Preseason baseline neurocognitive performances and symptom reporting on immediate post-concussion assessment and cognitive testing: A comparison of adolescent student-athletes tested in spanish and english

Justin E. Karr, Mauricio A. Garcia-Barrera, Jacqueline M. Marsh, Bruce A. Maxwell, Paul D. Berkner, Grant L. Iverson

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


Context: Student-athletes are commonly administered the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery at preseason baseline and postconcussion. The ImPACT is available in many languages, but few researchers have examined differences in cognitive performances and symptom ratings based on the language of administration. Objective: To examine differences in ImPACT neurocognitive composites and symptom reporting at preseason baseline testing between student-athletes who completed ImPACT in Spanish versus English. Design: Cross-sectional study. Setting: Preseason baseline testing for a high school concussion-management program in Maine. Patients or Other Participants: Adolescent student-athletes who completed testing in Spanish (n=169) and English (n =169) were matched on age, gender, and health and academic history. Language groups were compared on each outcome for the full sample and for gender-stratified subsamples. Main Outcome Measure(s): Neurocognitive composite scores and individual and total symptom severity ratings from the ImPACT battery. Results: Athletes tested in Spanish displayed lower levels of neurocognitive performance on 2 of 5 composite scores (visual motor speed: P <.001, d=0.51; reaction time: P=.004, d = 0.33) and reported greater symptom severity (P <.001, r = 0.21). When the analyses were stratified by gender, similar visual motor speed differences were observed between language groups among boys (P = .001, d = 0.49) and girls (P = .001, d = 0.49), whereas reaction time showed a larger group difference for boys (P=.012, d=0.42) than for girls (P=.128, d =0.21). Language-group differences in symptom reporting were similar for boys (P=.003, r=0.22) and girls (P=.008, r=0.21), with more frequent endorsement of physical and affective symptoms by athletes tested in Spanish. Conclusions: Language-group differences in total symptom severity were small (r = 0.21) and in neurocognitive performances were small to medium (d=0.05-0.51). Versus previous authors who compared athletes tested in Spanish and English with ImPACT, we observed smaller effects, which may be attributable to close matching on variables related to neurocognitive performances and symptom reporting.

Original languageEnglish
Pages (from-to)879-886
Number of pages8
JournalJournal of Athletic Training
Issue number8
StatePublished - Aug 2021

Bibliographical note

Funding Information:
These data were gathered as part of the Maine Concussion Management Initiative (MCMI) under the direction of the principal investigator Paul D. Berkner, DO. We thank the Maine Athletic Trainers’ Association for their collaboration with the MCMI. Grant L. Iverson, PhD, has been reimbursed by the government, professional scientific bodies, and commercial organizations for discussing or presenting research relating to mild traumatic brain injury (mTBI) and sport-related concussion at meetings, scientific conferences, and symposiums. He has a clinical practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mild TBIs (including athletes). He has received honoraria for serving on research panels that provided scientific peer review of programs. He is a coinvestigator, collaborator, or consultant on grants relating to mild TBI funded by the federal government and other organizations. He has received research support from test publishing companies in the past, including ImPACT Applications Systems, Psychological Assessment Resources, and CNS Vital Signs. He has received research support from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association and a grant from the National Football League. He serves as a scientific advisor for BioDirection, Inc; Sway Medical, LLC; and Highmark Inc. He acknowledges unrestricted philanthropic support from the National Rugby League, Mooney-Reed Charitable Foundation, and ImPACT Applications, Inc.

Publisher Copyright:
© 2021 National Athletic Trainers' Association Inc.. All rights reserved.


  • Concussion
  • Cross-cultural comparison
  • Neuropsychology
  • Postconcussion syndrome
  • Sports

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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