The Cognitive Exam

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.