Examining College Student Athlete Attitudes Towards Concussion Testing and Reporting Concussions

Examining College Student Athlete Attitudes and Behaviors Toward Baseline Neurocognitive Concussion Testing FryK, Anderson, M, Anderson, M, Schatz, P, Elbin, RJ: University of Arkansas, Fayetteville, Arkansas Context: Examining athletes’ attitudes toward concussion diagnosis, management, and treatment can lead to improved multi-faceted management of a concussion injury. Although attitudes towards concussion injuries have been studied, the examination of athletes’ attitudes towards baseline computerized neurocognitive testing is understudied and is warranted. Objective: To examine the relationship between sex, concussion history, and previous exposure to baseline testing on athletes’ perceptions of effort provided during baseline testing and the utility of neurocognitive testing. Methods: College athletes (18-23 years) completing a baseline neurocognitive test (Immediate Post-Concussion Assessment and Cognitive Test: ImPACT) were asked to complete an anonymous 33-item online survey. Survey questions included demographics and inquired about athletes’ effort and utility of baseline and post-concussion neurocognitive testing. A series of chi-square analyses measured the association between sex, concussion history, and previous exposure to baseline testing on effort provided during testing and utility of the test. Level of statistical significance was p \u3c .05. Results: One hundred eighty-two (88 males, 95 females) athletes (M =19.05, SD = 1.15 years) completed the survey. Thirty-eight percent (70/183) reported prior concussion history and 27% (50/182) were first time test takers. Ninety-four percent (172/183) reported providing above average to maximal effort on the baseline test they completed prior to completing the survey. Ninety percent (158/176) and 87% (156/179) of the sample reported that the baseline and post-concussion test results were useful in mitigating premature return to play, respectively. There was no association between sex, concussion history, or previous exposure to baseline testing on reported effort or perceptions of utility for baseline neurocognitive testing (p \u3e .05). Conclusion: The majority of athletes report high effort on baseline neurocognitive testing and recognize the utility of this measure for safe return to play

Display Enhanced Testing For Concussions And Mild Traumatic Brain Injury

Cognitive assessment systems and methods that provide an integrated solution for evaluating the presence or absence of cognitive impairment. The present invention is used to test cognitive functions of an individual including information processing speed, working memory, work list learning and recall, along with variations of these tasks. Immersive and non-immersive systems and methods are disclosed. Testing and results feedback using the present invention may be completed in real time, typically in less than 15 minutes.Emory UniversityGeorgia Tech Research Corporatio

Neurocognitive findings in adults who played youth football

Chronic Traumatic Encephalopathy (CTE) has been linked to contact sports, most notably boxing and American football, due to their propensity for repetitive head impacts. Concerns in the community for the safety of athletes in all contact sports has driven a significant amount of research into concussions, their long term effects, and strategies for treatment and prevention. Knowledge of long term brain health in response to neurotrauma is limited, a gap especially noticeable in the literature on non-catastrophic brain injuries sustained as a child. Concussion is a common injury that is often self-resolving with no lasting neurologic or cognitive deficits. Although repetitive brain trauma is hypothesized to be necessary and sufficient to lead to CTE, no human or animal models have definitively demonstrated the pathophysiologic connection or confirmed the mechanism of symptoms. The research to date has been case based, lacking prospective cohorts, with data complicated by convenience sampling. These factors limit the generalizability of conclusions. CTE is neuropathologically defined with variable symptoms; however, it is only diagnosable at postmortem autopsy making the etiology and prevalence difficult to understand. As more research is published to understand if there is an association between a neurocognitive degenerative disease and contact sports, the concentration is on professional athletes. Yet professional athletes do not represent the overwhelming majority of all contact sport participants. The proposed study will compare adults who participated in youth football, but not beyond the high school level, to a control group of adults who did not play contact sports. Evaluating their cognitive function with an online assessment, the Behavior Rating Inventory of Executive Function – Adult Version (BRIEF-A), data will be analyzed for signs of clinical cognitive impairment. The objective is to measure adults who represent the high percentage of youth football players who do not continue to the advanced levels. Data obtained from this study will help communities make informed decisions, and create the foundation for future studies on long term benefits and risks of contact sports for children

The Role of Neurocognitive Tests in the Assessment of Adult Attention-Deficit/Hyperactivity Disorder

Despite widespread recognition that attention-deficit/hyperactivity disorder (ADHD) is a lifelong neurodevelopmental disorder, optimal methods of diagnosis among adults remain elusive. Substantial overlap between ADHD symptoms and cognitive symptoms of other mental health conditions, such as depression and anxiety, and concerns about validity in symptom reporting have made the use of neuropsychological tests in ADHD diagnostic assessment appealing. However, past work exploring the potential diagnostic utility of neuropsychological tests among adults has often relied on a relatively small subset of tests, has failed to include symptom and performance validity measures, and often does not include comparison groups of participants with commonly comorbid disorders, such as depression. The current study examined the utility of an extensive neuropsychological measure battery for diagnosing ADHD among adults. Two hundred forty-six participants (109 ADHD, 52 depressed, 85 nondisordered controls) completed a multistage screening and assessment process, which included a clinical interview, self, and informant report on behavior rating scales, performance and symptom validity measures, and an extensive neuropsychological testing battery. Results indicated that measures of working memory, sustained attention, response speed, and variability best discriminated ADHD and non-ADHD participants. While single test measures provided performed poorly in identifying ADHD participants, analyses revealed that a combined approach using self and informant symptom ratings, positive family history of ADHD, and a reaction time (RT) variability measure correctly classified 87% of cases. Findings suggest that neuropsychological test measures used in conjunction with other clinical assessments may enhance prediction of adult ADHD diagnoses

Return to Play Decision Making with Concussed Athletes: Sports Medicine Practitioners’ Responses

Sports-related concussions continue to be a serious health concern as the prevalence and incidence of concussion continue to increase annually (Center for Disease Control [CDC], 2016). Decisions regarding return to play (RTP) following concussion represent one of the biggest challenges for sports medicine professionals. The literature recommends implementing an individualized, collaborative, multi-dimensional approach to increase accuracy when assessing concussion recovery and making RTP decisions (McCrory et al., 2013). The current study examined the self-reported practices of sports medicine professionals surrounding RTP decisions. The study utilized an author-developed questionnaire, Sports Medicine Practice Questionnaire (SMPQ), administered as an online survey to assess the practices of sports medicine professionals responsible for returning athletes to play after a concussion. A sample of 141 participants responded to the SMPQ. Most respondents (89%, n = 126) reported using neurocognitive testing to aid in their RTP decision. A majority of respondents (95%) reported engaging in consultation practices to confirm readiness to RTP. Significant consultation discrepancies were observed between participants’ preference for consulting with team physicians versus neuropsychologists. Gender differences regarding consultation practices were noted with females consulting with neuropsychologists more than their male counterparts. Significant regional differences between the Northeast and South were found with the South endorsing greater implementation of post-exertional neurocognitive testing. From the pilot questionnaire consisting of 43 items, a revised brief 16-item SMPQ was generated, which yielded an internal consistency Cronbach a = .70. The implications of the findings are discussed with regard to the Concussion in Sports Group consensus statement (McCrory et al., 2017) and recognized current guidelines on the implementation of neurocognitive tests, gradual RTP exertion protocols, and consultation practices when making the RTP decision

Concussion Assessment Management in High School and Collegiate Athletics

Research indicates that protocol regarding concussion assessment management at the high school and collegiate level is advancing, however, there are holes in consistency that need to be filled in order to ensure accuracy. The purpose of this synthesis was to review the literature on concussion assessment management in high school and collegiate athletics. The results indicate that the lack of consistency comes as a direct result of key factors including a school’s lack of funding and lack of resources, the emphasis placed on the self-efficacy of athletic trainers, and the willingness of athletic trainers to follow guidelines provided for the testing methods

Determining the False Positive Rate of a Concussion Battery in Healthy Division I Collegiate Athletes

Context: Athletic participation accounts for 1.6-3.8 million concussions, or mild traumatic brain injuries (mTBI) every year in the United States. Accurate assessment and diagnosis of concussions is critical to protect athletes from further injury. The Fourth International Conference on Concussion in Sport Consensus Statement recommends a multifaceted concussion assessment which includes symptom inventories, postural stability assessment, and neurocognitive testing. The accuracy of each test is vital in correctly diagnosing concussions. The Balance Error Scoring System (BESS), Standardized Assessment of Concussion (SAC), and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) are among the most commonly used assessment tools by NCAA athletic trainers. Objectives: (1) evaluate the false positive rate of a clinical concussion assessment battery (BESS, SAC, ImPACT) in a healthy Division I collegiate athlete population and (2) identify trends in pass/fail rates based on months elapsed from baseline testing. Design: Prospective longitudinal study. Setting: A large university in southeast Georgia. Participants: Fifty Division I collegiate athletes were recruited as participants. Forty-eight participants fulfilled the study requirements. Main Outcome Measure(s): Descriptive statistics were run for all demographic variables, along with scores on the various dependent variables. Failure rates for each test were then determined. Any increase in BESS score, decrease in SAC score, or change in an ImPACT composite score exceeding the reliable change index was classified as a false positive for the concussion battery. A one-way repeated measures ANOVA was run to determine changes in scores by testing time (baseline vs. current) and time elapsed from baseline. Tukey post-hoc testing and planned simple contrasts were evaluated as needed. Results: The concussion battery produced an 81% false positive rate. BESS produced the most false positives (62.5%), followed by ImPACT (33.3%), and SAC (27.1%). No significant interactions were found between the time from baseline testing and differences in scores from baseline to current testing. There was a significant main effect across time between BESS baseline scores and testing scores. Conclusions: Eighty-one percent of participants demonstrated a deficit from their baseline scores on one or more of the assessments, thus failing the concussion battery and giving objective evidence of a possible concussion. When a patient fails an objective assessment used to identify and diagnose a concussion, they are at risk of being removed from all participation. To return to participation, the current recommendation is a symptom free graduated return to play protocol taking about seven days to complete. This may result in significant playing time lost for the athlete

Examining the relationship between neurocognitive performance and functional fitness levels among older adults

The goal of this thesis was to examine the relationship between neurocognitive performance and functional fitness levels among older adults. This is important because the geriatric population is the fastest growing demographic in the United States (USDHHS, CDC & Prevention, 2012). By 2030, the older adult population is expected to double. With the cumulative health effects associated with aging and pathological disease, adults typically experience a normal decline in cognitive function termed age-associated memory impairment (AAMI) (Kramer, Colcombe, McAuley, Scalf, & Erickson, 2005; O’Brien, 1999). It is believed to be a non-progressive disorder. Mild cognitive impairment (MCI), on the other hand, is a slightly more aggressive and permanent form of memory loss affecting 27% of adults age 65 and older (Bischkopf, Busse, & Angermeyer, 2002). Therefore, it is imperative to understand, now, the relationship between physical activity and functional fitness as it relates to neurocognitive preservation. Primarily, paper-pencil neuropsychological tests are used to measure cognition (Lovell, 2006). Keywords: aging, cognition, functional fitness, geriatric neuropsychological tests, health-related quality of life, ImPACT, neurocognitive performance, and physical activit

COMPARISON OF FIRST-TIME NEUROCOGNITIVE BASELINE COGNIGRAM ASSESSMENTS BETWEEN AMERICAN AND BRAZILIAN PROFESSIONAL BULL RIDING ATHLETES

The purpose of this study was to compare the first-time neurocognitive concussion baseline outcomes, using the Cognigram assessment software, between American and Brazilian professional bull riders. The analysis was performed using the database provided by the Professional Bull Riding Association Sports Medicine staff. The Cognigram assessment measures and analyses four outcomes: Psychomotor Function, Attention, Learning, and Working Memory Speed. The study examined the test outcomes of 210 professional bull riders (150 American, 60 Brazilian). A one-way multivariate analysis of covariance (MANCOVA) was used to determine if there a significant difference in the four assessment outcomes when comparing the country of origin subject groups. The results of the analysis reported country of origin has a significant effect on the assessment outcomes, F(8, 406) = 6.407, p \u3c .001, Wilks’ Λ = .788, partial η² = .112. Post hoc analysis reported significant differences in three outcomes (Bonferroni correction, α = .012): Psychomotor Function, F(2, 206) = 21.25, p \u3c .001, partial η² = .17, Attention, F(2, 206) = 18.90, p \u3c .001, partial η² = .16, and Working Memory Speed, F(2, 206) = 7.70, p \u3c .001, partial η² = .07. Country of Origin did not have a significant effect on Learning, F(2, 206) = 1.14, p = .321, partial η² = .01. Extrinsic factors (Testing environment and format and familiarity of testing content) and intrinsic factors (time orientation and physical and mental status at the time of testing) could have significant effects on the disparity between the two groups, affecting assessment outcomes. If cultural bias has a significant effect on Cognigram assessment outcomes, this poses a threat to the validity of the assessment toll; and this may contribute to an increase in the probability of under diagnosis of sport related concussions for Brazilian bull riders