Concussion Assessment in Low Socioeconomic Urban High School Athletes: Influence of Learning Disabilities, Previous History of Concussion, Grade Point Average, Cognitive Maturity and Effort on concussion baseline scores.

Principle Investigator: Tamerah N. Hunt, PhD, AT, Assistant Professor of Clinical Allied Medical Professions

Institution:The Ohio State University Medical Center

Title: Concussion Assessment in Low Socioeconomic Urban High School Athletes: Influence of Learning Disabilities, Previous History of Concussion, Grade Point Average, Cognitive Maturity and Effort on concussion baseline scores.

Abstract: Concussion in adolescents is costly and potentially catastrophic. Implementing concussion assessment programs for adolescent athletes are necessary to manage clinical care in high school sports. However, confounding factors may affect test interpretation, such as learning disabilities (LD), previous history of concussion (PHC), cognitive maturity (CM), and/or poor effort. Any of these confounders during baseline testing is expected to complicate clinical interpretation of subsequent testing following a concussion. Pre-injury environment and academic ability prior to injury may predispose to additional deficits, potentially resulting in variation on neuropsychological tests. Consequently, a thorough understanding of confounding factors is important in the interpretation of scores and in return to play decisions in low socioeconomic urban athletes. Professional medical associations suggest the use of neuropsychological and balance testing to assess concussive injuries, these tests may be difficult to interpret in populations with these conditions.

Aims:

  1. Determine the stability of test scores in a cognitively maturing population between groups of low socioeconomic urban athletes and non-athletes.
  2. Determine the effect of LD and/or GPA on neuropsychological test scores using effort scores and PHC as covariates.

Study Design: A prospective longitudinal between-groups cohort design.

Materials and Methods: High school students will be recruited prior to the competitive football season to establish pre-injury baseline cognitive and balance function. Participants will be administered a symptom checklist, computerized neuropsychological test battery (ImPACT composite scores) and the Balance Error Scoring System (BESS) during baseline concussion assessment. All participants will complete annual concussion baseline testing to track the effect of cognitive maturity. Specific Aims will be assessed utilizing statistical techniques inclusive but not limited to descriptive statistics. Fisher’s exact test, and regression models.

Main Outcome Measures: ImPACT composite and BESS.

Significance: The long-term consequences and effects of confounders associated with adolescent concussion are unknown. This research will provide the first evidence of the impact of LD, PHC, CM and effort in low socioeconomic urban adolescent athletes. It will also establish the degree of fluctuation in neuropsychological performance during adolescent maturation which may obscure the detection of recovery. Ultimately, we intend to provide evidence to support the creation of new clinical paradigms for the management of concussion in low-socioeconomic urban adolescents.