The Functional Assessment of Neurocognition in Sport (FANS): Shifting Concussion Return to Play Determination from the Clinic to the Field
March 25, 2023
By Tina Chen
U-M Concussion Center post-doctoral fellow Landon Lempke, along with co-investigators Dr. Benjamin Brett from the Medical College of Wisconsin’s Departments of Neurosurgery and Neurology and Dr. Douglas Terry from the Vanderbilt University Medical Center’s Department of Neurological Surgery, received grant funding from the Eastern Athletic Trainers’ Association to lead a project addressing the current gap in concussion return to play assessments. The project will determine the reliability and validity of their novel cognitive-motor assessment battery called the Functional Assessment of Neurocognition in Sport (FANS) designed to emulate the demands of on-field sports.
Landon Lempke, PhD, Post-doctoral Research Fellow, U-M Concussion Center
“Our ultimate goal is to improve clinical decision-making and concussion healthcare, but in a stepwise fashion to ensure we do not put the proverbial cart before the horse, which would cause an undue burden on both patients and clinicians.”
Current concussion assessments have strong diagnostic accuracy and serve an important role in initial injury healthcare. However, their diagnostic strength decreases after the acute timeframe, and collective research indicates a return to pre-injury levels long before biomarker-based (e.g., functional magnetic resonance imaging or spectroscopy). Current assessments also do not reflect the on-field sports demands, as they only require static balancing or simple finger-movement for neurocognitive testing. Thus, the team believes current concussion assessments have limited ability to inform safe return-to-play decision-making and are not valid for this purpose.
Dr. Lempke and co-investigators, therefore, developed FANS to address the current gaps in concussion management. After a concussion, the FANS battery assesses verbal and visual memory, reaction time, processing speed, and cognitive-motor flexibility, commonly impaired with concussion. Traditional neurocognitive testing often assesses these same domains by using a computer and finger-movement input to respond. FANS differs starkly from traditional neurocognitive testing as participants respond during testing through full-body movements and athletic tasks to better emulate the on-field sport demands in a standardized manner.
“Our first step here is to determine whether FANS is both reliable and valid among healthy individuals without a concussion to ensure a psychometrically sound and appropriate assessment is possible before implementing into post-concussion evaluations,” said Dr. Lempke. “If FANS is reliable and valid, we will then have individuals experiencing a concussion complete FANS before returning to play and monitor them over time so that we can determine if FANS possesses augmentative clinical utility. Our ultimate goal is to improve clinical decision-making and concussion healthcare, but in a stepwise fashion to ensure we do not put the proverbial cart before the horse, which would cause an undue burden on both patients and clinicians.”