Omar Akhand1, Matthew S Galetta2, Lucy Cobbs3, Lisena Hasanaj4, Nikki Webb5, Julia Drattell6, Prin Amorapanth7, John-Ross Rizzo8, Rachel Nolan9, Liliana Serrano10, Janet C Rucker11, Dennis Cardone12, Barry D Jordan13, Arlene Silverio14, Steven L Galetta15, Laura J Balcer16. 1. Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: omar.akhand@nyumc.org. 2. Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: matthew.galetta@nyumc.org. 3. Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: lucy.cobbs@nyumc.org. 4. Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: lisena.hasanaj@nyumc.org. 5. Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA. Electronic address: nikki.webb@nyu.edu. 6. Department of Recreation and Athletics, New York University, New York, NY, USA. Electronic address: julia.drattell@nyumc.org. 7. Department of Physical Medicine and Rehabilitation, New York University School of Medicine, New York, NY, USA. Electronic address: prin.amorapanth@nyumc.org. 8. Department of Neurology, New York University School of Medicine, New York, NY, USA; Department of Physical Medicine and Rehabilitation, New York University School of Medicine, New York, NY, USA. Electronic address: johnross.rizzo@nyumc.org. 9. Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: rachel.nolan@nyumc.org. 10. Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address: liliana.serrano2@nyumc.org. 11. Department of Neurology, New York University School of Medicine, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA. Electronic address: janet.rucker@nyumc.org. 12. Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA. Electronic address: dennis.cardone@nyumc.org. 13. Burke Rehabilitation Hospital, White Plains, NY, USA. Electronic address: bjordan@burke.org. 14. Department of Orthopaedics, Primary Care Sports Medicine, New York University School of Medicine, New York, NY, USA. 15. Department of Neurology, New York University School of Medicine, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA. Electronic address: steven.galetta@nyumc.org. 16. Department of Neurology, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA. Electronic address: laura.balcer@nyumc.org.
Abstract
OBJECTIVE: Measures of rapid automatized naming (RAN) have been used for over 50 years to capture vision-based aspects of cognition. The Mobile Universal Lexicon Evaluation System (MULES) is a test of rapid picture naming under investigation for detection of concussion and other neurological disorders. MULES was designed as a series of 54 grouped color photographs (fruits, random objects, animals) that integrates saccades, color perception and contextual object identification. Recent changes to the MULES test have been made to improve ease of use on the athletic sidelines. Originally an 11 × 17-inch single-sided paper, the test has been reduced to a laminated 8.5 × 11-inch double-sided version. We identified performance changes associated with transition to the new, MULES, now sized for the sidelines, and examined MULES on the sideline for sports-related concussion. METHODS: We administered the new laminated MULES to a group of adult office volunteers as well as youth and collegiate athletes during pre-season baseline testing. Athletes with concussion underwent sideline testing after injury. Time scores for the new laminated MULES were compared to those for the larger version (big MULES). RESULTS: Among 501 athletes and office volunteers (age 16 ± 7 years, range 6-59, 29% female), average test times at baseline were 44.4 ± 14.4 s for the new laminated MULES (n = 196) and 46.5 ± 16.3 s for big MULES (n = 248). Both versions were completed by 57 participants, with excellent agreement (p < 0.001, linear regression, accounting for age). Age was a predictor of test times for both MULES versions, with longer times noted for younger participants (p < 0.001). Among 6 athletes with concussion thus far during the fall sports season (median age 15 years, range 11-21) all showed worsening of MULES scores from pre-season baseline (median 4.0 s, range 2.1-16.4). CONCLUSION: The MULES test has been converted to an 11 × 8.5-inch laminated version, with excellent agreement between versions across age groups. Feasibly administered at pre-season and in an office setting, the MULES test shows preliminary evidence of capacity to identify athletes with sports-related concussion.
OBJECTIVE: Measures of rapid automatized naming (RAN) have been used for over 50 years to capture vision-based aspects of cognition. The Mobile Universal Lexicon Evaluation System (MULES) is a test of rapid picture naming under investigation for detection of concussion and other neurological disorders. MULES was designed as a series of 54 grouped color photographs (fruits, random objects, animals) that integrates saccades, color perception and contextual object identification. Recent changes to the MULES test have been made to improve ease of use on the athletic sidelines. Originally an 11 × 17-inch single-sided paper, the test has been reduced to a laminated 8.5 × 11-inch double-sided version. We identified performance changes associated with transition to the new, MULES, now sized for the sidelines, and examined MULES on the sideline for sports-related concussion. METHODS: We administered the new laminated MULES to a group of adult office volunteers as well as youth and collegiate athletes during pre-season baseline testing. Athletes with concussion underwent sideline testing after injury. Time scores for the new laminated MULES were compared to those for the larger version (big MULES). RESULTS: Among 501 athletes and office volunteers (age 16 ± 7 years, range 6-59, 29% female), average test times at baseline were 44.4 ± 14.4 s for the new laminated MULES (n = 196) and 46.5 ± 16.3 s for big MULES (n = 248). Both versions were completed by 57 participants, with excellent agreement (p < 0.001, linear regression, accounting for age). Age was a predictor of test times for both MULES versions, with longer times noted for younger participants (p < 0.001). Among 6 athletes with concussion thus far during the fall sports season (median age 15 years, range 11-21) all showed worsening of MULES scores from pre-season baseline (median 4.0 s, range 2.1-16.4). CONCLUSION: The MULES test has been converted to an 11 × 8.5-inch laminated version, with excellent agreement between versions across age groups. Feasibly administered at pre-season and in an office setting, the MULES test shows preliminary evidence of capacity to identify athletes with sports-related concussion.
Authors: Paul McCrory; Willem Meeuwisse; Jiří Dvořák; Mark Aubry; Julian Bailes; Steven Broglio; Robert C Cantu; David Cassidy; Ruben J Echemendia; Rudy J Castellani; Gavin A Davis; Richard Ellenbogen; Carolyn Emery; Lars Engebretsen; Nina Feddermann-Demont; Christopher C Giza; Kevin M Guskiewicz; Stanley Herring; Grant L Iverson; Karen M Johnston; James Kissick; Jeffrey Kutcher; John J Leddy; David Maddocks; Michael Makdissi; Geoff T Manley; Michael McCrea; William P Meehan; Shinji Nagahiro; Jon Patricios; Margot Putukian; Kathryn J Schneider; Allen Sills; Charles H Tator; Michael Turner; Pieter E Vos Journal: Br J Sports Med Date: 2017-04-26 Impact factor: 13.800
Authors: B L Plassman; R J Havlik; D C Steffens; M J Helms; T N Newman; D Drosdick; C Phillips; B A Gau; K A Welsh-Bohmer; J R Burke; J M Guralnik; J C Breitner Journal: Neurology Date: 2000-10-24 Impact factor: 9.910
Authors: Shirley Z Wu; Rachel Nolan-Kenney; Nicholas J Moehringer; Lisena F Hasanaj; Binu M Joseph; Ashley M Clayton; Janet C Rucker; Steven L Galetta; Thomas M Wisniewski; Arjun V Masurkar; Laura J Balcer Journal: J Neuroophthalmol Date: 2021-05-17 Impact factor: 4.415