Article Text

Download PDFPDF
Normative performance on cleveland clinic concussion application for youth, high school and college athletes
  1. Rick Figler1,2,
  2. Susan Linder1,3,
  3. Andrew Russman1,2,4,
  4. Jason Cruickshank1,2,
  5. Bob Grey1,2,
  6. Sarah Ozinga3,
  7. Maureen Lally1,
  8. Tanujit Day1,5,
  9. Jay Alberts1,3,4
  1. 1Cleveland Clinic Concussion Centre, Cleveland, Ohio
  2. 2Cleveland Clinic Sports Health, Cleveland, Ohio
  3. 3Cleveland Clinic Department of Biomedical Engineering, Cleveland, Ohio
  4. 4Cleveland Clinic Department of Neurology, Cleveland, Ohio
  5. 5Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio


Objective The utilisation of a multi-factorial approach to evaluating relevant neuro-cognitive and motor function is a critical element in effective and comprehensive concussion management. In this project, normative data were gathered utilising the Cleveland Clinic Concussion (C3) iPad Application in youth, high school and college athletes.

Design Prospective normative study.

Setting Field-based.

Participants Pre-season C3 data were collected in more the 6,500 youth (N=607), high school (N=5415) and college (N=744) athletes; approximately 32% females. Data were collected between Fall 2014 and Spring 2015.

Interventions NA.

Outcome measures Neurocognitive assessment modules of C3 include information processing (simple and choice reaction time), attention and working memory (Trail Making Test) and postural stability. Balance is quantified through biomechanical processing of accelerometer and gyroscope data gathered from the iPad during performance of the BESS.

Main results No gender effects were present for performance on the neurocognitive modules; however, postural stability was significantly worse for youth males compared to female peers (P<0.01). Youth were significantly slower in performance of neurocognitive modules (simple and choice reaction time and Trails; (P<0.0001)). Neurocognitive and postural stability measures were similar across high school and college athletes.

Conclusions Slower neurocognitive performance in youth relative to older athletes underscores the need to utilise age appropriate normative data in the management of concussion, particularly if no baseline is acquired. The control of postural stability develops at different rates as a function of age and gender, therefore balance assessment across the injury spectrum must utilise specific age-gender normative values.

Competing interests JLA, SML and SBO have authored intellectual property associated with the mobile application presented in this study.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.