Vision comprises 50% of brain pathways; these are frequently involved in concussion.  Yet, vision assessment is limited in current concussion testing.  We introduced two quick, simple and accessible vision-based tests to youth ice hockey athletes.  We examined the relation of MULES (Mobile Universal Lexicon Evaluation System, picture naming) and SUN (Staggered Uneven Number) test scores to age in youth athletes.

The MULES and SUN were developed for concussion yet also identify patients with mild cognitive impairment, multiple sclerosis, and Parkinson’s disease.  The MULES and SUN have not been introduced for baseline and sideline testing in sports.

Among 103 youth athletes (median age 12 years [range=5-17]), average best times were 51 seconds (range=28-163) for MULES and 68 seconds (range=36-330) for SUN.  Learning effects, common for timed measures, were noted between trials 1 and 2 for the MULES (median improvement 8.1 seconds [range=-31-58], p<0.001, Wilcoxon signed-rank test).  Learning effects for the SUN, however, were, on average, absent (median improvement=0 [range=-94-58], p=0.39).  While both MULES and SUN showed progressively faster times with increasing age (R-squared=0.59, p<0.001 for MULES; R-squared=0.81, p<0.001 for SUN, nonparametric regression models), associations of younger age with slower test times were substantially greater for MULES (model effect=-5.4) vs. SUN (model effect=0).