In particular, Iverson, et al. Athletes with concussions were 47 times more likely to have two or more declines across the five composite scores than non-concussed subjects. The authors determined the Pearson test-retest correlation coefficients for the verbal memory, visual memory, reaction time, and processing speed composite scores, which ranged from 0.
Such test-retest coefficients are comparable to or higher than many other neuropsychological tests [ 25 ]. Similarly, Schatz, et al. Interestingly, the ImPACT battery contains criteria that identify invalid performance believed to be due to a variable or insufficient effort on the part of the examinee [ 27 ]. Therefore, Schatz and Sandel concluded that the online version of ImPACT is a valid measure of neurocognitive performance at the acute stages of a concussion.
It has high levels of sensitivity and specificity, even when athletes appear to be denying post-concussion symptoms. By attempting to hide the symptoms of a concussion or otherwise look good on the ImPACT test, athletes displayed more variable behavior and paradoxically distinguished themselves from matched controls. This allowed the test to identify their neurocognitive deficits [ 23 ]. Those athletes who were more forthcoming with symptom data displayed more normal ranges of behavior, thus overlapping with more normal controls.
This resulted in decreased specificity. The Pediatric ImPACT was developed as a computerized assessment battery for children aged five to 12 years in order to provide developmentally appropriate stimuli and task instructions, factor-derived composite scores, empirically-based clinical algorithms, and comprehensive normative data sets.
The six Pediatric ImPACT neurocognitive subtests are based upon the original measure with adaptations of task instructions, cognitive demands, stimuli, and format to make them appropriate for younger children. The reliability and usefulness of the ImPACT test battery as a valid instrument in the evaluation of a sports-related concussion have been confirmed by several sources [ 16 , 23 , 25 ]. They are intended as part of the medical evaluation that doctors perform to assess signs and symptoms of a head injury [ 28 - 29 ].
HeadMinder, Inc. The test includes six subtests that evaluate the speed of information processing, visual recognition, and reaction time. Three composite scores are automatically computed: simple reaction time, complex reaction time, and processing speed [ 30 ]. Past research has documented the reliability and validity of the CRI. It has been observed to be sensitive in identifying post-concussion symptoms and resistant to retest effects.
However, Broglio, et al. These domains are reaction time, decision-making, matching, working memory, and attention. Collie, et al. Moreover, CogSport was found to display high correlations with conventional paper and pencil neuropsychological tests of information processing and attention [ 32 ].
However, considerable variability in the sensitivity and specificity of the composite scores has been reported [ 33 ]. Neuronal injury resulting from concussive injury can prompt impaired visual movements and oculomotor speed in concussed patients. Poor oculomotor function has been reported as one of the most robust discriminators for the identification of mild traumatic brain injury.
The visual-motor deficits often reported by such patients include difficulty with saccades, accommodation, smooth pursuit, fixation, reading, and photosensitivity [ 12 ]. The KD test is traditionally used to evaluate reading efficiency in children that may be compromised by dyslexia or impaired saccadic eye movements. However, it has recently been promoted as a practical sideline concussion tool for its ease of administration and the rapid manner in which it can be performed.
It can usually be given in less than two minutes [ 12 ]. Specifically, the KD test requires athletes to read single digit numbers from a series of three cards. The numbers on each card are uniquely arranged and spaced, with a progressive increase in difficulty with each successive card. The athlete holds the cards at a self-chosen comfortable distance and reads the numbers from left to right and top to bottom, as quickly as possible without making an error.
The athlete is permitted three attempts to complete each card, and the fastest time without an error is recorded for each card. Each of the best times is summed for a total time. Tjarks, et al. Reaction time progressively decreased. These results are consistent with the notion that participants were progressively recovering from their brain injuries across the period of the study.
Moreover, they support the clinical utility of the KD test in acute concussion diagnosis [ 12 ]. In a prospective observational cohort study, 22 concussion events were recorded. Notably, only five concussive incidents were witnessed, and the remaining 17 unrecognized concussive incidents were identified with KD testing [ 34 ].
KD was able to identify players that had not shown or reported any signs or symptoms of concussion, but who had a meaningful head injury. Thus, the authors concluded that KD is suitable for rapid assessment in a limited time frame on the sideline to assess and review suspected concussed players. The individuals with unrecognized concussions identified with KD on average presented fewer symptoms, lower symptom severity, better balance examination, and better immediate and delayed memory scores than those with witnessed concussions.
However, none of these differences were significant. Advantages of the KD test include its relatively low cost and a minimal level of expertise required to administer the test. KD tests for impairment of eye movement, attention, language, and other areas that correlate with suboptimal brain function that may occur following a concussive episode [ 34 ].
Many diagnostic modalities can be utilized for the diagnosis and evaluation of concussions. However, no single test has proven sufficient for stand-alone use in the diagnosis of sports-related concussions. Because of the limitations of available concussion rating scales, there is an important need to assess other objective methods for concussion diagnosis and evaluation.
Due to the individualized nature of each concussion, post-injury assessment and management require a complex understanding of both clinical and non-clinical factors. Though the available assessment tools may facilitate the evaluation of concussive injury and subsequent return-to-play decisions, the psychometrics, test setting, administrators, and other individual characteristics of the athletes contribute a substantial number of issues that must be taken into consideration.
Healthcare providers involved in the evaluation of sports-related concussion should understand the influence of such factors and manage decisions accordingly. Given that concussive injury is dynamic and highly personalized, skill, experience, and flexibility on the part of the clinician are essential in guiding effective management of injured athletes.
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Do not disregard or avoid professional medical advice due to content published within Cureus. The authors have declared financial relationships, which are detailed in the next section. Mark R. National Center for Biotechnology Information , U. Journal List Cureus v. Published online Dec 7. Author information Article notes Copyright and License information Disclaimer.
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CDC is not responsible for Section compliance accessibility on other federal or private website. While the Standardized Assessment of Concussion is commonly used as a screening tool on the sideline of practices, games, and other sporting events , it is not the only screening tool that is used. Other screening tools that are used include:. In terms of legal liability, coaches, teams, leagues, schools, camps, physicians, and other individuals and entities can potentially be held liable when an athlete is allowed or forced to return to play despite showing signs of a concussion.
These individuals and entities owe a duty of care, and ignoring concussion risks will constitute a breach of this duty in some cases. If you have questions about pursuing a claim for legal liability for a sports-related concussion, we encourage you to get in touch.
Our attorneys represent professional athletes, amateur athletes, and parents of youth athletes throughout Connecticut. For a free and confidential consultation, call us directly or request an appointment online today. Our Blogs. Written by Berkowitz. August 12, The SAC Screens for Five Signs of Concussion Symptoms The Standardized Assessment of Concussion is used to screen individuals who have suffered head injuries, and who have been involved in falls and collisions, for signs of concussions.
What is the date? What day of the week is it? What year is it? What time of day is it? Neurologic Function The neurologic function component of the SAC focuses on aspects of cognitive ability other than recall. Specifically, the individual performing the screening is tasked with assessing six aspects of neurologic functionality: Loss of Consciousness — While the individual performing the SAC screening is tasked with determining both the occurrence and duration of loss of consciousness, any loss of consciousness should lead to the athlete or other subject being formally diagnosed.
Retrograde Amnesia — Traumatic brain injuries can cause individuals to lose memories of past events. Screening for retrograde amnesia involves asking the subject questions about his or her past to which the subject should know the answer. Anterograde Amnesia — Anterograde amnesia refers to the loss of the ability to create new memories following a traumatic brain injury. Screening for anterograde amnesia involves asking the subject questions about events occurring subsequent to the impact suspected of causing a possible concussion.
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