What traditional neuropsychological assessment got wrong about mild traumatic brain injury. II: limitations in test development, research design, statistical and psychometric issues

ABSTRACT

Primary Objective

This is Part II of a four-part opinion review on traditional neuropsychological assessment methods and findings associated with mild traumatic brain injury (mTBI). This Part II review focuses on historical, psychometric and statistical issues involving traditional neuropsychological methods that have been used in neuropsychological outcome studies of mTBI, but demonstrates the critical limitations of traditional methods.

Research Design

This is an opinion review.

Methods and Procedures

Traditional neuropsychological tests are dated and lack specificity in evaluating such a heterogenous and complex injury as occurs with mTBI.

Main Outcome and Results

In this review, we demonstrate traditional neuropsychological methods were never developed as standalone measures for detecting subtle changes in neurocognitive or neurobehavioral functioning and likewise, never designed to address the multifaceted issues related to underlying mTBI neuropathology symptom burden from having sustained a concussive brain injury.

Conclusions

For neuropsychological assessment to continue to contribute to clinical practice and outcome literature involving mTBI, major innovative changes are needed that will likely require technological advances of novel assessment techniques more specifically directed to evaluating the mTBI patient. These will be discussed in Part IV.

KEYWORDS:

• Traditional neuropsychological assessment
• concussion
• mild traumatic brain injury
• mTBI
• advanced neuroimaging
• neuropathology

Acknowledgments

No grant funding was used in writing this review and reflects the opinions of the three authors. As a review article, there was no research effort requiring an Institutional Review Board. Dr. Bigler is retired, emeritus professor of psychology and neuroscience, Brigham Young University, Provo, Utah. Dr. Bigler does participate in cases involving legal consultation about the effects of brain injury. Dr. Allder is a consulting neurologist at Re: Cognition Health, London, England where both clinical and medicolegal services are provided. Dr. Victoroff is a retired neurologist.

Disclosure statement

As stated in the Acknowledgement section. Drs. Bigler and Alder participate in cases involving legal consultation about the effects of brain injury.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02699052.2024.2376261.

Notes

1. Part I of this IV part review explains how terminology is used, including the complex issues and limitations of persistent post-concussion syndrome (PPCS).

2. Google Scholar indicates cited by 886 other articles.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.