A case study investigation into the utility of baseline data versus normative data using a computer-based concussion management programme

Abstract

Neuropsychological testing is recognised as one of the cornerstones of concussion evaluation, contributing significantly to both an understanding of the injury as well as management of the recovery process. Despite the high incidence of concussion at school level, traditional paper-and-pencil neuropsychological testing has generally been absent from school concussion management programmes, largely due to time and cost constraints. Now, the recent development of computerised neuropsychological testing is providing the opportunity for including neurocognitive assessment in this process. The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a valid and reliable instrument of this type and normed on 13 - 18 year old North American high school athletes, as well as adult groups. The current recommendation is that athletes are baselined preseason in order to provide an individualised comparative level against which to monitor recovery and provide return-to-play recommendations. This in itself is quite a cumbersome process, thus the present study set out to ascertain whether baseline testing of all athletes is necessary, or whether the use of US or SA normative data alone would provide an appropriate standard against which to interpret the postinjury scores. From a leading South African rugby playing school, the 1st and 2nd rugby teams, (16 - 18 years) were baselined using ImPACT. Three athletes, who were subsequently referred with concussion during the rugby season, were followed up with serial testing on ImPACT. An analysis of the follow up scores was conducted to chart the athletes' recovery process, in relation to the athletes own baseline scores (using US and SA reliable change indices) and age appropriate US and SA normative ranges. The relative utility of individual baselines scores versus these normative ranges was then critically evaluated. It was concluded that a combination of both baseline and normative data provided optimal management of the athlete, with the methods complementing each other in the interpretation of post-injury results. Overall, the SA normative ranges seemed to provide slightly better management guidelines than the US normative ranges when used with this sample of South African high school athletes.