A Novel Neuropsychological Tool for Immersive Assessment of Concussion and Correlation with Subclinical Head Impacts.

• Authors: Tamara Espinoza, Emory University; Kristopher A Hendershot, Emory University; Brian Liu, Georgia Tech Research Institute (GTRI), Advanced Human Integration Branch, Atlanta, Georgia, USA.; Andrea Knezevic, Emory University; Breanne B Jacobs, Emory University; Russell K Gore, Complex Concussion Clinic, Shepherd Center, Atlanta, Georgia, USA.; Kevin M Guskiewicz, University of North Carolina; Jeffery J Bazarian, University of Rochester; Shean E Phelps, Georgia Tech Research Institute (GTRI), Advanced Human Integration Branch, Atlanta, Georgia, USA.; David Wright, Emory University; Michelle LaPlaca, Emory University
• Journal Title: Neurotrauma Rep
• Volume: Volume 2, Number 1
• Publisher: Mary Ann Liebert, Inc. | 2021, Pages 232-244
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1089/neur.2020.0022
• Subjects: Engineering, Biomedical; Health Sciences, Medicine and Surgery
• Keywords: concussion; helmet impact sensor; mild traumatic brain injury; neuropsychological test; subconcussive impact

Abstract

Mild traumatic brain injury (mTBI) remains a diagnostic challenge and therefore strategies for objective assessment of neurological function are key to limiting long-term sequelae. Current assessment methods are not optimal in austere environments such as athletic fields; therefore, we developed an immersive tool, the Display Enhanced Testing for Cognitive Impairment and mTBI (DETECT) platform, for rapid objective neuropsychological (NP) testing. The objectives of this study were to assess the ability of DETECT to accurately identify neurocognitive deficits associated with concussion and evaluate the relationship between neurocognitive measures and subconcussive head impacts. DETECT was used over a single season of two high school and two college football teams. Study participants were instrumented with Riddell Head Impact Telemetry (HIT) sensors and a subset tested with DETECT immediately after confirmed impacts for different combinations of linear and rotational acceleration. A total of 123 athletes were enrolled and completed baseline testing. Twenty-one players were pulled from play for suspected concussion and tested with DETECT. DETECT was 86.7% sensitive (95% confidence interval [CI]: 59.5%, 98.3%) and 66.7% specific (95% CI: 22.3%, 95.7%) in correctly identifying athletes with concussions (15 of 21). Weak but significant correlations were found between complex choice response time (processing speed and divided attention) and both linear (Spearman rank correlation coefficient 0.262, p = 0.02) and rotational (Spearman coefficient 0.254, p = 0.03) acceleration on a subset of 76 players (113 DETECT tests) with no concussion symptoms. This study demonstrates that DETECT confers moderate to high sensitivity in identifying acute cognitive impairment and suggests that football impacts that do not result in concussion may negatively affect cognitive performance immediately following an impact. Specificity, however, was not optimal and points to the need for additional studies across multiple neurological domains. Given the need for more objective concussion screening in triage situations, DETECT may provide a solution for mTBI assessment.