The Cognitive Exam

Brionn K. Tonkin, David Y. Balser

Research output: Chapter in Book/Report/Conference proceedingChapter


Cognitive testing is a necessary component of a sideline or physician office sports concussion evaluation, as symptom-based testing may under-report concussion. Taken in isolation, the cognitive performance of a wheelchair athlete may be indistinguishable from an ambulatory athlete, but most cognitive tests have measurement limitations that complicate cognitive test administration. Tests that measure elements like reaction time or require a written or keyboard component are affected by reduced upper extremity dexterity or polytrauma/syndromes including brain injury with increased prevalence in the wheelchair using population. Therefore, normative assessment scores may be inaccurate for certain wheelchair athletes, which increases the importance of obtaining baseline scores. The Sport Concussion Assessment Tool has the best evidence of any sideline concussion evaluation, though other cognitive tests have similar diagnostic characteristics. Computerized neuropsychological tests such as the ImPACT are designed to measure evolution of concussion over time, but they require upper extremity manual dexterity and administration by a health professional. Traditional neuropsychological testing administered by a neuropsychologist remains the gold standard to account for the effects of concussion on cognition and account for disabilities that result in wheelchair use for participation in sport.

Original languageEnglish (US)
Title of host publicationConcussion Management for Wheelchair Athletes
Subtitle of host publicationEvaluation and Examination
PublisherSpringer International Publishing
Number of pages32
ISBN (Electronic)9783030830045
ISBN (Print)9783030830038
StatePublished - Jan 1 2021

Bibliographical note

Publisher Copyright:
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021.


  • Cognitive testing
  • Concussion
  • Neuropsychological testing
  • Sideline diagnosis
  • Wheelchair sports


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