Abstract:
Context: Computerized neuropsychological testing, postural stability testing and self-reported symptomology are all used in a comprehensive concussion assessment plan. Few studies have looked at the clinical relevance between high and low symptom responders and their performance on a neuropsychological and postural balance assessment. Objective: To determine the relationships between ImPACT and the NeuroCom sensory organization test (SOT) and self-reported symptomology at 24-hours post-concussion. Design: Cross sectional study from 2004 2011. Setting: Research laboratory. Patients or Other Participants: 119 collegiate athletes diagnosed with a concussion (80 male, 39 female): age 20.34 ± 1.44 years. Interventions: All participants were evaluated approximately 24 hours post-concussion on the ImPACT neuropsychological test, NeuroCom postural stability assessment using the SOT and Head Injury Scale (HIS) to assess self-reported symptomology. The HIS consists of 22 symptoms, which assess symptom duration (1-6 rating scale) and symptom severity (06 rating scale). Low responders were defined as approximately the lower 25% of duration scores (≤12) and severity scores (≤11). Whereas, high responders were defined as approximately the upper 25% of duration scores (≥30) and severity scores (≥33). Significance was set a priori at P<.05. Main Outcome Measures: Twenty-two self-reported symptoms ranked in severity and duration; mean stability and the SOT sub scores of somatosensory, visual, vestibular and visual conflict scores from the SOT, and the ImPACT composite scores for verbal and visual memory, visual motor and reaction time. Results: High responders for symptom severity (n=26) had significantly declined scores in verbal memory (F1,55=7.27; P=.009), visual memory (F1,55 =4.42; P=.040), reaction time(F1,55=6.00; P=.018), SOT mean stability(F1,51=6.71; P=.012), and SOT visual (F1,51=8.79; P=.005) compared to low responders (n=31). Mean time to become selfreport symptom free was 12.50 ± 7.4 days for high severity responders and 8.70 ± 5.3 days for low responders. High responders for symptom duration (n=27) had significantly declined verbal memory (F1,52=5.83; P=.019), visual memory (F1,52=4.09; P=.048), reaction time (F1,52=8.22; P=.006), SOT mean stability (F1,45=6.10; P=.017), and SOT visual (F1,45=5.13; P=.028) scores compared to low responders (n=27). Mean time to become self-report symptom free was 12.83 ± 7.2 days for high duration responders and 8.29 ± 5.2 days for low responders. Conclusions: Our results show that high symptom responders demonstrated a significant decline in ImPACT and NeuroCom scores compared to low symptom responders, in the first 24 hours postconcussion. While this is not an unexpected finding, our data demonstrates that those with a greater symptom response were more impaired on typical measures used for concussion assessment. Further, those who had higher self-report symptoms tended to take more time until symptom-free. While self-report symptoms are one part of a comprehensive concussion management plan, we advocate a multifaceted approach to include neuropsychological testing and postural stability assessment.