Conception and Preliminary Evaluation of the Quigley-Fenner Concussion Assessment

Sport-related concussion (SRC) is a significant public health concern in collegiate athletics, and computerized neurocognitive testing (CNT) is a cornerstone of SRC management. The most widely used CNT, ImPACT, has faced criticism for its limited subtest reliability, ceiling effects on verbal memory tasks, and poor usability. Prior work from this laboratory documented minimal detectable change values and reliability coefficients for ImPACT subtests in Division I student-athletes, revealing several subtests with poor reliability and a word memory task susceptible to ceiling effects that limit clinical utility. These findings, combined with evidence of poor usability, motivated the development of a novel, no-cost CNT: the Quigley-Fenner Concussion Assessment (QFCA). The QFCA is a six-task computerized battery modelled on validated neuropsychological tests, including word memory, story memory, image memory, digit span, and simple and complex reaction time paradigms. The present dissertation evaluated the QFCA across three sequential aims.Aim 1 assessed usability by comparing healthy college-aged controls' (n=42) ratings of the QFCA and ImPACT across three dimensions. Participants rated the QFCA significantly higher on enjoyment (p<0.001) and clarity of instructions (p=0.028), with no significant difference in perceived challenge. These findings support the QFCA's design goals, though it is noted that enjoyment does not constitute evidence of psychometric quality. Aim 2 established the preliminary test-retest reliability (7–14 day interval) and construct validity of the QFCA in the same healthy control sample. Image memory demonstrated the strongest reliability, with ICCs ranging from 0.704 to 0.809, values broadly comparable to ImPACT design memory ICCs (0.67–0.76) reported in Quigley et al. (2025). Average complex reaction time yielded an ICC of 0.66, consistent with ImPACT's analogous XO reaction time score. Word memory and story memory showed poor ICCs, attributable to pronounced ceiling effects in the healthy sample rather than inherent task limitations. Construct validity analyses revealed significant positive correlations between all QFCA image memory scores and corresponding ImPACT design memory subtests (ρ=0.37–0.49), and a strong correlation between QFCA complex reaction time and ImPACT XO average correct reaction time (r>0.50, p<0.001). Word memory validity correlations were non-significant, consistent with the ceiling-related variance restriction. Aim 3 assessed the preliminary clinical sensitivity of the QFCA in a small sample of concussed collegiate student-athletes (n=9; 4 female, 5 male) compared to sex-matched healthy controls. Word memory demonstrated the strongest and most consistent sensitivity across both sexes: word memory delayed recall achieved a sensitivity of 1.00 and an AUC of 0.97 in females, and the U=0.00 for word memory delayed recall in males indicated that every concussed male scored below every control male. Story memory and image memory showed limited sensitivity, consistent with ceiling effects in the normative data. Collectively, these findings provide early proof-of-concept for the QFCA as a user-friendly, no-cost CNT with preliminary psychometric and clinical support for its image memory, reaction time, and word memory components. Digit span and story memory were identified as the tasks most in need of revision, and future iterations of the QFCA should incorporate targeted task modifications followed by repeated reliability, validity, and sensitivity analyses to advance toward clinical deployment.

Level thesis:degree_level

Doctorate Degree

Year dc:date.issued

2026

Author dc:creator

• Quigley, Kristen Grace

Advisor dc:contributor.advisor

• Murray, Nicholas G

Committee members dc:contributor.committeemember

• Mathew, Dennis
• Jiang, Fang
• Constantino, Nora L
• Webster, Michael A

• Concussion
• Neurocognitive testing
• Sport-related concussion
• Student-athlete

Language dc:language.iso

en_US, English

Repository record dc:identifier.uri

https://scholarwolf.unr.edu/handle/11714/11836

OAI identifier oai:identifier

oai:scholarwolf.unr.edu:11714/11836