title: The “Value Added” of Neurocognitive Testing after Sports-Related Concussion Sensitivity and specificity of the ImPACT Test Battery for concussion in athletes. A Comparison of Four Computerized Neurocognitive Assessment Tools to a Traditional Neuropsychological Test Battery in Service Members with and without Mild Traumatic Brain Injury Depression and neurocognitive performance after concussion among male and female high school and collegiate athletes. Inter-rater and test–retest reliability of quality assessments by novice student raters using the Jadad and Newcastle–Ottawa Scales SEX DIFFERENCES IN NEUROPSYCHOLOGICAL FUNCTION AND POST‐CONCUSSION SYMPTOMS OF CONCUSSED COLLEGIATE ATHLETES Exploring differences in computerized neurocognitive concussion testing between African American and White athletes. Long-term outcomes after uncomplicated mild traumatic brain injury: a comparison with trauma controls. Effects of concussion on attention and executive function in adolescents. Cognition in the days following concussion: comparison of symptomatic versus asymptomatic athletes. Acute Effects and Recovery After Sport‐Related Concussion: A Neurocognitive and Quantitative Brain Electrical Activity Study Neuropsychological alterations and neuroradiological findings in patients with post-traumatic concussion: Results of a pilot study. Recovery of cerebral blood flow following sports-related concussion. Acute Clinical Predictors of Symptom Recovery in Emergency Department Patients with Uncomplicated Mild Traumatic Brain Injury or Non-Traumatic Brain Injuries. Effect of concussion on clinically measured reaction time in 9 NCAA division I collegiate athletes: a preliminary study. Athletic Trainers' Concussion-Assessment and -Management Practices: An Update. Clinical versus Functional Reaction Time: Implications for Postconcussion Management
abstract: Background Neurocognitive testing has been endorsed as a “ cornerstone ’ of concussion management by recent Vienna and Prague meetings of the Concussion in Sport Group . Neurocognitive testing is important given the potential unreliability of athlete self-report after injury . Relying only on athletes'ormalities after injury . Study Design Case control study ; Level of evidence , 3 . Methods High school and college athletes with a diagnosed concussion were tested 2 days after injury . Postinjury neurocognitive performance ( Immediate Postconcussion Assessment and Cognitive Testing ) and symptom ( postconcussion symptom ) scores were compared with preinjury ( baseline ) scores and with those of an agex and education-matched noninjured athlete control group . “ Abnormal ” test performance was determined statistically with Reliable Change Index scores . Results Sixty-four percent of concussed athletes reported a significant increase in symptoms , as judged by postconcussion symptom scores , compared with preinjury baseline at 2 days after injury . Eighty-three percent of the concussed sample demonstrated significantly poorer neurocognitive test results relative to their own baseline performance . The addition of neurocognitive testing result ed in a net increase in sensitivity of 19 % . Ninety-three percent of the sample had either abnormal neurocognitive test results or a significant increase in symptoms , relative to their own baseline ; 30 % of a control group demonstrated either abnormalities in neurocognitive testing or elevated symptoms , as judged by postconcussion symptom scores . For the concussed group , use of symptom and neurocognitive test results result ed in an increased yield of 29 % overreliance on symptoms alone . In contrast , 0 % of the control group had both symptoms and abnormal neurocognitive testing . Conclusion Reliance on patients ’ self-reported symptoms after concussion is likely to result in underdiagnosis of concussion and may result in premature return to play . Neurocognitive testing increases diagnostic accuracy when used in conjunction with self-reported symptoms This study explored the diagnostic utility of the composite scores of Immediate Post-Concussion Assessment and Cognitive Testing ( ImPACT ) and Post Concussion Symptom Scale scores ( PCSS ) . Recently concussed high school athletes ( N=72 ) were tested within 72 h of sustaining a concussion , and data were compared to non-concussed high school athletes with no history of concussion ( N=66 ) . Between-groups MANOVA revealed a significant multivariate effect of concussion on test performance ( p<.001 ) ; univariate ANOVAS revealed all six measures contributed to the between-groups differences . A discriminant function analyses was conducted to measure the ability of the five ImPACT composite scores , as well as the PCSS to classify concussion status . One discriminant function was identified that consisted of the Visual Memory , Processing Speed , and Impulse Control composite scores PCSS , which correctly classified 85.5 % of the cases . Approximately 82 % of participants in the concussion group and 89 % of participants in the control group were correctly classified . Using these data , the sensitivity of ImPACT was 81.9 % , and the specificity was 89.4 % . As part of a formal concussion management program , ImPACT is a useful tool for the assessment of the neurocognitive and neurobehavioral sequelae of concussion , and can also provide post-injury cognitive and symptom data that can assist a practitioner in making safer return to play decisions Objective Computerized neurocognitive assessment tools ( NCATS ) are often used as a screening tool to identify cognitive deficits after mild traumatic brain injury ( mTBI ) . However , differing methodology across studies renders it difficult to identify a consensus regarding the validity of NCATs . Thus , studies where multiple NCATs are administered in the same sample using the same methodology are warranted . Method We investigated the validity of four NCATs : the ANAM4 , CNS-VS , CogState , and ImPACT . Two NCATs were r and omly assigned and a battery of traditional neuropsychological ( NP ) tests administered to healthy control active duty service members ( n = 272 ) and to service members within 7 days of an mTBI ( n = 231 ) . Analyses included correlations between NCAT and the NP test scores to investigate convergent and discriminant validity , and regression analyses to identify the unique variance in NCAT and NP scores attributed to group status . Effect sizes ( Cohen 's f2 ) were calculated to guide interpretation of data . Results Only 37 ( 0.6 % ) of the 5,655 correlations calculated between NCATs and NP tests are large ( i.e. r ≥ 0.50 ) . The majority of correlations are small ( i.e. 0.30 > r ≥ 0.10 ) , with no clear patterns suggestive of convergent or discriminant validity between the NCATs and NP tests . Though there are statistically significant group differences across most NCAT and NP test scores , the unique variance accounted for by group status is minimal ( i.e. semipartial R2 ≤ 0.033 , 0.024 , 0.062 , and 0.011 for ANAM4 , CNS-VS , CogState , and ImPACT , respectively ) , with effect sizes indicating small to no meaningful effect . Conclusion Though the results are not overly promising for the validity of the four NCATs we investigated , traditional methods of investigating psychometric properties may not be appropriate for computerized tests . We offer several conceptual and method ological considerations for future studies regarding the validity of NCATs OBJECTIVES To prospect ively examine the relationship of sport-related concussion with depression and neurocognitive performance and symptoms among male and female high school and college athletes . A secondary objective was to explore age and sex differences . DESIGN Pretest , multiple posttest , repeated- measures design . SETTING Laboratory . PARTICIPANTS High school and collegiate athletes ( N=75 ) with a diagnosed concussion . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES  Beck Depression Inventory-II and computerized neurocognitive test battery ( Immediate Post-concussion Assessment and Cognitive Test )  , which includes concussion symptoms ( Post-concussion Symptom Scale ) at baseline and at 2 , 7 , and 14 days postinjury . RESULTS Concussed athletes exhibited significantly higher levels of depression from baseline at 2 days ( P≤.001 ) , 7 days ( P=.006 ) , and 14 days postconcussion ( P=.04 ) . Collegiate athletes demonstrated a significant increase in depression at 14 days postconcussion than did high school athletes ( P=.03 ) . There were no sex differences in depression levels . Neurocognitive decrements at 14 days were supported for reaction time ( P=.001 ) and visual memory ( P=.001 ) . Somatic depression at 7 days postconcussion was related to slower reaction time at 7 days postconcussion . Somatic depression at 14 days postinjury was related to lower visual memory scores at 14 days postinjury . CONCLUSIONS Although not clinical ly significant , athletes experienced increased depression scores up to 14 days after concussion that coincided with neurocognitive decrements in reaction time and visual memory . Somatic depression appears to be most salient with regard to lower neurocognitive performance . Mood assessment s after concussion are warranted to help monitor and enhance recovery Introduction Quality assessment of included studies is an important component of systematic review s. Objective The authors investigated inter-rater and test – retest reliability for quality assessment s conducted by inexperienced student raters . Design Student raters received a training session on quality assessment using the Jadad Scale for r and omised controlled trials and the Newcastle – Ottawa Scale ( NOS ) for observational studies . Raters were r and omly assigned into five pairs and they each independently rated the quality of 13–20 articles . These articles were drawn from a pool of 78 papers examining cognitive impairment following electroconvulsive therapy to treat major depressive disorder . The articles were r and omly distributed to the raters . Two months later , each rater re-assessed the quality of half of their assigned articles . Setting McMaster Integrative Neuroscience Discovery and Study Program . Participants 10 students taking McMaster Integrative Neuroscience Discovery and Study Program courses . Main outcome measures The authors measured inter-rater reliability using κ and the intraclass correlation coefficient type 2,1 or ICC(2,1 ) . The authors measured test – retest reliability using ICC(2,1 ) . Results Inter-rater reliability varied by scale question . For the six-item Jadad Scale , question -specific κs ranged from 0.13 ( 95 % CI −0.11 to 0.37 ) to 0.56 ( 95 % CI 0.29 to 0.83 ) . The ranges were −0.14 ( 95 % CI −0.28 to 0.00 ) to 0.39 ( 95 % CI −0.02 to 0.81 ) for the NOS cohort and −0.20 ( 95 % CI −0.49 to 0.09 ) to 1.00 ( 95 % CI 1.00 to 1.00 ) for the NOS case – control . For overall scores on the six-item Jadad Scale , ICC(2,1)s for inter-rater and test – retest reliability ( accounting for systematic differences between raters ) were 0.32 ( 95 % CI 0.08 to 0.52 ) and 0.55 ( 95 % CI 0.41 to 0.67 ) , respectively . Corresponding ICC(2,1)s for the NOS cohort were −0.19 ( 95 % CI −0.67 to 0.35 ) and 0.62 ( 95 % CI 0.25 to 0.83 ) , and for the NOS case – control , the ICC(2,1)s were 0.46 ( 95 % CI −0.13 to 0.92 ) and 0.83 ( 95 % CI 0.48 to 0.95 ) . Conclusions Inter-rater reliability was generally poor to fair and test – retest reliability was fair to excellent . A pilot rating phase following rater training may be one way to improve agreement OBJECTIVE Our purpose was to determine whether sex differences exist with respect to post-concussion symptoms and neurocognitive function in concussed collegiate athletes . METHODS A prospect i ve dependent- sample cohort design was used to compare baseline and post-concussion neuropsychological test scores and endorsed symptoms as functions of serial post-concussion assessment with respect to time and sex . The Immediate Post-concussion Assessment and Cognitive Testing ( ImPACT ) battery was administered to a multicenter analysis group of 79 concussed athletes . This computerized neuropsychological test was given to the athletes during the preseason and , on average , 2 and 8 days postinjury . RESULTS Multivariate analyses revealed no significant between-group differences on baseline test performance with respect to sex on any of the ImPACT composite scores or on the total symptom score . Multivariate analyses of post-concussion data revealed a significant main effect of time on ImPACT scores , but no main effect of sex was identified , and no time-by-sex interaction existed . Post hoc analysis revealed that concussed female athletes performed significantly worse than concussed male athletes on visual memory tasks ( P = 0.001 ) , and analysis of endorsed post-concussion symptoms revealed that concussed men were significantly more likely than concussed women to report post-concussion symptoms of vomiting ( P = 0.001 ) and sadness ( P = 0.017 ) . Athletes ' scores were examined individually using the reliable-change methodology . At 2 days post-injury , 58 % of concussed athletes had one or more reliable incidents of performance decline or increases in symptom reporting . At 8 days post-concussion , 30 % of concussed athletes were still showing one or more reliable change from preseason values . CONCLUSIONS College athletes exhibit differences on visual memory composite scores and symptoms post-concussion as a function of sex . These data support the importance of evaluating neuropsychological status and post-concussion symptoms in concussed athletes . In addition , these data illustrate the importance of analyzing an individual athlete 's recovery pattern , because individual differences in recovery trajectories may be overshadowed by global norm-group comparisons The purpose of the current study was to explore potential differences in pre- and post-concussion performance on a computerized neurocognitive concussion test between African American and White high-school and collegiate student-athletes . A prospect i ve case-control design was used to compare baseline and 2- and 7-day post-concussion computerized neurocognitive performance and symptoms between 48 White and 48 African American athletes matched for age , gender , and concussion history . The Immediate Post-Concussion Assessment Cognitive Test ( ImPACT ) version 2.0 ( NeuroHealth System , LLC , Pittsburgh , PA , USA ) computer software program was used to assess neurocognitive function ( i.e. , verbal and visual memory , motor processing speed , and reaction time ) and concussion symptoms . Regardless of race/ethnicity , there were significant decrements in computerized neurocognitive performance and increased symptoms following a concussion for the entire sample . African Americans and Whites did not differ significantly on baseline or post-concussion verbal memory , visual memory , reaction time , and total reported symptoms . However , African American participants were 2.4 × more likely to have at least one clinical ly significant cognitive decline on ImPACT at 7 days post-concussion and scored lower at 7 days post-concussion compared with baseline on processing speed than White participants . The authors concluded that the baseline ImPACT test was culturally equivalent and construct valid for use with these two racial/ethnic groups . However , in contrast , the findings support deleterious performance for the African American athletes compared with the White athletes on the ImPACT post-concussion evaluation that is of critical clinical relevance and warrants further research The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and  pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted BACKGROUND Head trauma in adolescents has been linked with deficits in attention and executive function that can compromise the performance of everyday tasks . Although previous research has examined this issue using computerized neuropsychological testing , little work has been done using laboratory-based measurements of attention and executive function in this population . A longitudinal analysis of recovery patterns of these measures among adolescents is central to underst and ing the effects of concussions across the age spectrum . PURPOSE This study prospect ively and longitudinally examined laboratory-based measures of attention and executive function in concussed adolescents sequentially during a 2-month period after injury . METHODS Two measures of attention and executive function , the Attentional Network Test and the Task-Switching Test  , were administered to 20 concussed adolescents within 72 h postinjury as well as at 1 wk , 2 wk , 1 month , and 2 months postinjury . Twenty healthy , matched control subjects were similarly assessed at the same time intervals . Data were analyzed by two-way , mixed-effects ANOVA to determine the effect of group and time on the dependent variables . RESULTS Compared with control subjects , the concussed group exhibited a significantly greater switch cost on the Task-Switching Test ( P = 0.038 , mean difference value = 38 ms ) and a significantly greater reaction time for the Attentional Network Test conflict effect component ( P = 0.015 , mean difference value = 34 ms ) for up to 2 months after injury . CONCLUSIONS Concussed adolescents have difficulty recovering executive function after injury and may require extended recuperation time before full recovery is achieved . Evaluations focusing on attention and executive function can be useful additions in the assessment and follow-up after head injury BACKGROUND Concussion is a common neurological injury occurring during contact sport . Current guidelines recommend that no athlete should return to play while symptomatic or displaying cognitive dysfunction . This study compared post-concussion cognitive function in recently concussed athletes who were symptomatic/asymptomatic at the time of assessment with that of non-injured ( control ) athletes . METHODS Prospect i ve study of 615 male Australian Rules footballers . Before the season , all participants ( while healthy ) completed a battery of baseline computerised ( CogSport ) and paper and pencil cognitive tasks .  Sixty one injured athletes ( symptomatic = 25 and asymptomatic = 36 ) were reassessed within 11 days of being concussed ; 84 controls were also reassessed . The serial cognitive function of the three groups was compared using analysis of variance . RESULTS The performance of the symptomatic group declined at the post-concussion assessment on computerised tests of simple , choice , and complex reaction times compared with the asymptomatic and control groups . The magnitude of changes was large according to conventional statistical criteria . On paper and pencil tests , the symptomatic group displayed no change at re assessment , whereas large improvements were seen in the other two groups . CONCLUSION Injured athletes experiencing symptoms of concussion displayed impaired motor function and attention , although their learning and memory were preserved . These athletes displayed no change in performance on paper and pencil tests in contrast with the improvement observed in asymptomatic and non-injured athletes . Athletes experiencing symptoms of concussion should be withheld from training and competition until both symptoms and cognitive dysfunction have resolved Objective To investigate the clinical utility and sensitivity of a portable , automatic , frontal quantitative electroencephalographic ( QEEG ) acquisition device currently in development in detecting abnormal brain electrical activity after sport-related concussion . Design This was a prospect i ve , non-r and omized study of 396 high school and college football players , including cohorts of 28 athletes with concussion and 28 matched controls . All subjects underwent preseason baseline testing on measures of postconcussive symptoms , postural stability , and cognitive functioning , as well as QEEG . Clinical testing and QEEG were repeated on day of injury and days 8 and 45 postinjury for the concussion and control groups . Main Outcomes and Results The injured group reported more significant postconcussive symptoms during the first 3 days postinjury , which resolved by days 5 and 8 . Injured subjects also performed poorer than controls on neurocognitive testing on the day of injury , but no differences were evident on day 8 or day 45 . QEEG studies revealed significant abnormalities in electrical brain activity in the injured group on day of injury and day 8 postinjury , but not on day 45 . Conclusions Results from the current study on clinical recovery after sport-related concussion are consistent with early reports indicating a typical course of full recovery in symptoms and cognitive dysfunction within the first week of injury . QEEG results , however , suggest that the duration of physiological recovery after concussion may extend longer than observed clinical recovery . Further study is required to replicate and extend these findings in a larger clinical sample , and further demonstrate the utility of QEEG as a marker of recovery after sport-related concussion INTRODUCTION Mild traumatic brain injury ( mTBI ) has traditionally been considered to cause no significant brain damage since symptoms spontaneously remit after a few days . However , this idea is facing increasing scrutiny . The purpose of this study is to demonstrate the presence of early cognitive alterations in a series of patients with mTBI and to link these findings to different markers of brain damage . METHODS We conducted a prospect i ve study of a consecutive series of patients with mTBI who were evaluated over a 12-month period . Forty-one ( 3.7 % ) of the 1144 included patients had experienced a concussion . Patients underwent a routine clinical evaluation and a brain computed tomography ( CT ) scan , and were also administered a st and ardised test for post-concussion symptoms within the first 24hours of mTBI and also 1 to 2 weeks later . The second assessment also included a  neuropsychological test battery .  The results of these studies were compared to those of a control group of 28 healthy volunteers with similar characteristics . Twenty patients underwent an MRI scan . RESULTS Verbal memory and learning were the cognitive functions most affected by mTBI . Seven out of the 20 patients with normal CT findings displayed structural alterations on MR images , which were compatible with diffuse axonal injury in 2 cases . CONCLUSIONS Results from this pilot study suggest that early cognitive alterations and structural brain lesions affect a considerable percentage of patients with post-concussion syndrome following mTBI IMPORTANCE Animal models suggest that reduced cerebral blood flow ( CBF ) is one of the most enduring physiological deficits following concussion . Despite this , longitudinal studies documenting serial changes in regional CBF following human concussion have yet to be performed . OBJECTIVE To longitudinally assess the recovery of CBF in a carefully selected sample of collegiate athletes and compare time course of CBF recovery with that of cognitive and behavioral symptoms . DESIGN , SETTING , AND PARTICIPANTS A cohort of collegiate football athletes ( N = 44 ) participated in this mixed longitudinal and cross-sectional study at a private research institute specializing in neuroimaging between March 2012 and December 2013 .  Serial imaging occurred approximately 1 day , 1 week , and 1 month postconcussion for a subset of participants ( n = 17 ) . All athletes reported no premorbid mood disorders , anxiety disorders , substance abuse , or alcohol abuse . MAIN OUTCOMES AND MEASURES  Arterial spin labeling magnetic resonance imaging  was used to collect voxelwise relative CBF at each visit . Neuropsychiatric evaluations and a brief cognitive screen  were also performed at all 3 points . Clinicians trained in sports medicine provided an independent measure of real-world concussion outcome ( ie , number of days withheld from competition ) . RESULTS The results indicated both cognitive ( simple reaction time ) and neuropsychiatric symptoms at 1 day postinjury that resolved at either 1 week ( cognitive ; P < .005 ) or 1 month ( neuropsychiatric ; P < .005 ) postinjury . Imaging data suggested both cross-sectional ( ie , healthy vs concussed athletes ; P < .05 ) and longitudinal ( 1 day and 1 week vs 1 month postinjury ; P < .001 ) evidence of CBF recovery in the right insular and superior temporal cortex . Importantly , CBF in the dorsal midinsular cortex was both decreased at 1 month postconcussion in slower-to-recover athletes ( t11 = 3.45 ; P = .005 ) and was inversely related to the magnitude of initial psychiatric symptoms ( Hamilton Depression Scale : r = -0.64 , P = .02 ; Hamilton Anxiety Scale : r = -0.56 , P = .046 ) , suggesting a potential prognostic indication for CBF as a biomarker . CONCLUSIONS AND RELEVANCE To our knowledge , these results provide the first prospect i ve evidence of reduced CBF in human concussion and subsequent recovery . The resolution of CBF abnormalities closely mirrors previous reports from the animal literature and show real-world validity for predicting outcome following concussion There is a subset of patients with mild traumatic brain injury ( mTBI ) who report persistent symptoms that impair their functioning and quality of life . Being able to predict which patients will experience prolonged symptom recovery would help clinicians target re sources for clinical follow-up to those most in need , and would facilitate research to develop precision medicine treatments for mTBI . The purpose of this study was to investigate the predictors of symptom recovery in a prospect i ve sample of emergency department trauma patients with either mTBI or non-mTBI injuries . Subjects were examined at several time points from within 72 h to 45 days post-injury . We quantified and compared the value of a variety of demographic , injury , and clinical assessment ( symptom , neurocognitive ) variables for predicting self-reported symptom duration in both mTBI ( n = 89 ) and trauma control ( n = 73 ) patients . Several injury-related and neuropsychological variables assessed acutely ( < 72 h ) post-injury predicted symptom duration , particularly loss of consciousness ( mTBI group ) , acute somatic symptom burden ( both groups ) , and acute reaction time ( both groups ) , with reasonably good model fit when including all of these variables ( area under the receiver operating characteristic curve [ AUC ] = 0.76 ) . Incorporating self-reported litigation involvement modestly increased prediction further ( AUC = 0.80 ) . The results highlight the multifactorial nature of mTBI recovery , and injury recovery more generally , and the need to incorporate a variety of variables to achieve adequate prediction . Further research to improve this model and vali date it in new and more diverse trauma sample s will be useful to build a neurobiopsychosocial model of recovery that informs treatment development OBJECTIVES To evaluate the effect of concussion on clinical ly measured reaction time ( RT(clin ) ) and in comparison to a computerized reaction time measure ( RT(comp ) ) . DESIGN Prospect i ve , repeated measures observational study . SETTING Athletic training clinic at a National Collegiate Athletic Association ( NCAA ) Division I university . PARTICIPANTS Data are reported for 9 collegiate athletes with acute concussion who were part of a larger cohort of 209 athletes recruited from the university 's football , women 's soccer , and wrestling teams before the start of their respective athletic seasons . METHODS  Baseline RT(clin ) and RT(comp )  were measured during preparticipation physical examinations . RT(clin ) measured the time required to catch a suspended vertical shaft by h and closure after its release by the examiner . RT(comp ) was derived from the simple RT component of the CogState-Sport computerized neurocognitive test battery . Athletes who subsequently sustained a physician-diagnosed concussion underwent repeated RT(clin ) and RT(comp ) testing within 72 hours of injury . A Wilcoxon signed rank test was used to compare baseline and after-injury RTs . MAIN OUTCOME MEASUREMENTS After-injury changes in RT(clin ) and RT(comp ) were calculated with respect to each athlete 's own preseason baseline value . RESULTS After-injury RT(clin ) was prolonged in 8 of the 9 athletes with concussions , whereas RT(comp ) was prolonged in 5 of the 9 athletes with concussions . The mean ( st and ard deviation ) RT(clin ) increased from 193 ± 21 ms to 219 ± 31 ms ( P = .050 ) , and mean RT(comp ) increased from 247 ± 75 to 462 ± 120 ms ( P = .214 ) . CONCLUSIONS We concluded that RT(clin ) appears to be sensitive to the known prolongation of RT after concussion and compares favorably with an accepted computerized RT measure . This study supports the potential utility of RT(clin ) as part of a multifaceted concussion assessment battery CONTEXT Athletic trainers ( ATs ) are often the first health care providers to conduct concussion assessment s and carry out postinjury management . Best practice s for concussion evaluation and management have changed rapidly in recent years , outdating previous reports of ATs ' concussion practice s. OBJECTIVE To examine ATs ' current concussion- assessment and -management techniques . DESIGN Cross-sectional study . SETTING Web-based survey . PATIENTS OR OTHER PARTICIPANTS A r and om convenience sample of 8777 ATs ( response rate = 15.0 % [ n = 1307 ] ; years certified = 15.0 ± 10.6 ) from the National Athletic Trainers ' Association membership . MAIN OUTCOME MEASURE(S ) Survey Web links were e-mailed to prospect i ve participants , with 2 follow-up e-mails sent by the National Athletic Trainers ' Association . The survey collected demographic information , the number of concussions assessed , the concussion-recovery patterns , and the assessment and return-to-participation ( RTP ) decision-making methods used . RESULTS The ATs reported assessing a median of 12.0 ( range = 0 - 218 ) concussions per year . A total of 95.3 % ( 953/1000 ) ATs cited clinical examination as the most frequently used concussion- assessment tool , followed by symptom assessment ( 86.7 % ; 867/1000 ) . A total of 52.7 % ( 527/1000 ) ATs described a 3-domain minimum multidimensional concussion- assessment battery . Published RTP guidelines were the most common RTP decision-making tool ( 91.0 % ; 864/949 ) , followed by clinical examination ( 88.2 % ; 837/949 ) . The ATs with master 's degrees were 1.36 times ( 95 % confidence interval [ CI ] = 1.02 , 1.81 ) more likely to use a 3-domain concussion- assessment battery than ATs with only bachelor 's degrees ( χ2 = 4.44 , P = .05 ) . Collegiate ATs were 2.12 ( 95 % CI = 1.59 , 2.84 ) and 1.63 ( 95 % CI = 1.03 , 2.59 ) times more likely to use a 3-domain concussion- assessment battery than high school and clinic-based ATs , respectively ( χ2 = 26.29 , P < .001 ) . CONCLUSIONS Athletic trainers were using the clinical examination , st and ardized assessment tools , and a 3-domain concussion- assessment -battery approach more frequently in clinical practice than previously reported . However , despite practice improvements , nearly half of ATs were not using a 3-domain minimum concussion- assessment battery . Clinicians should strive to implement multidimensional concussion assessment s in their practice s to ensure optimal diagnosis and management ABSTRACT Purpose This study aim ed to examine the association between clinical and functional reaction time ( RT ) assessment s with and without simultaneous cognitive tasks among healthy individuals . Methods Participants ( n = 41 , 49 % female ; 22.5 ± 2.1 yr ; 172.5 ± 11.9 cm ; 71.0 ± 13.7 kg ) completed clinical ( drop stick , Stroop ) and functional ( gait , jump l and ing , single-leg hop , anticipated cut , unanticipated cut ) RT assessment s in r and om order . All RT assessment s , except Stroop and unanticipated cut , were completed under single- ( movement only ) and dual-task conditions ( movement and subtracting by 6s or 7s ) . Drop stick involved catching a r and omly dropped rod embedded in a weighted disk . Stroop assessed RT via  computerized neurocognitive testing . An instrumented walkway measured gait RT when center-of-pressure moved after r and om stimulus . All other functional RT assessment s involved participants jumping forward and performing a vertical jump ( jump l and ing ) , balancing on one leg ( single-leg hop ) , or a 45 ° cut in a known ( anticipated cut ) or unknown ( unanticipated cut ) direction . RT was determined when the sacrum moved following r and om visual stimulus . Pearson correlation coefficients and a 5 × 2 repeated- measures ANOVA compared RT assessment s and cognitive conditions . Results Stroop RT outcomes did not significantly correlate with functional RT assessment s ( r range = −0.10 to 0.24 ) . A significant assessment by cognitive task interaction ( F4,160 = 14.01 ; P < 0.001 ) revealed faster single-task RT among all assessment s compared with dual-task ( mean differences , −0.11 to −0.09 s ; P < 0.001 ) , except drop stick ( P = 0.195 ) . Single-leg hop ( 0.58 ± 0.11 s ) was significantly slower compared with jump l and ing ( 0.53 ± 0.10 s ) , anticipated cut ( 0.49 ± 0.09 s ) , gait ( 0.29 ± 0.07 s ) , and drop stick ( 0.21 ± 0.03 s ; P values ≤ 0.001 ) . Dual-task assessment s were significantly slower than single-task assessment s ( mean difference , 0.08 s ; P < 0.001 ) . Conclusions Clinical and functional RT assessment s were not correlated with each other , suggesting that sport-like RT is not being assessed after concussion . Functional and dual-task RT assessment s may add clinical value and warrant further exploration after concussion
target: Robust RT deficits were observed acutely following concussion .
  Minimal magnitude differences were noted when comparing between- and within-subject effects , suggesting that pre-injury baselines may not add clinical value in determining post-injury RT impairment .
  RT deficits persisted up till the intermediate-term ( 21–59 days post-injury ) timeframe and indicate lingering deficits exist .
  Mean effect size differences were observed between RT measure types and computerized neurocognitive testing platforms ; however , all categories displayed negative effects consistent with impaired RT following concussion .
background: Reaction time ( RT ) deficits are reported following concussion , but it is unknown when these deficits normalize to pre-injury status .
  It is also unclear how factors such as RT measurement technique and participant characteristics influence post-concussion RT .
  The purpose of this systematic review and meta- analysis was to ( 1 ) characterize acute post-concussion ( 0–3 days ) RT impairments , ( 2 ) examine RT recovery over time , and ( 3 ) explore moderating factors related to acute RT impairment following concussion .