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Traumatic Brain Injury l: Introduction01:28

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DefinitionTraumatic brain injury, or TBI, is a disturbance of normal brain function induced by an external mechanical force, such as a direct blow to the head or a penetrating injury. It can affect both brain structure and function, producing a wide range of clinical outcomes. TBI is a heterogeneous condition, meaning its effects may differ based on the type, location, and severity of the injury.Basis of ClassificationTBI is classified based on severity, injury mechanism, or pathophysiology. In...

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Updated: Jul 11, 2026

A Neuroscientific Approach to the Examination of Concussions in Student-Athletes
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Immediate Post-concussion and Cognitive Testing: Ceiling Effects, Reliability, and Implications for Interpretation.

Charles E Gaudet1, Jeff Konin2, David Faust1

  • 1Department of Psychology, University of Rhode Island, Kingston, RI, USA.

Archives of Clinical Neuropsychology : the Official Journal of the National Academy of Neuropsychologists
|September 26, 2020
PubMed
Summary

This study found that the Immediate Post-concussion and Cognitive Testing (ImPACT) tool has concerning test-retest reliability, with ceiling effects potentially lowering scores. Users should consider these limitations in concussion assessment.

Keywords:
Baseline testingCeiling effectsConcussionImPACTNeurocognitive testingSerial assessmentTest–retest reliability

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Area of Science:

  • Neuroscience
  • Sports Medicine
  • Psychometrics

Background:

  • Immediate Post-concussion and Cognitive Testing (ImPACT) is widely used for concussion assessment.
  • Previous studies have raised concerns regarding ImPACT's test-retest reliability.

Purpose of the Study:

  • To investigate the psychometric properties of ImPACT.
  • To determine if ceiling effects influence ImPACT's reliability.

Main Methods:

  • Reviewed 92 ImPACT score reports from secondary school students (2010-2015).
  • Calculated test-retest reliabilities using Pearson correlations and intraclass correlation coefficients.
  • Analyzed score frequencies to identify ceiling effects.

Main Results:

  • Test-retest reliabilities ranged from 0.42 to 0.69 for composite scores and 0.19 to 0.71 for subscales.
  • Verbal and Visual Memory subscales showed the most significant ceiling effects.
  • Ceiling effects were observed in scores at or near the maximum possible score.

Conclusions:

  • Findings align with existing literature questioning ImPACT's reliability.
  • Identified ceiling effects likely reduce the reliability of certain ImPACT composite scores.
  • Recommends awareness of ceiling effects to prevent false-negative errors and suggests alternative assessment methods.