TY - JOUR
T1 - MULES on the sidelines
T2 - A vision-based assessment tool for sports-related concussion
AU - Fallon, Samuel
AU - Akhand, Omar
AU - Hernandez, Christopher
AU - Galetta, Matthew S.
AU - Hasanaj, Lisena
AU - Martone, John
AU - Webb, Nikki
AU - Drattell, Julia
AU - Amorapanth, Prin
AU - Rizzo, John Ross
AU - Nolan-Kenney, Rachel
AU - Serrano, Liliana
AU - Rucker, Janet C.
AU - Cardone, Dennis
AU - Galetta, Steven L.
AU - Balcer, Laura J.
N1 - Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2019/7/15
Y1 - 2019/7/15
N2 - Objective: The Mobile Universal Lexicon Evaluation System (MULES) is a test of rapid picture naming under investigation. Measures of rapid automatic naming (RAN) have been used for over 50 years to capture aspects of vision and cognition. MULES was designed as a series of 54 grouped color photographs (fruits, random objects, animals) that integrates saccades, color perception and contextual object identification. We examined MULES performance in youth, collegiate and professional athletes at pre-season baseline and at the sidelines following concussion. Methods: Our study teams administered the MULES to youth, collegiate and professional athletes during pre-season baseline testing. Sideline post-concussion time scores were compared to pre-season baseline scores among athletes with concussion to determine degrees and directions of change. Results: Among 681 athletes (age 17 ± 4 years, range 6–37, 38% female), average test times at baseline were 41.2 ± 11.2 s. The group included 280 youth, 357 collegiate and 44 professional athletes; the most common sports were ice hockey (23%), soccer (17%) and football (11%). Age was a predictor of MULES test times, with longer times noted for younger participants (P < .001, linear regression). Consistent with other timed performance measures, significant learning effects were noted for the MULES during baseline testing with trial 1 test times (mean 49.2 ± 13.1 s) exceeding those for trial 2 (mean 41.3 ± 11.2 s, P < .0001, paired t-test). Among 17 athletes with concussion during the sports seasons captured to date (age 18 ± 3 years), all showed increases (worsening) of MULES time scores from pre-season baseline (median increase 11.2 s, range 0.6–164.2, P = .0003, Wilcoxon signed-rank test). The Symptom Severity Score from the SCAT5 Symptom Evaluation likewise worsened from pre-season baseline following injury among participants with concussion (P = .002). Conclusions: Concussed athletes demonstrate worsening performance on the MULES test compared to their baseline time scores. This test samples a wide network of brain pathways and complements other vision-based measures for sideline concussion assessment. The MULES test demonstrates capacity to identify athletes with sports-related concussion.
AB - Objective: The Mobile Universal Lexicon Evaluation System (MULES) is a test of rapid picture naming under investigation. Measures of rapid automatic naming (RAN) have been used for over 50 years to capture aspects of vision and cognition. MULES was designed as a series of 54 grouped color photographs (fruits, random objects, animals) that integrates saccades, color perception and contextual object identification. We examined MULES performance in youth, collegiate and professional athletes at pre-season baseline and at the sidelines following concussion. Methods: Our study teams administered the MULES to youth, collegiate and professional athletes during pre-season baseline testing. Sideline post-concussion time scores were compared to pre-season baseline scores among athletes with concussion to determine degrees and directions of change. Results: Among 681 athletes (age 17 ± 4 years, range 6–37, 38% female), average test times at baseline were 41.2 ± 11.2 s. The group included 280 youth, 357 collegiate and 44 professional athletes; the most common sports were ice hockey (23%), soccer (17%) and football (11%). Age was a predictor of MULES test times, with longer times noted for younger participants (P < .001, linear regression). Consistent with other timed performance measures, significant learning effects were noted for the MULES during baseline testing with trial 1 test times (mean 49.2 ± 13.1 s) exceeding those for trial 2 (mean 41.3 ± 11.2 s, P < .0001, paired t-test). Among 17 athletes with concussion during the sports seasons captured to date (age 18 ± 3 years), all showed increases (worsening) of MULES time scores from pre-season baseline (median increase 11.2 s, range 0.6–164.2, P = .0003, Wilcoxon signed-rank test). The Symptom Severity Score from the SCAT5 Symptom Evaluation likewise worsened from pre-season baseline following injury among participants with concussion (P = .002). Conclusions: Concussed athletes demonstrate worsening performance on the MULES test compared to their baseline time scores. This test samples a wide network of brain pathways and complements other vision-based measures for sideline concussion assessment. The MULES test demonstrates capacity to identify athletes with sports-related concussion.
KW - Concussion
KW - Mobile Universal Lexicon Evaluation System (MULES)
KW - Picture naming
KW - Sports
KW - Vision
KW - Brain Concussion/diagnosis
KW - Humans
KW - Male
KW - Names
KW - Young Adult
KW - Symptom Assessment/methods
KW - Adolescent
KW - Adult
KW - Female
KW - Athletic Injuries/diagnosis
KW - Photic Stimulation
KW - Child
KW - Neurologic Examination/methods
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U2 - 10.1016/j.jns.2019.04.036
DO - 10.1016/j.jns.2019.04.036
M3 - Article
C2 - 31103959
AN - SCOPUS:85065618731
SN - 0022-510X
VL - 402
SP - 52
EP - 56
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
ER -