New Clinical Instrument Assesses Concussion in Young Athletes

Allison Gandey

February 17, 2010

February 17, 2010 — A simple visuomotor test may help clinicians identify concussion in young people who are often not otherwise monitored. Investigators are developing an inexpensive, portable assessment tool designed for use on the sidelines and in training rooms of sporting events.

"It is a standardized and simple clinical measure of reaction time that we have found to be reliable and valid in our prior work," report the researchers led by James Eckner, MD, from the University of Michigan at Ann Arbor.

The tool appears to be sensitive to changes in reaction time after concussion, they suggest. Investigators say the method could have a role as part of a multifaceted sport concussion assessment battery.

Their pilot study will be presented in April at the American Academy of Neurology 62nd Annual Meeting in Toronto, Ontario, Canada. First results were released February 15.

The investigators acknowledge the preliminary nature of the work. They recruited members of the varsity football, wrestling, and women's soccer teams at a single university.

Any athlete who subsequently sustained a physician-diagnosed concussion underwent reaction time clinical testing within 72 hours of injury. Just 7 athletes had a concussion.

Small Sample

Using the new tool, the researchers measured baseline mean reaction time. To test the injured athletes, the examiner released a rigid cylinder affixed to a weighted disk to assess how quickly they were able to catch it.

Investigators calculated the fall distance of the device using the formula for a body falling under the influence of gravity. They found that the reaction time of 6 of the 7 injured athletes was prolonged compared with their baseline measurement. Mean ± SD reaction time increased from 198 ± 21 milliseconds at baseline to 218 ± 29 milliseconds after injury (effect size, 0.795).

Asked by Medscape Neurology to comment on the study, Anthony Alessi, MD, from Neuro Diagnostics in Norwich, Connecticut, said, "The authors clearly state that it is only a pilot study, but the sample size is very small, and it is difficult to draw any conclusions from this."

Dr. Alessi suggests it is overly simplistic to assume that traumatic brain injuries, including concussion, can be accurately assessed with just one tool. "Many marketers have tried to sell software and other devices as a substitute for a complete neurological assessment," he said. "In doing so, they are being dishonest and jeopardizing the health of young athletes."

Portable Tool

Dr. Alessi suggests a larger study of the current tool is necessary. "I believe this instrument may be very useful," he noted. "The results should be well correlated with a clinical examination."

Dean Karahalios, MD, from the NorthShore University Health System in Chicago, Illinois, added that he has been following this research team for some time and he says the work is exciting.

"Current computer-based technologies are expensive and hard to implement," he noted. "This could break a barrier and get testing out into the field and help evaluate young people who might not otherwise be assessed."

Dr. Karahalios says he would have liked to see this reaction time test compared with other measures. "My concern is that reaction time is just 1 area that could be adversely affected by concussion. Other problems could be missed."

But on the whole, Dr. Karahalios says he sees this instrument as a step in the right direction and could prove useful in monitoring more athletes.

The researchers have disclosed no relevant financial relationships.

American Academy of Neurology (AAN) 62nd Annual Meeting: Abstract 1215. Presented April 10-17, 2010.

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