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Improved post-injury cognitive test results: examining invalid baseline ImPACT testing.

Lisa M Manderino1, John Gunstad1

  • 1Department of Psychological Sciences, Kent State University, Kent, Ohio, USA.

Brain Injury
|February 2, 2022
PubMed
Summary

Many athletes show improved cognitive test scores after a suspected concussion compared to their baseline, suggesting unrepresentative ImPACT test data may be common. Current validity checks may miss these cases, impacting concussion assessment accuracy.

Keywords:
Concussioneffort testsneuropsychological assessmentneuropsychologist/neuropsychologysport

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Area of Science:

  • Sports Medicine
  • Neuroscience
  • Cognitive Psychology

Background:

  • Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is widely used for concussion evaluation.
  • Existing validity indices may not adequately detect unrepresentative baseline cognitive performances in athletes.
  • The actual prevalence of such unrepresentative baselines is currently unknown.

Purpose of the Study:

  • To determine the frequency of unrepresentative baseline ImPACT assessments in NCAA athletes.
  • To evaluate if post-injury performance improvements indicate flawed baseline data.
  • To assess the sensitivity of current ImPACT validity thresholds.

Main Methods:

  • Included post-injury ImPACT assessments from NCAA athletes with initially valid baseline scores.
  • Utilized published reliable change indices (RCI) to identify significant post-injury improvements from baseline.
  • Analyzed 155 post-injury assessments, excluding invalid protocols.

Main Results:

  • A significant proportion of athletes (43.9%, 68 out of 155) demonstrated reliable improvement on at least one ImPACT composite score post-injury.
  • This improvement occurred even when baseline protocols were initially deemed valid.
  • These findings suggest potential issues with baseline data representativeness.

Conclusions:

  • The prevalence of unrepresentative baseline ImPACT performances may be underestimated by current validity metrics.
  • Many athletes with potentially flawed baseline data may go undetected.
  • Further research is necessary to enhance ImPACT assessment validity and improve player safety protocols.