Evaluation of a Simple Test of Reaction Time for Baseline Concussion Testing in a Population of High School Athletes
MacDonald J., Wilson J., Young J., Duerson D., Swisher G., Collins C., Meehan W. The Clinical Journal of Sports Medicine.2014; ahead of print.
Take Home Message: The clinical reaction time test is a cost efficient, simple test to perform; however, further validation of this clinical measure is warranted before incorporation into the concussion protocol.
A common sign following a concussion is impaired reaction time. It is not only important to measure reaction time due to is prognostic importance, but also because it has been found that reaction time decreases with multiple concussions as well as it is may be unsafe for an athlete to return to play if they have impaired reaction time. The simple reaction time test is validated within the collegiate population, but not within the high school population. Therefore, the purpose of this study was to assess the reliability and validly of the clinical reaction time test in a high school population. Four hundred and forty-eight high school athletes (75% male; average age 15.5 years) that competed in football or soccer during their 2011 to 2012 (222 athletes) or 2012 to 2013 (226 athletes) academic years were included in this study. Athletes completed a baseline neurocognitive exam (i.e., AxonSports) and clinical reaction time test. The authors assessed how related that clinical reaction time was to computerized reaction time. To complete the clinical reaction time test the authors asked an athlete to catch the device between his/her thumb and fingers. After one unrecorded practice attempt the athlete completed 8 attempts. The test administer measured the distance the device fell before being caught using the 0.5-cm incremental markings on the device. The total distance the device fell before being caught was converted into the athlete’s reaction time. Within the first year of the study, the computerized reaction and the clinical reaction time were barely related. During the second year of the study, there was no relationship between the tests. Among 176 athletes who completed the test in both years the authors found that there was marginal reliability for both the computer ( 2011: average 313.8 ms versus 2012: average 336.1 ms) and clinical reaction time (2011: average 230. 0 ms versus 2012: average 218.8).
This is an important study because validity and reliability are fundamental characteristics that need to be established for any clinical test such as the clinical reaction time test. The clinical reaction time test device produced a “faster” measure of reaction time compared to the computer. However, the clinical reaction time task was not as reliable as the computerized reaction time test. Additionally, the relationship between the tests were low to nonexistent. This could be due to the high school athletes taking the tests in a group environment, where the computerized test may be sensitive to distractions. Age may also play a factor, where younger athletes may still be developing hand eye coordination. Further reliability and validity testing is necessary before incorporating the clinical reaction time test into the concussion protocol for high school athletes. This study is a nice reminder that a test validated in one population (for example, college athletes) might not work in another population (for example, high school athletes).
Questions for Discussion: Have you used this test before? If so, what are your thoughts? Do you prefer the computerized version to assess reaction time? If so, why do you prefer the computerized version?
Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban
Consistency of a Clinical Reaction Time Assessment Between Seasons: A Possible Low Cost Concussion Assessment?Effectiveness of Computerized Neurocognitive Testing