Computerized neurocognitive
testing within 1 week of sport-related concussion: Meta-analytic review and
analysis of moderating factors

A., Braithwait R., Dakan S., Elbin RJ. Journal of the International
Neuropsychological Society. 2014; 20:1-9.

Take Home Message: Computerized
neurocognitive testing results suggest athletes suffer small impairments within
one week of a concussion. Several factors may lead to more pronounced
impairments: age, type of neurocognitive test, and test administrator.

commonly use computer neurocognitive testing to assess concussion. The
reliability and validity of these tests have come into question based on
several reviews (e.g., Mayers & Redick, 2012); however, Schatz et al (2012) pointed out flaws in
those reviews. It is imperative that we have an objective examination of computer
neurocognitive tests to determine their ability to identify the subtle effects
of concussion so that we can implement them and interpret them optimally.  Therefore, Kontos et al performed a meta-analysis of 37 studies to
determine the effects of concussion as measured by computerized neurocognitive
testing administered within the first week of injury as well as to examine results
among subgroups (i.e., type of neurocognitive exam, sport, & age). Overall,
the authors found that computerized neurocognitive testing indicate that there
are impairments after a concussion. The most sensitive outcome measures after a
concussion included code substitution, visual memory, processing speed, and
composite memory. In contrast, reaction time improved after a concussion. It is
important to note though that the amount of impairment varied a lot across the
37 studies, which suggest there may be important factors influencing the
results. For example, the authors found that computer neurocognitive testing
detected more impairments among younger adolescence (12-15 years old) compared with
older adolescence (16-18 years old) and college-aged (over 19 years old)
athletes. Athletes also demonstrated more pronounced impairments when they
competed in collision/contact sports, were tested by a neuropsychologist, or
tested with ImPACT.

large meta-analysis substantiates the need for a comprehensive approach to
concussion assessment. The small impairments detected with computerized
neurocognitive testing are likely a reflection of the complex and
individualized nature of a concussion injury. Unfortunately, we do not know for
sure how much impairment each concussion causes; we only know what the test is
telling us. From my previous experience, I have observed larger differences
with ImPACT between baseline and post concussion testing. Among computerized
neurocognitive assessments, ImPACT may be the most sensitive to changes after a
concussion. ImPACT may be beneficial because it includes a balanced set of
components that demonstrate an effect for concussion. Still, despite ImPACT being
used in 23 studies the size of impairment detected was very variable, which may
indicate that there are other important factors influencing the ability to
detect changes after a concussion (such as, test administrator or athlete’s
age). As expected younger athletes experienced the greatest effect, which may
indicate that younger athletes are at a greater risk for greater impairment,
this age group has smaller learning curves, or they take the test more
seriously than the older population. The authors also found that computer
neurocognitive testing detected large impairments when the test was
administered by a neuropsyochologist or researcher. It is important to note
though that it remains unclear if this is because of the administrator or that
the test was administered in a smaller group or a quieter setting, which we’ve
previously discussed was better than testing in a large group (see below). It
is important to note that the definition of concussion varied across the
studies, which may be another reason why this meta-analysis found that the
amount of impairment varied a lot across studies. This study is important
because it reinforces the individualized nature of concussions.  There are numerous factors that may influence
computer neurocognitive test results that need to be considered since we are
only detecting small impairments with these tests. Therefore, it may be ideal
to test other impairments in addition to neurocognitive; such as, vestibular
and ocular-motor changes.

Questions for Discussion:
Do you believe computerized neurocognitive testing is helpful in concussion
assessment? What other tests do you use to assess and return an athlete to play
following a concussion?

by: Jane McDevitt, PhD
by: Jeffrey Driban


Kontos AP, Braithwaite R, Dakan S, & Elbin RJ (2014). Computerized Neurocognitive Testing within 1 Week of Sport-Related Concussion: Meta-analytic Review and Analysis of Moderating Factors. Journal of the International Neuropsychological Society : JINS, 20 (3), 324-32 PMID: 24521662