Group Versus Individual Administration Affects Baseline Neurocognitive Test Performance
Moser RS, Schatz P, Neidzwski K, Ott SD. Am J Sports Med. 2011; 39(11): 2325-2330.
Computer-based tests are proving to be cost efficient and effective ways of documenting baseline neurocognitive function to later be used as an evaluation instrument for suspected concussions. The computer-based test can be administered to many athletes at one time with few or no medical personnel present; however, there is limited research on the effects of administering the tests in a group versus individual setting. The purpose of this study was to determine if those tested individually have a significantly better baseline compared to those assessed in a group. This study utilized a cohort of high school athletes with no exclusionary criteria (e.g., ADD, history of concussion, learning disability were included) that completed preseason baseline tests using the online version of ImPACT. Athletes were assigned to completing the test in either a group setting (n = 150) of 20 athletes per group at their school or individually at a private neuropsychological clinic (n = 166). They found athletes that were tested in a group setting scored significantly lower on verbal memory (83.4 vs. 86.5), visual memory (71.6 vs. 76.7), motor processing speed (35.6 vs. 38.4), and reaction time (0.61 vs. 0.58). The groups also had a higher number of students that obtained invalid results in a group setting (14 athletes) compared to the individual setting (1 athlete). When researchers excluded athletes with ADD, history of concussion, and learning disability athletes still had similar significant results. Due to differences in the brain during the maturation process they controlled for age in motor processing speeds and reaction time variables, and also had similar results. No significance was seen between groups in the total symptom score.
Having a baseline to compare preconcussion neurocognitive function to post concussion neurocognitive function to assist in return to play decision for medical personnel is important. If this baseline is not a true representation then it can deface the validity of the computed-based program. Baseline neurocognitive tests are routinely administered in group settings within high schools and college/university settings to establish a more cost and time efficient process. However, distractions in group like settings can affect the neurocognitive results. This may be why there was a significant difference between group and individual baseline scores within visual memory, verbal memory, motor processing speed, and reaction time, and not in reporting their total symptom score. This was significant even after eliminating the athletes with previous history of concussion, ADD, and those with a learning disability, which can be more easily distracted. This study demonstrates the need for more research on how this test is administered. Other variables like administrators instructions, lighting, seating arrangement, and removing extraneous sounds could all lead to a more controlled environment that a significant difference may not be identified between group versus individual testing. If you use a computer based neurocognitive exam how do you control for a good baseline test? How many athletes do you test per time and do you remain at the test to oversee and answer questions?
Written by: Jane McDevitt MS, ATC, CSCS
Reviewed by: Stephen Thomas
Reliability of the Online Version of ImPACT in High School Athletes
Reliability of Self-Reported Concussion History
Moser RS, Schatz P, Neidzwski K, & Ott SD (2011). Group versus individual administration affects baseline neurocognitive test performance. The American Journal of Sports Medicine, 39 (11), 2325-30 PMID: 21828367