Ransom Danielle M, Ahumada Luis, Amankwah Ernest K, Katzenstein Jennifer M, Goldenberg Neil A, Mularoni P Patrick
Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Arch Clin Neuropsychol. 2022 Oct 19;37(7):1545-1554. doi: 10.1093/arclin/acac023.
International consensus statements highlight the value of neuropsychological testing for sport-related concussion. Computerized measures are the most frequently administered assessments of pre-injury baseline and post-injury cognitive functioning, despite known measurement limitations. To our knowledge, no studies have explored the convergent validity of computerized Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and traditional, well-validated paper and pencil (P&P) neuropsychological tests in high school student athletes. This study aimed to assess a "hybrid" adolescent test battery composed of ImPACT and P&P measures to determine the extent of shared variance among ImPACT and P&P tests to inform comprehensive yet streamlined assessment.
Participants included male and female high school student athletes in the Southeastern United States participating in American football, hockey, and soccer who completed a battery of ImPACT and P&P tests (N = 69).
We performed principal component analysis with ProMax rotation to determine components of the hybrid battery that maximally accounted for observed variance of the data (Kaiser-Meyer-Olkin factor adequacy = 0.71). Our analysis revealed four independent factors (Verbal Learning and Memory, ImPACT Memory and Speed, Verbal Processing Speed/Executive Functions, and Nonverbal Processing Speed/Executive Functions) explaining 75% of the variance.
Findings of this study in adolescent student athletes support those from the adult literature demonstrating the independence of ImPACT and P&P tests. Providers should be aware of limitations in using standalone ImPACT or P&P measures to evaluate cognitive functioning after concussion. If confirmed in a larger, clinical sample, our findings suggest that a hybrid battery of computerized and P&P measures provides a broad scope of adolescent cognitive functioning to better inform recovery decisions, including return to play after concussion.
国际共识声明强调了神经心理学测试在与运动相关的脑震荡中的价值。尽管已知存在测量局限性，但计算机化测量是损伤前基线和损伤后认知功能最常用的评估方法。据我们所知，尚无研究探讨计算机化的脑震荡后即刻评估与认知测试（ImPACT）和传统的、经过充分验证的纸笔神经心理学测试在高中生运动员中的收敛效度。本研究旨在评估由ImPACT和纸笔测量组成的“混合”青少年测试组合，以确定ImPACT和纸笔测试之间的共同方差程度，为全面但简化的评估提供依据。
参与者包括美国东南部参加美式橄榄球、曲棍球和足球的男女高中生运动员，他们完成了一系列ImPACT和纸笔测试（N = 69）。
我们进行了具有普罗麦克斯旋转的主成分分析，以确定混合测试组合中能最大程度解释数据观察方差的成分（凯泽-迈耶-奥尔金因子充足性 = 0.71）。我们的分析揭示了四个独立因素（言语学习与记忆、ImPACT记忆与速度、言语处理速度/执行功能以及非言语处理速度/执行功能），解释了75%的方差。
本研究在青少年学生运动员中的发现支持了成人文献中的研究结果，表明ImPACT和纸笔测试具有独立性。医疗服务提供者应意识到使用单一的ImPACT或纸笔测量来评估脑震荡后认知功能的局限性。如果在更大的临床样本中得到证实，我们的研究结果表明，计算机化和纸笔测量的混合测试组合能够广泛涵盖青少年认知功能，从而更好地为康复决策提供信息，包括脑震荡后重返比赛。
