Correspondence of Maximum and Typical Performance Measures of Cognitive Processing.

We examined associations among cognitive processing measures that varied on a continuum from maximum to typical performance tasks in the context of an ego depletion study. Our intent was to replicate and extend the findings of Charek, Meyer, and Mihura, which showed that ego depletion had an expected effect on selected scores from the Rorschach inkblot task. We hypothesized that Rorschach variables indicative of cognitive sophistication would correlate with neuropsychological measures of cognitive ability and that Rorschach variables theoretically unassociated with cognitive processing would not correlate with those criterion measures. These hypotheses were supported, providing evidence of convergent and discriminant validity. We also hypothesized ego depletion effects on all measures; however, none were evident. Methodological considerations and implications of the findings are discussed.

Preliminary Evidence of a Dose-Response for Continuing to Play on Recovery Time After Concussion.

OBJECTIVE: To investigate a dose-response relationship between continuing to play following concussion and outcomes. PARTICIPANTS: A total of 130 athletes (age 11-19 years). DESIGN: Repeated-measures design comparing symptoms, neurocognitive performance, and recovery time between 52 athletes immediately removed from play (Removed), 24 who continued to play for 15 minutes or less (Short-Play), and 32 who continued to play for more than 15 minutes (Long-Play). MAIN MEASURES: Recovery was the number of days from injury to clearance. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) measured neurocognitive outcomes and the Post-Concussion Symptom Scale (PCSS) measured symptom severity. RESULTS: Long-Play (44.09 ± 27.01 days) took longer to recover than Short-Play (28.42±12.74 days) and Removed (18.98 ± 13.76 days). Short-Play was 5.43 times more likely, and Long-Play 11.76 times more likely, to experience protracted recovery relative to Removed. Both Play groups had worse neurocognitive performance and higher symptom scores than Removed at days 1 to 7, with Long-Play demonstrating worse reaction time than Short-Play. At days 8 to 30, both Play groups performed worse than Removed on visual memory and visual motor speed, while only Long-Play performed worse on verbal memory and reaction time. CONCLUSIONS: Results provide initial evidence of a dose-response effect for continuing to play on recovery from concussion, highlighting the importance of removal from play.

Mobile Ecological Momentary Assessment of Postconcussion Symptoms and Recovery Outcomes.

OBJECTIVE: Evaluate mobile ecological momentary assessment (mEMA) as an approach to measure sport-related concussion (SRC) symptoms, explore the relationships between clinical outcomes and mEMA, and determine whether mEMA was advantageous for predicting recovery outcomes compared to traditional symptom report. SETTING: Outpatient concussion clinic. PARTICIPANTS: 20 athletes aged 12 to 19 years with SRC. METHODS: Prospective study of mEMA surveys assessing activity and symptoms delivered via mobile application (3 time blocks daily) and clinical assessment at visit 1 (<72 hours postinjury) and visit 2 (6-18 days postinjury). Linear mixed models examined changes in mEMA symptoms over time and relationships among simultaneous report of activity type (cognitive, physical, sedentary, vestibular) and symptoms. Linear regressions evaluated the association among symptoms for activity types and clinical outcomes. MAIN MEASURES: mEMA symptom scores, Post-Concussion Symptom Scale, neurocognitive testing, vestibular/oculomotor screening (VOMS). RESULTS: mEMA response rate was 52.4% (N = 1155) for prompts and 50.4% per participant. Symptoms were lower in the morning (P < .001) compared with afternoon and evening. Higher mEMA symptoms were reported during vestibular compared with physical (P = .035) and sedentary (P = .001) activities. mEMA symptoms were positively associated with Post-Concussion Symptom Scale (PCSS) (P = .007), VOMS (P = 0.001-0.002), and recovery time (P < .001), but not neurocognitive scores. mEMA symptom score (P = .021) was a better predictor of recovery time than PCSS at either clinic visit. CONCLUSION: mEMA overcomes barriers of traditional symptom scales by eliminating retrospective bias and capturing fluctuations in symptoms by time of day and activity type, ultimately helping clinicians refine symptom management strategies.

Office-based concussion evaluation, diagnosis, and management: adult.

Concussion is a major public health concern, with an estimated 1.6-3.8 million sport-related concussions occurring annually in the United States. Although the majority of injured athletes recover within 7-21 days, 20-30% of athletes experience protracted recovery spanning more than a month, suggesting as many as 320,000-760,000 athletes may experience prolonged symptoms. This highlights the need for efficacious clinical interventions to facilitate recovery. While concussion was historically conceptualized as a homogeneous injury, a more nuanced understanding has recently emerged and led to a refined approach of categorizing concussions into clinical trajectories or symptom profiles. These categorizations correspond with targeted rehabilitation strategies focused on specific symptom clusters and deficits. Multidisciplinary teams, with collaborating neuropsychologists, neurologists, neurosurgeons, sports medicine physicians, athletic trainers, and physical therapists, are valuable to concussion management due to the heterogeneous nature of the injury. This chapter will provide an overview of a multimodal, clinical profile-based approach to assessment and targeted treatment of athletes with sport-related concussion. We describe a profile-based model for conceptualizing the injury, review relevant modifying factors, discuss components of a comprehensive assessment, and examine targeted treatment approaches.

The Impact of an Ego Depletion Manipulation on Performance-Based and Self-Report Assessment Measures.

We investigated the impact of ego depletion on selected Rorschach cognitive processing variables and self-reported affect states. Research indicates acts of effortful self-regulation transiently deplete a finite pool of cognitive resources, impairing performance on subsequent tasks requiring self-regulation. We predicted that relative to controls, ego-depleted participants' Rorschach protocols would have more spontaneous reactivity to color, less cognitive sophistication, and more frequent logical lapses in visualization, whereas self-reports would reflect greater fatigue and less attentiveness. The hypotheses were partially supported; despite a surprising absence of self-reported differences, ego-depleted participants had Rorschach protocols with lower scores on two variables indicative of sophisticated combinatory thinking, as well as higher levels of color receptivity; they also had lower scores on a composite variable computed across all hypothesized markers of complexity. In addition, self-reported achievement striving moderated the effect of the experimental manipulation on color receptivity, and in the Depletion condition it was associated with greater attentiveness to the tasks, more color reactivity, and less global synthetic processing. Results are discussed with an emphasis on the response process, methodological limitations and strengths, implications for calculating refined Rorschach scores, and the value of using multiple methods in research and experimental paradigms to validate assessment measures.