Auditory comprehension performance of college students with and without sport concussion on Computerized-Revised Token Test Subtest VIII

Psychometric Properties of Computerized Cognitive Tools and Standard Neuropsychological Tests Used to Assess Sport Concussion: A Systematic Review

Athletic programs are more frequently turning to computerized cognitive tools in order to increase efficiencies in concussion assessment. However, assessment using a traditional neuropsychological test battery may provide a more comprehensive and individualized evaluation. Our goal was to inform sport clinicians of the best practices for concussion assessment through a systematic literature review describing the psychometric properties of standard neuropsychological tests and computerized tools. We conducted our search in relevant databases including Ovid Medline, Web of Science, PsycINFO, and Scopus. Journal articles were included if they evaluated psychometric properties (e.g., reliability, sensitivity) of a cognitive assessment within pure athlete samples (up to 30 days post-injury). Searches yielded 4,758 unique results. Ultimately, 103 articles met inclusion criteria, all of which focused on adolescent or young adult participants. Test-retest reliability estimates ranged from .14 to .93 for computerized tools and .02 to .95 for standard neuropsychological tests, with strongest correlations on processing speed tasks for both modalities, although processing speed tasks were most susceptible to practice effects. Reliability was improved with a 2-factor model (processing speed and memory) and by aggregating multiple baseline exams, yet remained below acceptable limits for some studies. Sensitivity to decreased cognitive performance within 72 h of injury ranged from 45%-93% for computerized tools and 18%-80% for standard neuropsychological test batteries. The method for classifying cognitive decline (normative comparison, reliable change indices, regression-based methods) affected sensitivity estimates. Combining computerized tools and standard neuropsychological tests with the strongest psychometric performance provides the greatest value in clinical assessment. To this end, future studies should evaluate the efficacy of hybrid test batteries comprised of top-performing measures from both modalities.

Electrophysiology reveals cognitive-linguistic alterations after concussion

Language deficits and alterations to the N400 ERP are commonly reported in aphasia and moderate-to-severe traumatic brain injury (TBI), but have seldomly been investigated after mild TBI, such as concussion. In the present study, the N400 was recorded from young adults within 1-month after concussion and matched controls during a sentence processing task. The N400 recorded to semantically incongruent sentence-final words was significantly more negative and with a more anterior distribution in the concussion group than control group. Among the concussion group, a weaker N400 was associated with more concussion symptoms, slower response time, and poorer executive functioning. Multiple regression results showed that concussion occurrence and male gender were independently associated with a more negative N400-effect, whereas symptoms were associated with a weaker N400. These findings provide novel evidence that alterations to lexical-semantic networks may occur after concussion and vary based on individual differences in post-concussion symptoms and cognitive function.

Prospective Exploration of Cognitive-Communication Changes With Woodcock-Johnson IV Before and After Sport-Related Concussion

Purpose The purpose of this study was to evaluate changes in cognitive-communication performance using Woodcock-Johnson IV Tests (WJIV) from pre-injury baseline to post sport-related concussion. It was hypothesized that individual subtest performances would decrease postinjury in symptomatic individuals. Method This prospective longitudinal observational nested cohort study of collegiate athletes assessed cognitive-communicative performance at preseason baseline and postinjury. Three hundred and forty-two male and female undergraduates at high risk for sport-related concussion participated in preseason assessments, and 18 individuals met criteria post injury. WJIV subtest domains included Word Finding, Speeded Reading Comprehension, Auditory Comprehension, Verbal Working Memory, Story Retell, and Visual Processing (letter and number). The power calculation was not met, and therefore data were conservatively analyzed with descriptive statistics and a planned subgroup analysis based on symptomatology. Results Individual changes from baseline to postinjury were evaluated using differences in standard score performance. For symptomatic individuals, mean negative decreases in performance were found for Retrieval Fluency, Sentence Reading Fluency, Pattern Matchings, and all cluster scores postinjury. Individual performance declines also included decreases in story retell, verbal working memory, and visual processing. Conclusions This study identified within-subject WJIV performance decline in communication domains post sport-related concussion and reinforces that cognitive-communication dysfunction should be considered in mild traumatic brain injury. Key cognitive-communication areas included speeded naming, reading, and verbal memory, though oral comprehension was not sensitive to change. Future clinical research across diverse populations is needed to expand these preliminary findings.

The auditory comprehension changes over time after sport-related concussion can indicate multisensory processing dysfunctions

BACKGROUND

Although science findings and treatment approaches of a concussion have changed in recent years, there continue to be challenges in understanding the nature of the post-concussion behavior. There is growing a body of evidence that some deficits can be related to an impaired auditory processing.

PURPOSE

To assess auditory comprehension changes over time following sport-related concussion (SRC) in young athletes.

METHODS

A prospective, repeated measures mixed-design was used. A sample of concussed athletes (n = 137) and the control group consisted of age-matched, non-concussed athletes (n = 143) were administered Subtest VIII of the Computerized-Revised Token Test (C-RTT). The 88 concussed athletes selected for final analysis (neither previous history of brain injury, neurological, psychiatric problems, nor auditory deficits) were evaluated after injury during three sessions (PC1, PC2, and PC3); controls were tested once. Between- and within-group comparisons using RMANOVA were performed on the C-RTT Efficiency Score (ES).

RESULTS

ES of the SRC athletes group improved over consecutive testing sessions (F = 14.7, p < .001), while post-hoc analysis showed that PC1 results differed from PC2 and PC3 (ts ≥ 4.0, ps < .001), but PC2 and PC3 C-RTT ES did not change statistically (t = 0.6, p = .557). The SRC athletes demonstrated lower ES for all test session when compared to the control group (ts > 2.0, Ps<.01).

CONCLUSION

Dysfunctional auditory comprehension performance following a concussion improved over time, but after the second testing session improved performance slowed, especially in terms of its timing. Yet, not only auditory processing but also sensorimotor integration and/or motor execution can be compromised after a concussion.