title: Mobile Universal Lexicon Evaluation System (MULES) test: A new measure of rapid picture naming for concussion.
abstract: OBJECTIVE
  This study introduces a rapid picture naming test, the Mobile Universal Lexicon Evaluation System (MULES), as a novel, vision-based performance measure for concussion screening. The MULES is a visual-verbal task that includes 54 original photographs of fruits, objects and animals. We piloted MULES in a cohort of volunteers to determine feasibility, ranges of picture naming responses, and the relation of MULES time scores to those of King-Devick (K-D), a rapid number naming test.
  
  
  METHODS
  A convenience sample (n=20, age 34±10) underwent MULES and K-D (spiral bound, iPad versions). Administration order was randomized; MULES tests were audio-recorded to provide objective data on temporal variability and ranges of picture naming responses.
  
  
  RESULTS
  Scores for the best of two trials for all tests were 40-50s; average times required to name each MULES picture (0.72±0.14s) was greater than those needed for each K-D number ((spiral: 0.33±0.05s, iPad: 0.36±0.06s, 120 numbers), p<0.0001, paired t-test). MULES scores showed the greatest degree of improvement between trials (9.4±4.8s, p<0.0001 for trials 1 vs. 2), compared to K-D (spiral 1.5±3.3s, iPad 1.8±3.4s). Shorter MULES times demonstrated moderate and significant correlations with shorter iPad but not spiral K-D times (r=0.49, p=0.03).
  
  
  CONCLUSIONS
  The MULES test is a rapid picture naming task that may engage more extensive neural systems than more commonly used rapid number naming tasks. Rapid picture naming may require additional processing devoted to color perception, object identification, and categorization. Both tests rely on initiation and sequencing of saccadic eye movements.
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: lucy.cobbs@nyumc.org.
authors.forename: Lucy
authors.initials: L
authors.lastname: Cobbs
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: lisena.hasanaj@nyumc.org.
authors.forename: Lisena
authors.initials: L
authors.lastname: Hasanaj
authors.affiliation: Department of Physical Medicine and Rehabilitation, New York University School of Medicine, New York, NY, USA. Electronic address: prin.amorapanth@nyumc.org.
authors.forename: Prin
authors.initials: P
authors.lastname: Amorapanth
authors.affiliation: Department of Physical Medicine and Rehabilitation, New York University School of Medicine, New York, NY, USA. Electronic address: johnross.rizzo@nyumc.org.
authors.forename: John-Ross
authors.initials: JR
authors.lastname: Rizzo
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: rachel.nolan@nyumc.org.
authors.forename: Rachel
authors.initials: R
authors.lastname: Nolan
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: liliana.serrano2@nyumc.org.
authors.forename: Liliana
authors.initials: L
authors.lastname: Serrano
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: jenelle.raynowska@nyumc.org.
authors.forename: Jenelle
authors.initials: J
authors.lastname: Raynowska
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA. Electronic address: janet.rucker@nyumc.org.
authors.forename: Janet C
authors.initials: JC
authors.lastname: Rucker
authors.affiliation: Burke Rehabilitation Hospital, White Plains, NY, USA. Electronic address: bjordan@burke.org.
authors.forename: Barry D
authors.initials: BD
authors.lastname: Jordan
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA. Electronic address: steven.galetta@nyumc.org.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Galetta
authors.affiliation: Department of Neurology, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA. Electronic address: laura.balcer@nyumc.org.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Balcer
mesh_terms: D000328:Adult; D001924:Brain Concussion / Q000175:diagnosis*; D015331:Cohort Studies; D005133:Eye Movements / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009275:Names; D009483:Neuropsychological Tests; D010775:Photic Stimulation; D011930:Reaction Time / Q000502:physiology*; D012660:Semantics
keywords: Concussion; King-Devick test; Mobile Universal Lexicon Evaluation System; Saccades; Sports; Vision