Computerized Neurocognitive Performance Does Not Reflect Gross Visual-Motor Function During Concussion Baseline Assessments

Journal of Athletic Training. -


Bolding, B. A., K. R. Ford, J. M. Smoliga and A. Nguyen.



Context: Management of sport-related concussions commonly includes the use of computerized neurocognitive assessment methods. Verbal and visual memory, processing speed, and reaction time are assessed through a battery of modules on a personal computer. A potential limitation with this assessment method is that it may not effectively evaluate changes in gross visual-motor function resulting from a sport-related concussion. While an appropriate level of gross visual-motor function is essential in safe return to activity following injury and in the overall management of sport-related concussions, it is unknown if computerized neurocognitive assessment methods are effective in assessing the combination of neurocognitive performance and gross visual-motor function. Objective: To examine the relation between baseline performance using a computerized neurocognitive testing method and a gross visual-motor testing method. Design: Cross-sectional study. Setting: Athletic training clinic and research laboratory. Patients or Other Participants: Forty-nine male (20.1 ± 1.4yrs, 179.9 ± 6.6cm, 81.5 ± 14.0kg) and twenty-seven female (19.7 ± 1.1yrs, 165.0 ± 6.7cm, 65.0 ± 6.9kg) Division I lacrosse players participated. Intervention(s): All participants completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and Dynavision gross visual-motor tests (D2), as part of a concussion baseline assessment protocol. Main Outcome Measure(s): Separate Pearson correlations (r) examined the relation between ImPACT composite scores (visual-motor speed, reaction time, impulse control, verbal memory) and D2 visual-motor tests (visual-motor speed, right and left reaction score, dual task reaction, dual task memory recall) in males and females. Results: In males, the ImPACT composite scores of reaction time (0.617 ± 0.064s) were correlated (r = 0.369, P = 0.011) with D2 right limb reaction score (0.490 ± 0.082). ImPACT composite scores of verbal memory (83.8 ± 8.6) were correlated (r = 0.334, P = 0.022) with D2 dual task memory recall (4.73 ± 1.75). In females, only ImPACT composite scores of verbal memory (82.9 ± 11.9) were correlated (r = 0.605, P = 0.001) with D2 dual task reaction percentage (72.8 ± 18.6%). No other significant correlations (P > 0.05) were observed between the other ImPACT and D2 measures for males (rrange = -0.1870.259) and females (rrange = -0.2810.319). Conclusions: Weak to moderate correlations were only observed between baseline reaction performance tests using computerized neurocognitive and gross visual-motor assessment methods. Furthermore, reaction time may be specific to the right limb and not reflect reaction time of the contralateral limb. The lack of observed correlations between other components baseline tests indicates that computerized neurocognitive assessment methods may not be effective in evaluating the combination of neurocognitive and gross visual-motor performance. Based on these findings, the addition of gross visual-motor assessments should be considered in the management of sport-related concussion.

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