title: A novel approach to sports concussion assessment: Computerized multilimb reaction times and balance control testing.
abstract: BACKGROUND
  Mild traumatic brain injuries (MTBI) or concussions often result in problems with attention, executive functions, and motor control. For better identification of these diverse problems, novel approaches integrating tests of cognitive and motor functioning are needed. The aim was to characterize minor changes in motor and cognitive performance after sports-related concussions with a novel test battery, including balance tests and a computerized multilimb reaction time test. The cognitive demands of the battery gradually increase from a simple stimulus response to a complex task requiring executive attention.
  
  
  METHODS
  A total of 113 male ice hockey players (mean age = 24.6 years, SD = 5.7) were assessed before a season. During the season, nine concussed players were retested within 36 hours, four to six days after the concussion, and after the season. A control group of seven nonconcussed players from the same pool of players with comparable demographics were retested after the season. Performance was measured using a balance test and the Motor Cognitive Test battery (MotCoTe) with multilimb responses in simple reaction, choice reaction, inhibition, and conflict resolution conditions.
  
  
  RESULTS
  The performance of the concussed group declined at the postconcussion assessment compared to both the baseline measurement and the nonconcussed controls. Significant changes were observed in the concussed group for the multilimb choice reaction and inhibition tests. Tapping and balance showed a similar trend, but no statistically significant difference in performance.
  
  
  CONCLUSIONS
  In sports-related concussions, complex motor tests can be valuable additions in assessing the outcome and recovery. In the current study, using subtasks with varying cognitive demands, it was shown that while simple motor performance was largely unaffected, the more complex tasks induced impaired reaction times for the concussed subjects. The increased reaction times may reflect the disruption of complex and integrative cognitive function in concussions.
authors.affiliation: a Institute of Behavioural Sciences, Division of Cognitive Psychology and Neuropsychology, University of Helsinki , Helsinki , Finland.|b Validia Rehabilitation Helsinki , Finland , Helsinki , Finland.
authors.forename: Matti V
authors.initials: MV
authors.lastname: Vartiainen
authors.affiliation: c Department of Clinical Neurophysiology , Satakunta Central Hospital , Pori , Finland.
authors.forename: Anu
authors.initials: A
authors.lastname: Holm
authors.affiliation: d Brain Work Research Center , Finnish Institute of Occupational Health , Helsinki , Finland.
authors.forename: Jani
authors.initials: J
authors.lastname: Lukander
authors.affiliation: d Brain Work Research Center , Finnish Institute of Occupational Health , Helsinki , Finland.
authors.forename: Kristian
authors.initials: K
authors.lastname: Lukander
authors.affiliation: a Institute of Behavioural Sciences, Division of Cognitive Psychology and Neuropsychology, University of Helsinki , Helsinki , Finland.
authors.forename: Sanna
authors.initials: S
authors.lastname: Koskinen
authors.affiliation: e College of Medicine, The Ohio State University , Columbus , OH , USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Bornstein
authors.affiliation: a Institute of Behavioural Sciences, Division of Cognitive Psychology and Neuropsychology, University of Helsinki , Helsinki , Finland.
authors.forename: Laura
authors.initials: L
authors.lastname: Hokkanen
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001265:Athletic Injuries / Q000150:complications; D001924:Brain Concussion / Q000150:complications* / Q000175:diagnosis / Q000209:etiology; D003072:Cognition Disorders / Q000209:etiology*; D005121:Extremities / Q000503:physiopathology*; D005500:Follow-Up Studies; D007839:Functional Laterality; D006688:Hockey / Q000293:injuries; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D004856:Postural Balance / Q000502:physiology*; D011930:Reaction Time / Q000502:physiology*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D055815:Young Adult
keywords: Concussion; motor performance; multilimb; processing speed; reaction time