Sensory-Perceptual and Motor Tests
Tests of these functions can be illuminative for laterality issues as well in determining the extent of impairment in the corresponding cerebral hemisphere. Peripheral disorders must be ruled out as the cause of discrepancies or abnormal scores.
There are well- established norms from age 3 and up pertinent to motor sequencing, various hand movements, and reciprocal coordination. This area includes tests of tactile discrimination and fine motor or hand-arm movements. Rates of competence between the sides in simple items and in items with gradually increasing complexity are done for both tactile and fine motor functioning. The techniques of A.R. Luria (67) are often used for fine motor examination, with elements of executive function abilities intrinsic to completion of the more complex movements. Specific tests would include the Grooved Pegboard (68) for skill motor movements—a timed task involving peg placement in holes at various orientations to the shape of the pegs. Though interpretation must be done in the context of other data, such tests can provide information about the course of a disorder. An example is in chronic hydrocephalus, where monitoring with tactile proprioception as in finger recognition and number-writing perception can signal progression of the cerebral pathology.Brief Smell Identification (69) allows for standardized, forced-choice odor identification, with 12 microencapsulated odorants as a screening test for olfactory
3.4
Tests of Memory and Learning
| Instrument (ref.) | description | COMMENTS |
| Rivermead Behavioral Memory Test, | Tasks are analogues of everyday memory; has | Novel approach with everyday tasks increases |
| 2nd ed. Children’s Version (62) | immediate and delayed tasks; two versions: adult (age 11+) and children’s (ages 5-10); Four parallel forms. | utility in case planning and remediation. May miss moderate to mild deficits; alternative forms very useful, though enough statistics aren’t given for full utility; shows general disruption. |
| Wide Range Assessment of Memory | Traditional memory battery covers nonverbal | Excellent psychometrics; widely used; Has a |
| and Learning 2 (WRAML 2) (63) | and verbal, immediate, recognition and delayed; ages 5-90 | screening form |
| Test of Memory and Learning -2 (TOMAL-2) (64) | Ages 5-60; traditional battery; covers nonverbal, verbal, immediate, delayed, and cued recall | Good psychometrics; Easy to administer |
| Child Memory Scale (CMS) (65) | Ages 5-16; battery; parallel structure of adult Wechsler Memory Scale | Widely used; enables comparison with IQ and achievement as part of Wechsler series |
| California Verbal Learning Test -C | Ages 5-16; verbal memory assessed; short | Limited (only tests verbal abilities); hard to score |
| (CVLT-C) (66) | and long delay (20 min) procedures | by hand; good psychometrics |
function. Many studies have documented a high incidence of olfactory dysfunction post-brain injury in adults, correlated with higher-order cognitive skills that can be elusive to discern in direct fashion. The role in the developing brain is less delineated. Norms have been developed from age 5 and up.
Computerized Assessment
Within this area, a number of devices have already been listed under other sections, notably in the attention/ processing speed section.
The discussion here will be of the relatively recent use of computerized testing of cognitive functions specific to abilities disrupted by concussion. These abilities include speed of processing and reaction time, and are done with varying stimuli. An inherent limitation is the lack of auditory presentation in these instruments, where all stimuli are visual in presentation, even though language stimuli are used in conjunction with nonverbal stimuli (spatial location, line drawings) in one test listed. The repeatability and ease of administration is an advantage of these tests and so can be used for the serial monitoring recommended for complex concussion recovery. Scores on these devices serve as guidelines of functional capacity that determine return to activities, whether that is around cognitive demand (school) or physical demand (gym class, sports, bike riding, etc.). Balance assessment can also be used as a specific monitor representing a high-level dynamic function of the brain's motor control and an ability required for competent physical activity participation. There is ongoing debate about the sensitivity of cognitivie versus balance deficits as the most sensitive indicator of concussion sensitivity.There are only two computerized batteries that have norms within the pediatric population. Both include a symptom report. The HeadMinder Concussion Resolution Index (CRI) (70) has norms for ages 18-22 and “under 18.” The latter refers to a normative sample down to age 13, with analysis yielding no difference in the scoring of adolescents from ages 13-18 (71). The CRI is an Internet-based platform with six subtests, taking 25 minutes to administer. It yields three scores: processing speed index, simple reaction time index, and complex reaction time index. Verbal (written) stimuli were specifically avoided, with all stimuli in a visual icon format to minimize error due to language disability or English-as-second-language issues.
Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) (72) is available in Windows and Macintosh applications as well as through an online version.
An on-field Palm-based version is also available and includes a brief on-field mental status evaluation. It does use verbal stimuli, and there is reading involved in testing instructions, with a sixth grade required reading level (73). It has eight subtests in its current version and registers demographic/his- tory data, current concussion details (including information about anterograde and retrograde amnesia), as well as somatic and cognitive symptoms. There are four scores from ImPACT: verbal memory, visual memory, reaction time, and visuomotor speed. ImPACT has norms for ages 11 and above. Adolescent norms on this battery are extensive, and there is an extant literature on its use. Though developed primarily for sports concussion management, it has recently been used to characterize concussions presenting to an emergency room (74). A version is being developed for children ages 5-10.