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OBJECTIVE: To establish the minimal detectable change (MDC) of the subtests that comprise the composite scores from remotely administered Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) baselines. METHOD: Remote ImPACT baseline data from 172 (male = 45, female = 127) National Collegiate Athletic Association Division I student-athletes from the 2020 and 2021 athletic preseasons were used to calculate the MDC at the 95%, 90%, and 80% confidence intervals (CIs) for all subtest scores used to generate the four core composite scores and the impulse control composite. RESULTS: The MDCs for the verbal memory subtests at the 95% CI were 10.31 for word memory percent correct, 4.68 for symbol match total correct hidden, and 18.25 for three letters percentage correct. Visual memory subtest MDCs were 19.03 for design memory total percent correct and 4.90 for XO total correct memory. Visual motor speed subtest MDCs were 18.89 for XO total correct interference and 5.40 for three letters average counted correctly. Reaction time (RT) MDCs were 0.12 for XO average correct, 0.95 for symbol match average correct RT, and 0.28 for color match average correct. Impulse control MDCs were 5.97 for XO total incorrect and 1.15 for color match total commissions. One-way repeated measures MANOVA, repeated measures ANOVAs, and Wilcoxon signed-ranks test all suggested no significant difference between any subtests across two remote ImPACT baselines. CONCLUSIONS: The ImPACT subtest scores did not significantly change between athletic seasons. Our study suggests the subtests be evaluated in conjunction with the composite scores to provide additional metrics for clinical interpretation.
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Conmoción Encefálica , Pruebas Neuropsicológicas , Humanos , Masculino , Femenino , Adulto Joven , Pruebas Neuropsicológicas/estadística & datos numéricos , Pruebas Neuropsicológicas/normas , Conmoción Encefálica/diagnóstico , Conmoción Encefálica/fisiopatología , Traumatismos en Atletas , Tiempo de Reacción/fisiología , Atletas , Adolescente , AdultoRESUMEN
BACKGROUND: Virtual reality (VR) has been explored to improve baseline and postinjury assessments in sport-related concussion (SRC). Some experience symptoms related to VR, unrelated to concussion. This may deter use of vestibular/ocular motor screening (VOMS) using VR. Baseline VR VOMS symptomatology differentiates baseline from overall symptomatology. HYPOTHESIS: There will be no difference between current clinical manual VOMS (MAN), a clinical prototype (PRO), and VR for symptom provocation change score (SPCS) and near point of convergence (NPC) average score in a healthy population and sex differences among the 3 modes of administration. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 688 National Collegiate Athletic Association Division I student-athletes completed VOMS using 3 methods (MAN, N = 111; female athletes, N = 47; male athletes, N = 64; average age, 21 years; PRO, N = 365; female athletes, N = 154; male athletes, N = 211; average age, 21 years; VR, N = 212; female athletes, N = 78; male athletes, N = 134; average age = 20 years) over a 3-year period (2019-2021) during annual baseline testing. Exclusion criteria were as follows: self-reported motion sickness in the past 6 months, existing or previous neurological insult, attention deficit hyperactivity disorder, learning disabilities, or noncorrected vision impairment. Administration of MAN followed the current clinical protocols, PRO used a novel prototype, and VR used an HTC Vive Pro Eye head mounted display. Symptom provocation was compared using Mann-Whitney U tests across each VOMS subtest with total SPCS and NPC average by each method. RESULTS: MAN had significantly (P < 0.01) more baseline SPCS (MAN = 0.466 ± 1.165, PRO = 0.163 ± 0.644, VR = 0.161 ± 0.933) and significantly (P < 0.01) and more SPCS (MAN = 0.396 ± 1.081, PRO = 0.128 ± 0.427, VR = 0.48 ± 0.845) when compared with PRO and VR. NPC average measurements for VR (average, 2.99 ± 0.684 cm) were significantly greater than MAN (average, 2.91 ± 3.35 cm; P < 0.01; Cohen's d = 0.03) and PRO (average, 2.21 ± 1.81 cm; P < 0.01; Cohen's d = 0.57). For sex differences, female athletes reported greater SPCS with PRO (female athletes, 0.29 ± 0.87; male athletes, 0.06 ± 0.29; P < 0.01) but not in VR or MAN. CONCLUSION: Using a VR system to administer the VOMS may not elicit additional symptoms, resulting in fewer false positives and is somewhat stable between sexes. CLINICAL RELEVANCE: VOMS may allow for standardization among administrators and reduce possible false positives.
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Traumatismos en Atletas , Conmoción Encefálica , Deportes , Humanos , Masculino , Femenino , Adulto Joven , Adulto , Traumatismos en Atletas/diagnóstico , Estudios de Cohortes , Conmoción Encefálica/diagnóstico , AtletasRESUMEN
CONTEXT: Guardian Caps (GCs) are currently the most popular external helmet-add on designed to reduce the head impact magnitude experienced by American football players. GCs have been endorsed by influential professional organizations, however few studies evaluating the efficacy of GCs are publicly available. OBJECTIVE: The objective of this study is to present preliminary on-field head kinematics data for NCAA Division I American football players using instrumented mouthguards through closely matched pre-season workouts both with and without GCs. DESIGN: Case Series. SETTING: The study took place during the 2022 American football pre-season. PATIENTS OR OTHER PARTICIPANTS: 25 Male NCAA Division I student-athletes participating in American football completed some portion of the 6 workouts included in this study. Of the 25 total participants, 7 completed all 6 workouts using their instrumented mouthguards. MAIN OUTCOME MEASURE(S): The peak linear acceleration (PLA), peak angular acceleration (PAA) and total impacts were collected using instrumented mouthguards (iMG) during 3 pre-season workouts using traditional helmets (TRAD), and 3 with Guardian Caps used in additional to a traditional helmet (GC). The TRAD and GC values for PLA, PAA and total impacts were analyzed using ANOVAs. RESULTS: There was no significant difference between the collapsed mean values for the entire sample between TRAD and GC for PLA (TRAD=16.3±2.0, GC=17.2±3.3Gs; p=0.20), PAA (TRAD=992.1±209.2, GC=1029.4±261.1rad/s2; p=0.51 and the total amount of impacts (TRAD=9.3±4.7, GC=9.7±5.7; p=0.72). Similarly, no difference was observed between TRAD and GC for PLA (TRAD=16.1±1.2, GC=17.2±2.79Gs; p=0.32), PAA (TRAD=951.2±95.4, GC=1038.0±166.8rad/s2; p=0.29 and total impacts (TRAD=9.6±4.2, GC=9.7±5.04s; p=0.32) between sessions for the7 repeated players. CONCLUSIONS: These data suggest no difference in head kinematics data (PLA, PAA and total impacts) when GCs are worn. This study suggests GCs may not be effective in reducing the magnitude of head impacts experienced by NCAA Division I American football players.
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Purpose The objective of this study is to present preliminary on-field head kinematics data for NCAA Division I American football players through closely matched pre-season workouts both with and without Guardian Caps (GCs). Methods 42 NCAA Division I American football players wore instrumented mouthguards (iMMs) for 6 closely matched workouts, 3 in traditional helmets (PRE) and 3 with GCs (POST) affixed to the exterior of their helmets. This includes 7 players who had consistent data through all workouts. Results There was no significant difference between the collapsed mean values for the entire sample between PRE and POST for peak linear acceleration (PLA) (PRE=16.3, POST=17.2Gs; p=0.20), Peak Angular Acceleration (PAA) (PRE=992.1, POST=1029.4rad/s2; p=0.51 and the total amount of impacts (PRE=9.3, POST=9.7; p=0.72). Similarly, no difference was observed between PRE and POST for PLA (PRE=16.1, POST=17.2Gs; p=0.32), PAA (PRE=951.2, POST=1038.0rad/s2; p=0.29 and total impacts (PRE=9.6, POST=9.7; p=0.32) between sessions for the 7 repeated players. Conclusion These data suggest no difference in head kinematics data (PLA, PAA and total impacts) when GCs are worn. This study suggests GCs are not effective in reducing the magnitude of head impacts experienced by NCAA Division I American football players.