Concussion Assessment Tools: A Scoping Review

Ali Mojdeh (1, 2), Elaine Biddiss (1, 2), Shannon Scratch (2, 3), Tiffany Toong (2)

1) Institute of Biomaterial and Biomedical Engineering, University of Toronto, 2) Holland Bloorview Kids Rehabilitation Hospital, 3) Rehabilitation Sciences Institute, University of Toronto

Introduction. One of the major challenges in concussion management is determining when a person is ready to return-to-activity, as premature return-to-activity can put an individual at an increased risk of repeat concussion. At present there is no standard clinical practice for return-to-activity decision-making.
Objective. (1) Identifying and describing clinical tools used to assess readiness to return-to-activity following concussion; and, (2) exploring how/if these clinical tools are used to conduct multi-domain assessments in return-to-activity decision making.
Methods. A search of four databases was conducted to identify peer-reviewed, English language papers published from 2008-2018 that describe assessment tools used in return-to-activity clinical decision-making following concussion. Two reviewers independently screened and extracted data describing the assessment tool (domain, psychometric properties), the clinical population tested (age), return-to-activity analysis (implemented or not), and the protocol by which the tool was administered (computer, video, self-report, etc.).
Results. Seventy-one articles were included in the review. Among those, 47 examined adults (8 on active duty service members), 37 targeted children, and 10 targeted both. The three most commonly used tools were: Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) (23%), Sport Concussion Assessment Tool 2 or 3 (17.5%), and the Balance Error Scoring System (BESS) (17.5%). More than 90% of the articles, used single-domain tools for assessment and only 7 studies (9%) used multiple domain measures. Of the studies, 64 relied solely on single task assessment and 8 (11%), proposed and used multitask (2 or more tasks at the same time) assessments.
Conclusion. There are many assessment tools available for return-to-activity decision-making post-concussion that address a single domain of function. Very few protocols are proposed for using these tools to assess multiple domains that may be impacted. Assessment tools and protocols that consider function in multitask paradigms are even less common. Future research is needed to improve and standardize return-to-activity decision-making following concussion that consider multiple domains and multitask demands representative of real-life activities such as sports, driving, and work.