scholarly journals A Cohort Study of the Temporal Stability of ImPACT Scores Among NCAA Division I Collegiate Athletes: Clinical Implications of Test–Retest Reliability for Enhancing Student Athlete Safety

2020 ◽  
Vol 35 (7) ◽  
pp. 1131-1144
Author(s):  
Sara J Mason ◽  
Bradley S Davidson ◽  
Marybeth Lehto ◽  
Aurélie Ledreux ◽  
Ann-Charlotte Granholm ◽  
...  
Keyword(s):  
Reaction Time ◽  
Ncaa Division I ◽  
Verbal Memory ◽  
Temporal Stability ◽  
Division I ◽  
Cognitive Test ◽  
Motor Speed ◽  
Visual Motor ◽  
Composite Scores ◽  
The Impact

Abstract Objective In this study we examined the temporal stability of the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) within NCAA Division I athletes across various timepoints using an exhaustive series of statistical models. Methods Within a cohort design, 48 athletes completed repeated baseline ImPACT assessments at various timepoints. Intraclass correlation coefficients (ICC) were calculated using a two-way mixed effects model with absolute agreement. Results Four ImPACT composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, and Reaction Time) demonstrated moderate reliability (ICC = 0.51–0.66) across the span of a typical Division I athlete’s career, which is below previous reliability recommendations (0.90) for measures used in individual decision-making. No evidence of fixed bias was detected within Verbal Memory, Visual Motor Speed, or Reaction Time composite scores, and minimal detectable change values exceeded the limits of agreement. Conclusions The demonstrated temporal stability of the ImPACT falls below the published recommendations, and as such, fails to provide robust support for the NCAA’s recommendation to obtain a single preparticipation cognitive baseline for use in sports-related concussion management throughout an athlete’s career. Clinical interpretation guidelines are provided for clinicians who utilize baseline ImPACT scores for later performance comparisons.

Signs of cognitive dysfunction in adult players of club level rugby

2019 ◽  
Vol 50 (1) ◽  
pp. 128-140 ◽  
Author(s):  
Diana Zoccola ◽  
Ann B Shuttleworth-Edwards ◽  
Sarah E Radloff
Keyword(s):  
Reaction Time ◽  
Cognitive Dysfunction ◽  
Verbal Memory ◽  
Visual Memory ◽  
Rugby Union ◽  
Motor Speed ◽  
Visual Motor ◽  
The Impact ◽  
Rugby Players

The objective of this study was to investigate players of club level Rugby Union (hereafter rugby) over one rugby season, for signs of residual cognitive dysfunction due to repeated concussive events incurred during long-term participation in the sport. Adult male players of club level rugby, without a diagnosis of a concussion during the season ( n = 20), were compared with non-contact club level sports participants ( n = 22) of equivalent sex, age, education, and estimated IQ at pre-, mid-, and post-season intervals. Measures included the ImPACT Verbal Memory, Visual Memory, Visual Motor Speed and Reaction Time composites, and the Purdue Pegboard test. Statistical group comparisons revealed consistently poorer performance for rugby players compared with controls for ImPACT Visual Motor Speed and Reaction Time composites at all test intervals, and for the Purdue Pegboard tasks at the first two test intervals. Repeat measures comparisons across the three test intervals demonstrated differential learning patterns between groups on ImPACT Visual Memory, ImPACT Reaction Time, and Purdue Both tasks, suggestive of cognitive vulnerability in the rugby group. Overall, the results reveal deleterious cognitive performance in adult club level rugby players relative to equivalent non-contact sports controls. The finding serves to endorse indications from other studies that demonstrate persistent brain injury effects in association with long-term participation in a contact sport. Recommendations for further research and management of concussion in rugby players are discussed.

scholarly journals A-38 A Different Approach for Examining Gender Differences on Computerized Neurocognitive Testing: Percentile Ranks Versus Composite Scores

2020 ◽  
Vol 35 (5) ◽  
pp. 634-634
Author(s):  
P Schatz ◽  
K Slicer ◽  
R J Elbin
Keyword(s):  
Gender Differences ◽  
Reaction Time ◽  
Verbal Memory ◽  
Visual Memory ◽  
Motor Speed ◽  
Age And Gender ◽  
Visual Motor ◽  
Gender Based ◽  
And Gender ◽  
Composite Scores

Abstract Objective ImPACT is a popular tool used to assess neurocognitive function after concussion. Age- and gender-based percentile ranks are provided as part of the ImPACT clinical report, but only raw composite scores are provided for research. Percentile ranks may provide an alternate look at gender differences on neurocognitive testing. We sought to compare the use of percentile ranks versus composite scores when comparing neurocognitive performance between male and females. Method Pre-season baseline data from 3,238 collegiate athletes were exported from a larger multi-site database, 1,714 male (53%) and 1,524 female (47%), ages 18–22 (Mean = 19.3, SD = 1.2). ImPACT composite scores were extracted (Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time) and Percentile Ranks were calculated using age- and gender-based reference tables in the ImPACT 2017–2012 Technical Manual. One-way analyses of variance (ANOVA) were conducted with gender as the IV and the four composite scores and their associated percentile ranks as the DVs. Bonferroni correction for 8 comparisons set the alpha level to p < .006. Results ANOVAs revealed a significant effect of gender on ImPACT Verbal Memory [F(1,3236) = 16.32, p < .001], Visual Memory [F(1,3236) = 66.06, p < .001], Visual Motor Speed [F(1,3236) = 15.61,p < .001] but not Reaction Time [F(1,3236) = 2.59, p = .11]. When using percentile ranks, ANOVAs revealed a significant effect of gender on only Visual Motor Speed [F(1,3236) = 31.07, p < .001], but not Verbal Memory [F(1,3236) = 2.43, p = .12], Visual Memory [F(1,3236) = 0.48, p = .49], or Reaction Time [F(1,3236) = 0.61, p = .44]. Conclusions Use of ImPACT Composite Scores in concussion research may exaggerate or inappropriately promote gender differences on computerized neurocognitive testing. Given that age- and gender-based normative data are available, use of percentile ranks is recommended.

scholarly journals B-44 An Examination of Balance Measurements in Predicting Post-Concussion Neurocognitive Dysfunction

2019 ◽  
Vol 34 (6) ◽  
pp. 990-990
Author(s):  
A DaCosta ◽  
A Crane ◽  
M Fasciana ◽  
A LoGalbo
Keyword(s):  
Reaction Time ◽  
Verbal Memory ◽  
Visual Memory ◽  
Clinical Utility ◽  
Collegiate Athletes ◽  
Motor Speed ◽  
Balance Performance ◽  
Neurocognitive Dysfunction ◽  
Balance Deficits ◽  
Visual Motor

Abstract Objective Previous research indicates that athletes experiencing concussions demonstrate acute balance deficits (Guskiewicz, 2011). Although it is hypothesized that balance performance is related to neurocognitive function in athletes experiencing a concussion (Guskiewicz, Ross, & Marshall, 2001; Broglio, Sosnoff, Ferrara, 2009), limited research exists regarding the clinical utility of baseline measures. Method 68 collegiate athletes (ages 18-23; M = 19.62, SD = 1.44) were evaluated using the Balance error scoring system (BESS) and ImPACT at baseline and post-concussion. Multiple linear regressions were used to determine how BESS performance change across evaluations predicted post-concussion neurocognitive dysfunction compared to post-concussion performance alone. Results BESS performance changes from baseline to post-concussion significantly predicted post-concussion Verbal Memory (R² = .06, p = .05), Visual Memory (R² = .135, p = .002), Visual-Motor Speed (R² = .146, p = .001), Reaction Time (R² = .156, p = .001), and Total Symptom Scores (R² = .112, p = .005); while post-concussion BESS scores predicted Visual Memory (R² = .138, p = .002), Visual-Motor Speed (R² = .137, p = .002), and Reaction Time (R² = .145, p = .001). Therefore, assessing change in BESS performance is a more comprehensive predictor of neurocognitive dysfunction than solely post-concussion BESS performance. Conclusions Changes in BESS performance from baseline to post-concussion was found to be a more comprehensive predictor of neurocognitive dysfunction than post-concussion BESS scores alone. Therefore, our results support the clinical utility of evaluating balance at pre-participation to better understand neurocognitive risk factors.

scholarly journals THE RELATIONSHIP BETWEEN ACUTE MOOD, SLEEP, AND SEX ON NEUROCOGNITIVE PERFORMANCE POST-CONCUSSION IN ADOLESCENTS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0019
Author(s):  
Sara Stremlau ◽  
Richard Cameron Allred ◽  
Richard Gerkin ◽  
Steven Erickson ◽  
Jamie Pardini
Keyword(s):  
Reaction Time ◽  
Verbal Memory ◽  
Visual Memory ◽  
Cognitive Testing ◽  
Motor Speed ◽  
Neurocognitive Performance ◽  
Symptom Report ◽  
Mood Symptoms ◽  
Visual Motor ◽  
And Performance

Background: Both sleep disturbance and mood changes are common symptoms post-concussion (Sell & Rubeor, 2017). Studies have found these symptoms are correlated with poorer performance on neurocognitive testing (Kontos et al., 2012 and Kostyun et al., 2015). In addition, Brown et al., (2015) showed that females report more symptoms at both baseline and post-concussion compared to males on the Post-Concussion Scale and the Sport Concussion Assessment Tool 2. Hypothesis/Purpose: The purpose of this study is to investigate how a patient’s sex, as well as self-reported acute mood and sleep symptoms are related to neurocognitive performance in individuals with concussion. Methods: Data were acquired through IRB-approved retrospective chart review. Composite scores from the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computerized evaluation and self-reported symptom scores on the Post-Concussion Symptom Scale were gathered for 1619 adolescents age 12-18 (49.3% female) who presented to a large metropolitan outpatient clinic for treatment of concussion. Results: Females endorsed higher overall symptoms (x=19.52, SD 19.37, median 13.0 for females; x=12.88, SD 15.89, median 7.0 for males; Mann-Whitney U Test p<0.001). This same pattern emerged for the mood and sleep symptom clusters (female mood mean=2.92, SD 4.51; male mood mean=1.64, SD 3.34; female sleep mean=1.59, SD 2.0; male sleep mean=1.11, SD 1.84; both Independent Samples Mann-Whitney U Tests ps<0.001). There were significant but modest negative correlations between mood symptoms and performance on verbal memory (r=-0.174), visual memory (r=-0.213), and visual motor speed (r=-0.146) composites (all ps<0.01). There was positive correlation between reaction time composite and mood symptoms (r=0.191). There were significant but modest negative correlations between sleep symptoms and performance on verbal memory (r=-0.171), visual memory (r=-0.184), and visual motor speed (r=-0.161) composites (all ps<0.01). There was a positive correlation between reaction time composite and sleep symptoms (r=0.196, p<0.01). Conclusion: Consistent with prior research, adolescent females reported more symptoms post-concussion, including total symptom score, mood symptoms, and sleep symptoms. Adolescents presenting with more mood and sleep symptoms demonstrated poorer performance on neurocognitive testing. However, given the modest nature of the correlation, a significant amount of variation in test performance is not explained by symptom report. Results from this study underscore the importance of a multidimensional concussion assessment that includes both symptom report and cognitive testing when working with pediatric athletes. This study also reinforces the importance of understanding potential effects of sleep, mood, and sex on concussion.

scholarly journals Age of First Exposure to Contact Sports and Neurocognitive Performance in U.S. Service Academy Athletes

2019 ◽  
Vol 34 (5) ◽  
pp. 753-753
Author(s):  
J B Caccese ◽  
G L Iverson ◽  
K L Cameron ◽  
M N Houston ◽  
G T McGinty ◽  
...  
Keyword(s):  
Reaction Time ◽  
Symptom Severity ◽  
Sports Participation ◽  
Ice Hockey ◽  
Motor Speed ◽  
Neurocognitive Performance ◽  
Contact Sports ◽  
Visual Motor ◽  
Service Academy ◽  
The Impact

Abstract Purpose To examine the association between estimated age of first exposure (eAFE) to contact sports and neurocognitive performance and symptom ratings in collegiate U.S. Military Service Academy athletes. We hypothesized that contact-sports participation before the age of 12 would not be associated with worse neuropsychological test performance or greater symptom reporting. Methods Male cadets (N=891) who participated in contact sports [i.e., in lacrosse (n=211), wrestling (n=170), ice hockey (n=81), soccer (n=119), rugby (n=10)], or non-contact sports (n=298), completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test before the season. Generalized linear modeling was used to predict each cognitive domain score and the symptom severity score. Predictor variables were entered in the following order: group (contact vs. non-contact), eAFE (eAFE<12 vs. eAFE≥12), group-by-eAFE, and covariates for learning accommodation status, concussion history, and age. Results The group-by-eAFE interaction was not significant for any of the ImPACT composite scores (Verbal Memory, Wald Χ2=.073, p=.788; Visual Memory, Wald Χ2=2.71, p=.100; Visual Motor Speed, Wald Χ2=.078, p=.780; Reaction Time, Wald Χ2=.003, p=.955; Symptom Severity, Wald Χ2=2.87, p=.090). Learning accommodation history was associated with lower scores on Visual Motor Speed (Χ2=6.19, p=.013, B=-2.97). Older age was associated with faster reaction time (Χ2=4.40, p=.036, B=-.006) and lesser symptom severity (Χ2=5.55, p=.019, B=-.068). No other parameters were significant. Conclusion We observed no association between eAFE, contact-sport participation, cognitive functioning, or subjectively-experienced symptoms in this cohort. Earlier eAFE to RHI is not related to worse neurocognitive performance or greater subjectively-experienced symptoms in collegiate student-athletes enrolled in military academies.

A - 08 Within Subjects Comparison of Clinical Outcomes After First, Second, and Third Concussions in Adolescents*

2021 ◽  
Vol 36 (4) ◽  
pp. 648-648
Author(s):  
Feder AH ◽  
French J ◽  
Blaney N ◽  
Eagle SR ◽  
Kontos AP
Keyword(s):  
Clinical Outcomes ◽  
Verbal Memory ◽  
Visual Memory ◽  
Recovery Time ◽  
Cognitive Test ◽  
Motor Speed ◽  
Neurocognitive Performance ◽  
Symptom Scale ◽  
Visual Motor ◽  
Improved Performance

Abstract Objective The objective of the current study was to examine differences in clinical outcomes between adolescents’ first, second, and third concussions. Methods We conducted a retrospective medical chart review of adolescents (n = 40) aged 10–19 years-old (M = 13.0;SD = 1.9;56% male) who presented for evaluation of concussion at a specialty clinic for their first (Concussion 1 = C1), second (C2), and third (C3) concussions. Clinical outcomes included Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Post-Concussion Symptom Scale (PCSS), Vestibular/Ocular-Motor Screening (VOMS) scores from the first clinic visit for each injury, recovery time, and days between injuries. Paired samples t-tests were conducted to compare outcomes between concussions. Results When comparing initial presentation between C1 and C2, participants demonstrated no significant differences in ImPACT, PCSS (t[38] = 0.85, p = 0.402) or VOMS (t[34] = −0.75, p = 0.461), with the exception of faster Visual Motor Speed for C2 (t[38] = −3.45, p = 0.001). Participants demonstrated improved performance from C1 to C3 on ImPACT composites of Verbal Memory (t[38] = −4.22, p &lt; 0.001), Visual Memory (t[38] = −2.99, p = 0.005), Visual Motor Speed (t[38] = −5.14, p &lt; 0.001) and Reaction Time (t[38] = 0.11, p = 0.001). Symptom report was consistent on PCSS (t[38] = 1.80, p = 0.081) and VOMS (t[30] = −0.12, p = 0.903) between C1 and C3. Recovery time was similar comparing C1 to C2 (t[36] = −0.35,p = 0.725) and C1 to C3 (t[34] = 1.74,p = 0.090). Conclusions The results suggest adolescents demonstrate similar levels of symptoms, VOMS, and recovery time after first, second, and third concussions. Neurocognitive performance improved across C1 to C3, suggesting possible learning effect or improved performance with cognitive development. These results provide additional support for similarity between an athlete’s first and second concussion with further initial evidence that a third concussion does not result in worse outcomes.

scholarly journals Test-Retest Reliability of ImPACT Across a Two-Year Interval in Collegiate Athletes

2019 ◽  
Vol 34 (5) ◽  
pp. 778-778
Author(s):  
C Burley ◽  
A Datoc ◽  
R Bennett ◽  
L Lashley
Keyword(s):  
Verbal Memory ◽  
Visual Memory ◽  
Intraclass Correlation ◽  
Collegiate Athletes ◽  
Motor Speed ◽  
Retest Reliability ◽  
Symptom Scores ◽  
Visual Motor ◽  
Composite Scores ◽  
Test Retest Reliability

Abstract Purpose To examine the two-year test-retest reliability of Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) in a sample of collegiate athletes. Methods A total of 163 college athletes (63.8% female) completed two pre-season baseline assessments two years apart as mandated by their athletic programs. Participants completed the first baseline prior to their first year of competition (M age=18.38, M edu=12.13). Individuals with baselines flagged as invalid by ImPACT were excluded. No diagnosed concussions occurred between baseline assessments. Results Pearson r correlations for ImPACT composite scores between assessments ranged from .32 to .70. Paired samples t-tests indicated significant differences between verbal memory (t(162)=-4.61, p<.001, MD=-3.6) and visual-motor speed (t(162)=-4.10, p<.001, MD=-1.5) at time 1 and time 2. Intraclass correlation coefficients (ICCs) with a “two-way mixed” model and “consistency” type indicated higher reliability for all composite scores. Visual-motor speed (mean ICC=.83; .76–.87 95% confidence interval [CI]) was the most reliable composite score, followed by visual memory (.66; 95% CI .53-.75), impulse control (.62; 95% CI .48–.72), verbal memory (.58; 95% CI .43–.69), and reaction time (.49; 95% CI .30-.62). The total symptom score showed moderate reliability (.63; 95% CI .50–.73). Conclusion Overall, ImPACT composite and total symptom scores appear to maintain relative long-term stability in a collegiate sample across a two-year period. ImPACT composite scores showed moderate to good reliability, and total symptom scores showed moderate reliability. Results of this study corroborate previous research indicating moderately stable ImPACT scores across a 2-year test-retest period in collegiate athletes (Schatz, 2010).

The Effect of Test Setting Upon Test-Retest Reliability of ImPACT Baseline Tests in High School Athletes

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S23.2-S23
Author(s):  
Mark Thomas William Roberts ◽  
Jonathan Danield Lichtenstein
Keyword(s):  
High School ◽  
Reaction Time ◽  
Verbal Memory ◽  
Visual Memory ◽  
Motor Speed ◽  
High School Athletes ◽  
Retest Reliability ◽  
Concussion Management ◽  
Visual Motor ◽  
Test Retest Reliability

ObjectiveTo determine the test-retest reliability of ImPACT baseline tests across different schools within the same larger concussion management program.BackgroundImPACT is the most widely used concussion management cognitive testing tool. Baseline testing is often required for high school sports participation. Typically, testing occurs every 2 years based on test-retest reliability statistics in previous studies. Demographic and environmental factors, such as age, sex, number of participants, and supervision, all impact baseline performance. Studies to date have not examined test-retest differences across testing sites, such as between school differences.Design/MethodsCross-sectional retrospective design. Valid baseline tests from high school athletes over a 2-year interval were included. Participants who experienced concussions prior to or between tests were excluded. A total of 979 student athletes from 5 schools were included. The Intra-class correlations were determined over a 2-year period for each ImPACT composite score and school.ResultsICC estimates averaged between schools reflected good reliability for visual-motor speed (0.833), visual memory (0.673) and reaction time (0.615) over the two-year period. Verbal memory (0.586) and impulse control (0.556) were less reliable. Between schools a greater range of composite reliability was observed for reaction time (0.484–0.730) and impulse control (0.461–0.655) compared to verbal memory (0.534–0.637), visual memory (0.61–0.719), and visual-motor speed (0.769–914).ConclusionsAs previously established, reliability of ImPACT baselines vary by composite. This study revealed that reliability also varies by setting, as different schools yielded different ICCs. Consistent with the literature, the most reliable measure was visual-motor speed. The greatest difference in reliability between schools was for reaction time. These results suggest that test setting and environment affect reliability of ImPACT baseline scores, with varying effects per composite. Attention must be paid to environmental setting to improve reliability of baseline cognitive test performance to maximize athlete safety.

scholarly journals Baseline Neurocognitive Performance and Clearance for Athletes to Return to Contact

2017 ◽  
Vol 52 (1) ◽  
pp. 51-57 ◽  
Author(s):  
Breton M. Asken ◽  
James R. Clugston ◽  
Aliyah R. Snyder ◽  
Russell M. Bauer
Keyword(s):  
Cognitive Decline ◽  
Verbal Memory ◽  
Visual Memory ◽  
Sport Participation ◽  
Collegiate Athletes ◽  
Composite Score ◽  
Cognitive Test ◽  
Motor Speed ◽  
Neurocognitive Performance ◽  
Composite Scores

Context: Computerized neurocognitive assessments are commonly used to manage sport-related concussion. Variations in baseline performance may influence neurocognitive performance after injury as well as the amount of time needed for an athlete to be cleared for return to sport participation.Objective: To investigate the relationship between mean baseline Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) scores and postconcussion reliable decline as well as the association between postconcussion cognitive decline and days missed after injury.Design: Cross-sectional study.Setting: University concussion databank.Patients or Other Participants: A total of 84 collegiate athletes who sustained a concussion between 2008 and 2015 were studied. For each ImPACT composite score (verbal memory, visual memory, visual motor speed, reaction time), athletes were grouped based on the presence or absence of reliable decline and on the presence of reliable decline in 0, 1, 2, 3, or 4 cognitive domains.Main Outcome Measure(s): Outcome measures were baseline ImPACT composite scores and days missed due to concussion.Results: Athletes with a reliable decline in visual memory scored higher on baseline visual memory than did athletes with no decline or an improvement (t82 = −2.348, P = .021, d = 0.65). When comparing athletes who displayed a reliable decline with those who showed no change or an improvement in any composite score, days missed did not differ. The number of composite scores with a reliable decline demonstrated no main effect on days missed (P = .530).Conclusions: Athletes who exhibited cognitive decline in most or all of the composite scores did not miss more days after injury than athletes with a decline in fewer or none of the composite scores. Athletes should be educated regarding the lack of association between baseline neurocognitive scores and the presence or absence of a reliable decline after concussion, as well as the fact that, on average, individuals with a reliable decline across multiple domains did not miss more time after concussion.

scholarly journals A-28 Updated Baselines Show Improvement, Even When Athletes Sustain A Concussion Between Assessments

2020 ◽  
Vol 35 (5) ◽  
pp. 624-624
Author(s):  
S O'Connor ◽  
T Dean ◽  
P Schatz
Keyword(s):  
Verbal Memory ◽  
Visual Memory ◽  
Motor Speed ◽  
Change Scores ◽  
Visual Motor ◽  
Gender Based ◽  
And Gender ◽  
Percentile Scores ◽  
Composite Scores

Abstract Objective To explore change across repeated baseline assessments using raw scores and percentile scores, for athletes sustaining and not sustaining a concussion between baselines. Method Athletes (12–23 years) completed two valid, baseline neurocognitive test sessions using ImPACT. Participants were divided into independent groups based on having sustained a concussion between annual baselines (CONCUSSION; N = 269) or no concussion (NO CONCUSSION; N = 270) between baselines. Raw change scores were calculated between the first and follow-up baseline for both groups by subtracting the first baseline score from the updated baseline score on the four ImPACT composite scores. Age- and gender-based percentile scores were then applied for all participants, and percentile change scores were calculated in the same manner. Raw change scores and percentile change scores between groups were compared using 4 ANOVAs with a Bonferroni-corrected p-value of (p &lt; .0125). Results Using raw scores ANOVAs revealed that athletes in the CONCUSSION group showed significantly greater improvement on follow-up testing than athletes in the NO CONCUSSION group on Verbal Memory (p &lt; .001) and Visual Motor Speed (p = .001), but not on Visual Memory (p = .41) and Reaction Time (p = .04). Using percentile ranks, ANOVAs revealed significantly greater improvement in CONCUSSION group on Verbal Memory (p &lt; .001), but not on Visual Memory (p = .34), Visual Motor Speed (p = .03), or Reaction Time (p = .014). Conclusions Athletes sustaining a concussion between annual baseline assessments show increases on Verbal Memory and Visual Motor Speed follow-up testing when using raw composite scores, but only on Verbal Memory when using age- and gender-based percentile ranks.

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