Sports-Related Concussions in Youth Improving the Science, Changing the Culture (2014) / Chapter Skim
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Appendix C: Clinical Evaluation Tools
Appendix C: Clinical Evaluation Tools
Pages 309-336
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From page 309... ...
. Because most concussed individuals score 14 or 15 on the 15-point scale, its primary use in evaluating individuals for sports-related concussions is to rule out more severe brain injury and to help determine which athletes need immediate medical attention (Dziemianowicz et al., 2012)
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. Sport Concussion Assessment Tool 3 The Sport Concussion Assessment Tool 3 (SCAT3)
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, normative data and concussion cutoff scores are not yet available. However, a recent study to determine baseline values of the SCAT2 in normal male and female high school athletes found a high error rate on the concentration portion of the assessment in non-concussed athletes, suggesting the need for baseline testing in order to understand post-injury results (Jinguji et al., 2012)
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From page 312... ...
The Child SCAT3 includes versions of the SAC and Maddocks questions, the GCS, a medical history completed by the parent, child and parent concussion symptom scales, neck evaluation, and balance assessment. As is the case with the SCAT3 for adults, the Child SCAT3 has yet to be validated, so no normative data are available, nor are there concussion cutoff scores.
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. Studies of the King-Devick test involve 10 or fewer concussed athletes (Galetta et al., 2011a,b, 2013; King et al., 2012, 2013)
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Concussed athletes were tested within 48 hours of injury and a control was selected at the same time interval. Post-injury tests were compared to baseline scores and reliable change indices were calculated using the control group means and standard error of difference from the two time-points.
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The higher the score, the worse the athlete has performed. The BESS test has very good test-retest reliability (0.87 to 0.97 intraclass correlations)
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The low sensitivity of the SOT suggests the need to use additional evaluation tools to improve identification of individuals with concussion. SYMPTOM SCALES Acute Concussion Evaluation The Acute Concussion Evaluation (ACE)
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Follow-Up Action Plan Complete ACE Care Plan and provide copy to patient/family. ___ No Follow-Up Needed ___ Physician/Clinician Office Monitoring: Date of next follow-up ___ Referral: ___ Neuropsychological Testing ___ Physician: Neurosurgery____ Neurology____ Sports Medicine____ Physiatrist____ Psychiatrist____ Other ___ Emergency Department ACE Completed by:______________________________ © Copyright G
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From page 318... ...
Player Name:____________________________________________________ Date of Injury:__________________ Date of Exam:____________________ absent mild moderate severe Score 0 1 2 3 4 5 6 Headache Nausea Balance Problems/Dizziness Fatigue Drowsiness Feeling like "in a fog" Difficulty concentrating Difficulty remembering Sensitivity to light Sensitivity to noise Blurred vision Feeling slowed down TOTAL: Other symptoms evident since injury? : FIGURE C-4 Concussion symptom inventory.
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FIGURE C-5 Graded symptom checklist. SOURCE: Guskiewicz et al., 2004, Appendix A, p.
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validity. Finally, the measures shows reliable change in 8- to 15-year-olds with mild traumatic brain injury (mTBI)
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. Rivermead Post-Concussion Symptoms Questionnaire The Rivermead Post-Concussion Symptoms Questionnaire (RPCSQ)
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Player's Name: ____________________ Team: _________________ Position: ______________ 322 RATING BASELINE TESTING 2 TESTING 3 TESTING 4 TESTING 5 SYMPTOM None Mod. Severe Date: Date: Date: Date: Date: Headache 0 1 2 3 4 5 6 Nausea 0 1 2 3 4 5 6 Vomiting 0 1 2 3 4 5 6 Balance problems 0 1 2 3 4 5 6 Dizziness 0 1 2 3 4 5 6 Fatigue 0 1 2 3 4 5 6 Trouble falling asleep 0 1 2 3 4 5 6 Sleeping more than usual 0 1 2 3 4 5 6 Sleeping less than usual 0 1 2 3 4 5 6 Drowsiness 0 1 2 3 4 5 6 Sensitivity to light 0 1 2 3 4 5 6 Sensitivity to noise 0 1 2 3 4 5 6 Irritability 0 1 2 3 4 5 6 Sadness 0 1 2 3 4 5 6 Nervousness 0 1 2 3 4 5 6 Feeling more emotional 0 1 2 3 4 5 6 Numbness or tingling 0 1 2 3 4 5 6 Feeling slowed down 0 1 2 3 4 5 6 Feeling mentally "foggy" 0 1 2 3 4 5 6 Difficulty concentrating 0 1 2 3 4 5 6 Difficulty remembering 0 1 2 3 4 5 6 TOTAL SCORE FIGURE C-6 Post-concussion scale.
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From page 323... ...
investigated the construct validity of ANAM by examining the relationship between ANAM and a set of traditional clinical neuropsychological tests (Trail Making Test Part B, Consonant Trigrams total score, Paced Auditory Serial Addition test, the Hopkins Verbal Learning test, and the Stroop Color and Word test)
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In the second study, 21 New Zealand military personnel were administered the ANAM test battery eight times across 5 days. Individuals demonstrated practice effects on five of six subtests in the two studies.
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determined the reliability of CogSport by calculating intraclass correlation coefficients on serial data collected in 60 healthy youth volunteers at intervals of 1 hour and 1 week. In the same study, construct validity was determined by calculating intraclass correlation coefficients between CogSport and performance on traditional paper-and-pencil assessment tools (the Digit Symbol Substitution test and the Trail Making Test Part B)
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From page 326... ...
Because Axon Sport is a new computerized neuropsychological test battery, more research is warranted on this test battery to determine whether it is effective in assessing concussion outcomes. Concussion Resolution Index The CRI, developed by HeadMinder, Inc., is a Web-based computerized neuropsychological assessment battery composed of six subtests: reaction time, cued reaction time, visual recognition 1 and 2, animal decoding, and symbol scanning (Erlanger et al., 2003)
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Immediate Post-Concussion Assessment and Cognitive Testing ImPACT is an online computerized neuropsychological test battery composed of three general sections. First, athletes input their demographic and descriptive information by following instructions on a series of screens.
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The following scores were generated: neuropsychological verbal memory score, neuropsychological working memory score, neuropsychological visual memory score, neuropsychological processing speed score, neuropsychological attention score, neuropsychological reaction time score, neuropsychological motor score, and neuropsychological impulse control score. The results indicated significant correlations between neuropsychological domains and all ImPACT domain scores except the impulse control factor.
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Results indicated that motor processing speed was the most stable composite score with an intraclass correlation of 0.85, followed by reaction time (0.76) , visual memory (0.70)
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also found good concurrent validity between ImPACT scores and a battery of paper-and-pencil neuropsychological tests. However, there were differences in factor structure between the paper-and-pencil battery and the ImPACT battery, suggesting differences in "coverage" of neuropsychological constructs.
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2012. Magnitudes of decline on Automated Neuropsycho logical Assessment Metrics subtest scores relative to predeployment baseline performance among service members evaluated for traumatic brain injury in Iraq.
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2005. Exploring children's self-efficacy related to physical activity performance after a mild traumatic brain injury.
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2008a. Improving identification and diagnosis of mild traumatic brain injury with evidence: Psychometric support for the Acute Concussion Evaluation.
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1997. Monitoring recovery from traumatic brain injury using Automated Neuropsychological Assessment Metrics (ANAM V1.0)
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2010. Ex amining Sport Concussion Assessment Tool ratings for male and female youth hockey players with and without a history of concussion.
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2012. Reliable change in postconcussive symptoms and its functional conse quences among children with mild traumatic brain injury.
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