Developing a Comprehensive, Interdisciplinary Concussion Program.

There has been a growing trend of local and national coverage of and interest in concussion injuries over the past 2 decades. Increasing public concern over potential catastrophic and unknown long-term effects of sports-related concussion injuries has led to an acknowledgment of the strong public health need for addressing all concussion injuries, regardless of mechanism of injury. In efforts to address this need for concussion prevention and management, both in sports and nonsports, The University of Kansas Health System initiated the interdisciplinary Center for Concussion Management program in 2012. The program was created as a virtual clinic concept and includes voluntary participation from various providers across the institution, limited budget, and space obstacles. Since its inception, the program has continued to operate as its initial design of a multidisciplinary team model outside the sole ownership of 1 department, and has expanded to include education and outreach to local and regional schools and groups.

Pilot Feasibility Study Examining Pupillary Response During Driving Simulation as a Measure of Cognitive Load in Breast Cancer Survivors.

OBJECTIVES: To test the feasibility of adding driving simulation tasks to measure visuospatial ability and processing speed to an existing neurocognitive battery for breast cancer survivors (BCSs). SAMPLE & SETTING: 38 BCSs and 17 healthy controls from a cross-sectional pilot study conducted at the University of Kansas Medical Center. METHODS & VARIABLES: Exploratory substudy measuring pupillary response, visuospatial ability, and processing speed during two 10-minute driving simulations (with or without n-back testing) in a sample of BCSs with self-reported cognitive complaints and healthy controls. RESULTS: Feasibility of measurement of pupillary response during driving simulation was demonstrated. No between-group differences were noted for pupillary response during driving simulation. BCSs had greater visuospatial ability and processing speed performance difficulties than healthy controls during driving simulation without n-back testing and slower n-back response time. IMPLICATIONS FOR NURSING: Preliminary evidence showed a possible link between cancer/treatment on visuospatial ability and processing speed in BCSs.

Pupillary response: cognitive effort for breast cancer survivors.

PURPOSE: The purpose of this cross-sectional comparative pilot study was to evaluate cognitive effort, indexed by pupillary response (PR), for breast cancer survivors (BCS) with complaints of cognitive dysfunction following chemotherapy. STUDY AIMS: Compare the cognitive effort employed by BCS to healthy controls (HC) during neuropsychological tests (NPT) for memory, sustained attention, verbal fluency, visuospatial ability, processing speed and executive function; and Investigate the relationship between PR-indexed cognitive effort and participants' self-report of cognitive function. METHODS: Self-report of cognitive function was collected from 23 BCS and 23 HC. PR was measured during NPT. Independent two-sample t tests or Wilcoxon rank sum tests were used to compare group scores. Between-group effect size (Cohen's d) was calculated for each outcome. Correlation between mean self-report scores and PR values, as well as 95% confidence intervals, was calculated. RESULTS: No group differences were demonstrated for NPT performance. BCS reported more issues with cognitive function than HC (p < .0001). A group effect for BCS was seen with PR-indexed cognitive effort for components of most NPT (p < .05). PR was correlated with most self-report measures of cognitive function (r = 0.33-0.45). CONCLUSIONS: PR sensitivity to cognitive effort across a variety of NPT and correlation with self-report of cognitive function was demonstrated. The portability, affordability, and "real-time" aspects of PR are attractive for potential use in the clinic setting to assess cognitive function. A larger study is needed to confirm these results. Prospective investigation of PR in BCS is needed to demonstrate sensitivity to cognitive function changes over time.

Effectiveness of Semantic Encoding Strategy Training after Traumatic Brain Injury is Correlated with Frontal Brain Activation Change.

BACKGROUND: Traumatic Brain Injury (TBI) is frequently associated with chronic, treatment-resistant memory problems, and is one of the leading causes of disability in otherwise healthy adults. Cognitive rehabilitation therapies are used with the goal of improving memory functioning; however, not all patients benefit. Prefrontal cortex (PFC) is critical for employing effective memory strategies. We hypothesized that memory improvement after a brief cognitive intervention would be associated with increases in PFC activation during a memory task. METHODS: The current study used behavioral analyses and functional magnetic resonance imaging (fMRI) to examine the effects of two days of intensive semantic encoding strategy training on memory performance and brain activation patterns in patients in the post-acute stage of TBI. fMRI data were collected before and after training while participants learned word lists. RESULTS: Post-training vs. pre-training changes in total recall and semantic clustering during recall were positively correlated with post-training vs. pre-training changes in neural activation in PFC. CONCLUSIONS: These results suggest that variability in treatment response to cognitive training after TBI may be due in part to variability in PFC function, and that some survivors of TBIs may benefit from treatments specifically targeting the PFC.