Computerized versus clinical testing: examining validity of cognitive assessment in sports-related concussion

Archives of Clinical Neuropsychology. 2005 Oct;


Macher, R. B., P. A. Arnett and R. J. Echemendia.



Objective: Though both pencil-and-paper and computerized neuropsychological measures are used to measure the effects of sports-related concussion, computerized measures have appeal in that they are usually faster, simpler, and less expensive to administer. However, minimal empirical research has been conducted that compares these approaches. This study was designed to test the relative sensitivity of commonly used paper-and-pencil versus computerized verbal memory tests. Method: Twelve collegiate athletes aged 18–22 (eight males, four females) were tested at baseline and post-concussion (mean = 4.8 (2.8) days post-injury). Immediate recall on The Hopkins Verbal Learning Test—Revised (HVLT-R) and the Verbal Memory Composite from the ImPACT computerized neuropsychological assessment were administered. Results: Though within-subjects ANOVAs revealed no significant change from baseline to post-concussion on the HVLT-R (P > .45), there was a significant improvement on the ImPACT (P < .05). There was no reliable change from baseline to post-concussion on the HVLT-R for any participant, yet 3 of the 12 showed reliable improvement on the ImPACT. Conclusion: Our results indicate that the ImPACT Verbal Memory Composite appears more sensitive to change than the HVLT-R. This may suggest that the ImPACT is more prone to practice effects than the HVLT-R. Alternatively, given the variability in scheduling post-concussion assessment, it is possible that improved scores in the athletes reflected true recovery from the concussions that occurred in addition to typical practice effects. More research with a larger sample will help distinguish the two possibilities.

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