ANAM4 TBI Reaction Time-Based Tests Have Prognostic Utility for Acute Concussion

Abstract

The Concussion Restoration Care Center has used the Automated Neuropsychological Assessment Metrics version 4 Traumatic Brain Injury (ANAM4 TBI) battery in clinical assessment of concussion. The study's aim is to evaluate the prognostic utility of the ANAM4 TBI. In 165 concussed active duty personnel (all ultimately returned to duty) seen and tested on the ANAM4 TBI on days 3 and 5 (median times) from their injury, Spearman's ρ statistics showed that all performance subtests (at day 5) were associated with fewer days return-to-duty (RTD) time, whereas concussion history or age did not. Kruskal-Wallis statistics showed that ANAM4 TBI, loss of consciousness, and post-traumatic amnesia were associated with increased RTD time; ANAM4 TBI reaction time-based subtests, collectively, showed the largest effect sizes. A survival analysis using a Kaplan-Meier plot showed that the lowest 25% on the reaction time-based subtests had a median RTD time of 19 days, whereas those in the upper 25% had a median RTD time of approximately 7 days. Results indicate that until validated neurocognitive testing is introduced, the ANAM4 TBI battery, especially reaction time-based tests, has prognostic utility.

Reliable Change Estimates for Assessing Recovery From Concussion Using the ANAM4 TBI-MIL

“…This may need to be given additional interpretive weighting, as a growing body of literature has indicated that ANAM reaction time-based subtests may be the most sensitive indicators for determining postinjury changes in neurocognitive functioning. 16,18,20,21,[28][29][30][31] This study was designed using the strengths of each of the aforementioned studies. The primary aim of this study was to estimate RC parameters from a sample of healthy SMs that could be used by clinicians for postdeployment screening purposes.…”

A Mechanistic End-to-End Concussion Model That Translates Head Kinematics to Neurologic Injury

“…Reaction time has been used as one of the few neurobehavioral indices for quantifying mTBI sequelae (75, 76, 78, 109) and has been proposed as prognostic utility for acute mTBI (115, 116). In our neuronal network model, reaction time was approximated by the population response time, which was defined as the time at which the model network exhibited maximal response to attention-like stimulation.…”

Blast-related mild traumatic brain injury in the acute phase: Acute stress reactions partially mediate the relationship between loss of consciousness and symptoms

“…Selection of the ANAM TBI battery as a neuropsychological assessment tool was a weakness of the study. Although there is a body of evidence that lends support to its use in mTBI assessment and other settings there is also literature cautioning its use [6,37,44,49,63]. For example, ANAM instructions are documented to be confusing for elderly demented populations.…”

“…Used synonymously by clinicians in the US Department of Defense, US Department of Veterans' Affairs and many academic settings, concussion/mTBI is defined as a closed-head injury with normal structural imaging, a loss of consciousness (LOC) of no more than 30 minutes and/or alteration of consciousness or post-traumatic amnesia of no more than 24 hours [3,4]. In samples of patients with combat-related mTBIs from OEF/OIF, most mTBIs were caused by blast over-pressure from detonation of improvised explosive devices (IED) [5,6]. Combat blast or IED-related mTBI has been researched [7][8][9][10], but clinically-derived research in the acute phase (i.e.…”