We determined reliability and agreement for the Mobile Universal Lexicon Evaluation System (MULES) and Staggered Uneven Number (SUN) tests over a sports season for a collegiate cohort.  

Visual as well as cognitive dysfunction are common clinical presentations of concussion.  Formal clinical neuro-ophthalmic examinations and cognitive assessments have long administration times that require a specialist to perform.  The MULES and SUN assess many visual networks and performance requires the integration of saccadic eye movements, color perception, visual memory and object and number identification.  Rapid and reliable tests are important for assessing concussion on the sideline and in the clinic.  MULES and SUN were developed to quickly assess visual function following sports-related concussion both in collegiate and youth athletes.  They have also been studied in patients with multiple sclerosis, mild cognitive impairment and Parkinson’s disease.

Healthy collegiate athletes (n=21, mean age 20 years, 57.1% male) completed the MULES and SUN at two baseline visits, approximately two weeks apart, during the pre-season. The tests were administered again immediately at the post-season. The intra-class correlation coefficient (ICC) using a two–way mixed effects model and absolute agreement were calculated as a measure of reliability and agreement between both 1) the two pre-season assessments and 2) the first pre-season assessment and the post-season assessment.  Each side of the MULES and each line of the SUN were analyzed individually. 

For both MULES and SUN, high levels of reliability were demonstrated between the two pre-season baseline test scores and for pre-season vs. post-season scores (ICCs of 0.76-0.90, p<0.001 for all).