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Updated: Mar 7, 2026
A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
Reliability and Validity of the Functional Assessment of Neurocognition in Sport: A Paradigm Shift in Postconcussion
Landon B Lempke1,2, Benjamin L Brett3, Douglas P Terry4
1Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond.
Context:
Assessments used after concussion provide strong diagnostic accuracy and aid in initial health care planning, but they can have limited utility after the acute time frame. Current concussion assessments have low ecological validity in assessing return-to-sport readiness. We developed a functional assessment protocol, the Functional Assessment of Neurocognition in Sport (FANS), to address these limitations.
Objective:
To evaluate the psychometric properties of the FANS, including test-retest reliability, minimal detectable change, and divergent validity.
Design:
Descriptive laboratory study.
Setting:
Clinical laboratory.
Patients Or Other Participants:
A total of 17 healthy, physically active participants (10 [58.82%] women, 7 [41.18%] men; age = 21.94 ± 3.15 years, height = 170.49 ± 11.42 cm, mass = 72.99 ± 26.72 kg; 13 [76.5%] with no lifetime concussion history).
Main Outcome Measures:
Participants completed the FANS at 2 time points approximately 14 days apart and conventional clinical assessments (symptom checklist, balance testing, and computerized neurocognitive testing) at the first time point. We used the FANS to examine 7 cognitive domains (verbal memory, visual memory, reaction time, processing speed, cognitive-motor flexibility, delayed verbal memory, and delayed visual memory) by incorporating neuropsychological test paradigms with whole-body cognitive-movement tasks. We used intraclass correlation coefficients with 95% CIs and Pearson r correlations to evaluate test-retest reliability and divergent validity.
Results:
All FANS outcomes displayed acceptable test-retest reliability (intraclass correlation coefficient ≥ 0.63), with the lowest being the verbal memory interference subtest. Standard error of measurement and minimal detectable change values overall were small relative to their possible score ranges. Correlations between the FANS and conventional clinical assessments demonstrated select FANS reaction time and processing speed outcomes exceeded the divergent validity threshold with computerized neurocognitive testing reaction time (r range, -0.79 to 0.77).
Conclusions:
The FANS overall displayed acceptable test-retest reliability comparable with traditional neurocognitive test platforms and acceptable divergent validity. The FANS reaction time and processing speed may overlap partially with computerized neurocognitive testing reaction time, and this warrants further examination in a clinical population. Although the FANS is reliable and valid for use, future research is needed to establish the utility of the FANS for return-to-sport readiness for concussion.
