Abstract

Context: Student-athletes are commonly administered the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®) battery at preseason baseline and post concussion. The ImPACT® is available in many different languages, but few studies have examined differences in cognitive performances and symptom ratings based on language of administration.

Objective: This study examined differences on ImPACT® neurocognitive composites and symptom reporting at preseason baseline testing between student-athletes completing ImPACT® in Spanish versus English.

Design: Cross-sectional study.

Setting: Preseason baseline testing for a high school concussion management program in STATE-XXX.

Patients of Other Participants: Adolescent student-athletes completing testing in Spanish (n=169) and English (n=169) were matched on age, gender, and health/academic history. Language groups were compared on each outcome for the full sample and for gender-stratified subsamples.

Main Outcome Measure(s): Neurocognitive composite scores and individual and total symptom severity ratings from the ImPACT® battery.

Results: Athletes tested in Spanish had lower neurocognitive performances on two of five composite scores (i.e., Visual Motor Speed, p<.001, d=.51; Reaction Time: p=.004, d=.33) and reported greater symptom severity (p<.001, r=.21). When analyses were stratified by gender, similar Visual Motor Speed differences were observed between language groups among boys (p=.001, d=.49) and girls (p=.001, d=0.49), whereas Reaction Time showed a larger group difference for boys (p=.012, d=.42) than girls (p=.128, d=.21). Language group differences in symptom reporting were similar for boys (p=.003, r=.22) and girls (p=.008, r=.21), with more frequent endorsement of physical and affective symptoms by athletes tested in Spanish.

Conclusions: Language group differences in total symptom severity were small (r=.21), and language group differences in neurocognitive performances were small-to-medium (d=.05–.51). Compared to previous studies comparing athletes tested in Spanish and English on ImPACT®, smaller effects were observed in the current study, which may be attributable to close matching on variables related to neurocognitive performances and symptom reporting.

Key points:
  1. Adolescent student-athletes completing baseline preseason ImPACT® in Spanish had lower performances on the Visual Motor Speed and Reaction Time composite scores than those tested in English.

  2. When interpreting ImPACT®, clinicians should be mindful that some neurocognitive performances may be, on average, lower than expectation among student-athletes tested in Spanish when compared to English-language norms.

  3. During baseline preseason assessments, student-athletes tested in Spanish reported greater symptom severity, including more physical and affective symptoms, than those tested in English.

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Author notes

Funding

No sponsored funding was provided for this study. Dr. Grant Iverson acknowledges unrestricted philanthropic support from the Mooney-Reed Charitable Foundation and ImPACT® Applications, Inc.

Authors' contributions

Dr. Justin E. Karr conceptualized the study, conceptualized the statistical analyses, conducted the literature review, conducted the statistical analyses, wrote the manuscript, and approved the final manuscript. Dr. Mauricio A. Garcia-Barrera reviewed the Spanish translation of the battery of tests, edited the manuscript, and approved the final manuscript. Dr. Jacqueline M. Marsh assisted with preparing tables, reviewed the Spanish translation of the battery of tests, edited the manuscript, and approved the final manuscript. Dr. Bruce Maxwell helped design and coordinate data collection, managed the database of participants, and approved the final manuscript. Dr. Paul Berkner helped design and coordinate data collection, wrote the IRB, and approved the final manuscript. Dr. Grant L. Iverson conceptualized the study, conceptualized the statistical analyses, assisted with the literature review, edited the manuscript, and approved the final manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.