Evaluation of a Simple Test of Reaction Time for Baseline Concussion Testing in a Population of High School Athletes

Abstract

A video abstract showing how the RT clin device is used in practice is available as Supplemental Digital Content 1, http://links.lww.com/JSM/A43.

Reliability and Criterion Validity of a Novel Clinical Test of Simple and Complex Reaction Time in Athletes

“…These ICC's are lower than the 1 wk. test-retest and inter-rater reliabilities (ICC = .86 and .92, respectively) originally reported in a general healthy adult population (Eckner, et al, 2009), but they are higher than the 1 yr. value (ICC = .65) reported in collegiate athletes (Eckner, et al, 2011a), as well as the 1 yr. value reported by MacDonald, Wilson, Young, Duerson, Swisher, Collins, et al (in press) in high school athletes (ICC = .61).…”

Evaluating the Recovery Curve for Clinically Assessed Reaction Time After Concussion

“…Specifically, the average baseline reaction time recorded in the current study was between 7 and 48 milliseconds slower than that reported in other studies. 6,7,11,21 This discrepancy in reaction times is likely related to methodologic differences in the way the ruler-drop test was performed in each study. 6,7,11,21 Perhaps the most important difference between the variations of the ruler-drop test is related to visualization of the ruler.…”

“…Although early research on the ruler-drop test revealed acceptable test-retest reliability 16,17 and adequate criterion validity in collegiate athletes (r ¼ 0.45), 18 a recent study by MacDonald et al, 11 in which clinical reaction times were compared with results obtained by computerized methods, indicated that reaction times obtained with the ruler-drop test appeared to lack validity in high school-aged participants (ICC ¼ 0.61). Although this finding is troubling at first glance, MacDonald et al claimed that the lack of validity identified in their study was likely related to the difference in intrinsic motivation between the assessment methods (ie, clinical versus computerized).…”

“…Although this finding is troubling at first glance, MacDonald et al claimed that the lack of validity identified in their study was likely related to the difference in intrinsic motivation between the assessment methods (ie, clinical versus computerized). More specifically, they suggested that the performance feedback that participants received in real time when using the ruler-drop test (and presumably lacking with computer-based methods) may serve to incentivize or intrinsically motivate the participant 11 and, in turn, result in reaction times that are faster and more consistent than those identified via computerized methods. 11,19,24 This inherent motivation could be considered a benefit or advantage of the rulerdrop test over computerized methods.…”

“…1 A patient's recovery from concussion is typically tracked using clinical tools that are capable of evaluating symptoms, postural control, and neurocognitive function. 2,3 Because patients demonstrate measureable delays in reaction time after a sport-related concussion, [4][5][6][7][8][9][10][11][12][13] a change in reaction time is one of the various clinical measures of neurocognitive function regularly monitored postinjury and has been reported to be among the most sensitive indicators of cognitive impairment available to practitioners. 14 In fact, a number of authors 10,13 have reported a protracted recovery for reaction time after injury that persists beyond the resolution of symptoms, indicating that reaction time may be a useful measure for determining if an athlete who reports symptom resolution has indeed recovered fully from a concussion.…”