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Juliana Hotta Ansai, Larissa Pires de Andrade, Paulo Giusti Rossi, Theresa Helissa Nakagawa, Francisco Assis Carvalho Vale and José Rubens Rebelatto

accelerometers between AD and preserved cognition (PC) groups and between AD and MCI groups, without any distinction between PC and MCI groups. TUGT is widely used in clinical practice; however, this test has some limitations, including the analysis of total time and the main focus in time and not in other

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Bryan L. Riemann and Kevin M. Guskiewicz

Mild head injury (MHI) represents one of the most challenging neurological pathologies occurring during athletic participation. Athletic trainers and sports medicine personnel are often faced with decisions about the severity of head injury and the timing of an athlete's return to play following MHI. Returning an athlete to competition following MHI too early can be a catastrophic mistake. This case study involves a 20-year-old collegiate football player who sustained three mild head injuries during one season. The case study demonstrates how objective measures of balance and cognition can be used when making decisions about returning an athlete to play following MHI. These measures can be used to supplement the subjective guidelines proposed by many physicians.

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Nicole L. Hoffman, Hannes Devos and Julianne D. Schmidt

Psychology . Boca Raton, FL : CRC Press ; 2011 : 1 – 11 . 31. Marcotte TD , Rosenthal TJ , Roberts E , et al . The contribution of cognition and spasticity to driving performance in multiple sclerosis . Arch Phys Med Rehabil . 2008 ; 89 ( 9 ): 1753 – 1758 . PubMed doi:10.1016/j.apmr.2007

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Luke M. Ross, Johna K. Register-Mihalik, Jason P. Mihalik, Karen L. McCulloch, William E. Prentice, Edgar W. Shields and Kevin M. Guskiewicz


Recent evidence has revealed deficiencies in the ability to divide attention after concussion.


To examine the effects of a single vs a dual task on cognition and balance in healthy subjects and to examine reliability of 2 dual-task paradigms while examining the overall feasibility of the tasks.


Pretest–posttest experimental design.


Sports medicine research laboratory.


30 healthy, recreationally active college students.


Subjects performed balance and cognitive tasks under the single- and dual-task conditions during 2 test sessions 14 d apart.

Main Outcome Measures:

The procedural reaction-time (PRT) test of the Automated Neuropsychological Assessment Metrics (eyes-closed tasks) and an adapted Procedural Auditory Task (PAT; eyes-open tasks) were used to assess cognition. The NeuroCom Sensory Organization Test (SOT) and the Balance Error Scoring System (BESS) were used to assess balance performance. Five 2-way, within-subject ANOVAs and a paired-samples t test were used to analyze the data. ICCs were used to assess reliability across 2 test sessions.


On the SOT, performance significantly improved between test sessions (F 1,29 = 35.695, P < .001) and from the single to the dual task (F 1,29 = 9.604, P = .004). On the PRT, performance significantly improved between test sessions (F 1,29 = 57.252, P < .001) and from the single to the dual task (F 1,29 = 7.673, P = .010). No differences were seen on the BESS and the PAT. Reliability across test sessions ranged from moderate to poor for outcome measure.


The BESS appears to be a more reliable and functional tool in dual-task conditions as a result of its increased reliability and clinical applicability. In addition, the BESS is more readily available to clinicians than the SOT.

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Alexander T. Latinjak

? Consciousness and Cognition, 22 , 1412 – 1421 . doi:10.1016/j.concog.2013.09.012 10.1016/j.concog.2013.09.012 Seli P. , Carriere J.S. , Levene M. , & Smilek D. ( 2013 ). How few and far between? Examining the effects of probe rate on self-reported mind wandering . Frontiers in Psychology, 4

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Kevin M. Antshel, Laura E. VanderDrift and Jeffrey S. Pauline

The NCAA Growth, Opportunities, Aspirations and Learning of Students in College data were used to explore the relationship between self-reported high levels of difficulties thinking or concentrating and grade point average (GPA) in college student-athletes. We specifically investigated the mediators of the relationship between self-reported high levels of difficulties thinking or concentrating and GPA. Results revealed there was a significant indirect effect between self-reporting the highest level of difficulties thinking or concentrating and service use through GPA, moderated by identity, full model: F(4, 14738) = 184.28, p < .001; R 2 = .22. The athletic/academic identity variable acted as a moderator of the mediating effect of GPA on the relationship between self-reported high levels of difficulties thinking or concentrating and the use of academic resources on campus. If a student-athlete who is self-reporting high levels of difficulties thinking or concentrating identifies more as a student, GPA is likely to prompt academic service use. However, if the student-athlete identifies more as an athlete, GPA is less likely to lead to use of campus academic support resources.

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Isaac Estevan, Sergio Gandia, Israel Villarrasa-Sapiña, José Luis Bermejo and Xavier García-Massó

declines during DT, so performing a WMT and postural control simultaneously involves higher attentional demands than doing an ST only ( Abernethy, 1993 ; Gabbett et al., 2011 ; Teel, Register-Mihalik, Troy Blackburn, & Guskiewicz, 2013 ). Concerning the effect of WMT difficulty on cognition, we found

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Tamara C. Valovich McLeod and Johna K. Register-Mihalik

Patient Scenario:

An adolescent female youth soccer athlete, with a previous concussion history, suffered a second concussion 4 wk ago. Her postconcussive symptoms are affecting her school performance and social and family life.

Clinical Outcomes Assessment:

Concussion is typically evaluated via symptoms, cognition, and balance. There is no specific patient-oriented outcomes measure for concussion. Clinicians can choose from a variety of generic and specific outcomes instruments aimed at assessing general health-related quality of life or various concussion symptoms and comorbidities such as headache, migraine, fatigue, mood disturbances, depression, anxiety, and concussion-related symptoms.

Clinical Decision Making:

The data obtained from patient self-report instruments may not actively help clinicians make return-to-play decisions; however, these scales may be useful in providing information that may help the athlete return to school, work, and social activities. The instruments may also serve to identify issues that may lead to problems down the road, including depression or anxiety, or serve to further explore the nature of an athlete’s symptoms.

Clinical Bottom Line:

Concussion results in numerous symptoms that have the potential to linger and has been associated with depression and anxiety. The use of outcomes scales to assess health-related quality of life and the effect of other symptoms that present with a concussion may allow clinicians to better evaluate the effects of concussion on physical, cognitive, emotional, social, school, and family issues, leading to better and more complete management.

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Kelsey Picha, Carolina Quintana, Amanda Glueck, Matt Hoch, Nicholas R. Heebner and John P. Abt

Context: Reaction time (RT) is crucial to athletic performance. Therefore, when returning athletes to play following injury, it is important to evaluate RT characteristics ensuring a safe return. The Dynavision D2® system may be utilized as an assessment and rehabilitation aid in the determination of RT under various levels of cognitive load. Previous research has demonstrated good reliability of simple protocols when assessed following a 24- to 48-hour test–retest window. Expanding reliable test–retest intervals may further refine novel RT protocols for use as a diagnostic and rehabilitation tool. Objective: To investigate the test–retest reliability of a battery of 5 novel RT protocols at different time intervals. Design: Repeated measures/reliability. Setting: Interdisciplinary sports medicine research laboratory. Participants: Thirty healthy individuals. Methods: Participants completed a battery of protocols increasing in difficulty in terms of reaction speed requirement and cognitive load. Prior to testing, participants were provided 3 familiarization trials. All protocols required participants to hit as many lights as quickly as possible in 60 seconds. After completing the initial testing session (session 1), participants waited 1 hour before completing the second session (session 2). Approximately 2 weeks later (average 14 [4] d), the participants completed the same battery of tasks for the third session (session 3). Main Outcome Measures: The intraclass correlation coefficient, standard error of measurement, minimal detectable change, and repeated-measures analysis of variance were calculated for RT. Results: The intraclass correlation coefficient values for each of the 5 protocols illustrated good to excellent reliability between sessions 1, 2, and 3 (.75–.90). There were no significant differences across time points (F < 0.105, P > .05). Conclusions: The 1-hour and 14-day test–retest intervals are reliable for clinical assessment, expanding the time frames previously reported in the literature of when assessments can be completed reliably. This study provides novel protocols that challenge cognition in unique ways.