MICK (Mobile Integrated Cognitive Kit) App: Feasibility of an Accessible Tablet-Based Rapid Picture and Number Naming Task for Concussion Assessment in a Youth Ice Hockey League
Sara Hyman1, Mason Blacker1, Carter Bell1, Marc Balcer2, Binu Joseph1, Steven Galetta1, Laura Balcer1, Scott Grossman1
1Department of Neurology, NYU Grossman School of Medicine, 2Model Compilers
Objective:

We evaluated the capacity of the Mobile Universal Lexicon Evaluation System (MULES, rapid picture naming) and Staggered Uneven Number (SUN) testing to be effective during pre-season baseline testing in a cohort of youth athletes using a novel and freely-available app (Mobile Integrated Cognitive Kit, MICK) and paper-pencil testing.


Background:
Visual symptoms are common following concussion.  Rapid automatized naming (RAN) tasks are effective for identifying individuals with concussion and with other neurological disorders, such as multiple sclerosis, Parkinson’s disease and mild cognitive impairment (MCI) due to Alzheimer’s disease.  The MULES test of picture naming and the SUN test of number naming demonstrate increased time scores (worse performance) after concussion. 
Design/Methods:

Participants from a youth hockey league (n=59, median age 13 years, range 6-17) underwent pre-season testing.  Each participant completed two trials of MULES and SUN.  Children <10 years of age completed paper versions, while children aged 10 or greater used the MICK app.  The app records completion times for each trial and is semi-automated for use while supervised by research staff. 

Results:

As noted in prior studies, learning effects were noted between the two baseline trials for both the MULES (median improvement=11.3 sec, range=-32.3-92.0 sec, p<0.001, Wilcoxon sign-rank test) and SUN (median improvement=0.78 sec, range=-8.0-15.1 sec, p=0.002).  Median best baseline for the MULES was 50.4 sec (range=34.2-141.0 sec) and for SUN 71.1 sec (range=36.6-200.0 sec). Age was a predictor of best baseline times for both tests, with longer times for younger participants for MULES (p<0.001, rs=-0.67, Spearman rank correlation) and SUN (p<0.001, rs=-0.54).  Degrees of learning effect did not vary across age groups in this cohort (p=0.14, rs=-0.20). 

Conclusions:

Vision-based RAN tasks, such as the MULES and SUN, can be feasibly administered using the MICK app during pre-season baseline testing in youth sports teams. These data provide a foundation for post-injury sideline testing among youth athletes. 

10.1212/WNL.0000000000202327