewed studies.
data has been published since 2005 to assist clinicians in determining the
clinical value of this form of testing,” Resch said. “While these products are
an important component of concussion management, their development, marketing
and sales seem to have outpaced the evidence. So, some caution is needed.”
are Michael McCrea, an author of the 2005 study and director of brain injury
research at the Medical College of Wisconsin, and C. Munro Cullum, professor
and head of the neuropsychology program at UT Southwestern Medical Center.
attention that concussion in sport has gained in recent years, it is surprising
there has not been more research into the some of the newer computer-based
methods used to evaluate post-concussion symptoms,” Cullum said. “Since there
is no single brain-test or biomarker for concussion at this point, the
diagnosis of concussion remains a challenge in many cases, as it relies upon
reported and observed symptoms.”
McCrea and Cullum found 29 peer-reviewed articles since 2005 have addressed the
characteristics of commercially available computerized neurocognitive tests.
After a detailed analysis, they concluded that evidence on reliability and
validity of the tests wasn’t consistent.
example, in a May 2013 study published by the Journal of
Athletic Training, Resch and other researchers found that the ImPACT test
misclassified healthy study participants as impaired as much as 46 percent of
the time for some evaluation factors. ImPACT stands for Immediate Post
Concussion Assessment and Cognitive Testing and is by far the most used
computerized neurocognitive test for concussion management.
An Institute of Medicine report early this year said that the number of
people 19 and under treated in U.S. emergency rooms for concussions and other
non-fatal, sports and recreation-related traumatic brain injuries increased
from 150,000 in 2001 to 250,000 in 2009. With the recent settlement of a
landmark lawsuit filed by former NFL players, concussions remain in the
headlines and on the minds of athletes, parents, coaches and others in the
Recently, nearly 40 percent of athletic trainers reported using a
computerized neurocognitive tests as part of their response to a sports-related
concussion, according to the new paper. The convenient computerized tests are
typically used, just as pen and paper versions were in the past, to establish a
baseline to use as a point of comparison after an athlete is injured. But, because concussion symptoms can vary
widely across individuals and may be subtle, clear documentation of mild brain
injury can be difficult.
findings of the new survey should serve as a caution to those utilizing and
interpreting computerized cognitive test results, the researchers said.
testing is an important component of the concussion assessment, but should not
be used as a stand alone method to diagnose injury or determine an athlete's
level of recovery and fitness to return to play,” said McCrea. “A
multi-dimensional approach is supported by the evidence as best practice."
The new paper is called “Computerized Neurocognitive Testing in the
Management of Sport-Related Concussion: An Update.” It is available here: http://link.springer.com/article/10.1007%2Fs11065-013-9242-5.
Until more research is done, the new paper from Resch, McCrea and
Cullum recommends healthcare professionals who use the tests take some
an informed decision when choosing a test and investigating its limitations.
sure the test is part of a multi-faceted concussion management approach.
a clinical neuropsychologist into the sports-related concussion management team
to assist in interpretation of test results.
proper training of those administering the test.
quality control reviews of baseline testing.
In addition to the recently published research, Resch and Cullum have
been working together on a long-term study of concussion management in young
athletes. That work involves more than 2,000 North Texas middle school and high
school students and is in its third year.
The University of Texas at Arlington is a
comprehensive research institution of more than 33,300 students and 2,300
faculty members in the epicenter of North Texas. It is the second largest
institution in The University of Texas System. Total research expenditures
reached almost $78 million last year. Visit www.uta.edu to learn more.