Introducing the Mobile Integrated Cognitive Kit (MICK) App for Rapid Visual Assessment in a Youth Ice Hockey League for Concussion
Sara Hyman1, Mason Blacker1, Marc Balcer2, Christina Marini1, Samarah Ahmed1, Ruby Ross1, Mitchell Jarmol1, Scott Grossman1, Steven Galetta1, Laura Balcer1
1NYU Grossman School of Medicine, 2Model Compilers LLC
Objective:
This study introduced a new and accessible mobile device which administers vision-based testing for concussion assessment in a youth ice hockey league. The Mobile Integrated Cognitive Kit (MICK) facilitates the testing of rapid picture and number naming using the Mobile Universal Lexicon Evlauation System (MULES) and Staggered Uneven Number test (SUN).
Background:
Visual pathways involve >50% of the brain’s circuits, and are nearly universally involved in concussion. Rapid automatized naming tasks like the MULES and SUN are vision-based performance measures for identifying individuals with concussion. Use of a virtual platform will increase further the accessibility of these measures.
Design/Methods:
Members of a youth hockey league completed tablet-based versions of the MULES and SUN tests using the MICK app during pre-season baseline testing. The app records completion times for two trials of each test at pre-season baseline, and is semi-automated for use.
Results:
Among 71 participants (median age 13 years, range 7-17) median best MULES time for two trials was 51.3 seconds (range 34.0-103.6 seconds). Median best SUN time was 68.5 seconds (range 46.6-203.0 seconds). Learning effects were found between the two trials for the MULES (median improvement 7.3 sec, p<0.001, Wilcoxon signed-rank test) and SUN (median improvement 2.44 sec, p=0.002, Wilcoxon signed-rank test). Age was a predictor of best test times, with longer times noted for younger participants on the MULES (rs=-0.43, p<0.001, spearman rank correlation) and SUN (rs=-0.47, p<0.001). Learning effects did not vary across age groups for the MULES (rs=0.18, p=0.19) or SUN (rs=0.24, p=0.06).
Conclusions:
The MULES and SUN tests of rapid automatized naming are feasibly administered by non-physician personnel using the MICK among youth athletes. The MICK will allow for widespread dissemination of the MULES and SUN tests and will add a vision-based performence measure to concussion testing.