Further Development of the Assessment of Military Multitasking Performance: Iterative Reliability Testing.

The Assessment of Military Multitasking Performance (AMMP) is a battery of functional dual-tasks and multitasks based on military activities that target known sensorimotor, cognitive, and exertional vulnerabilities after concussion/mild traumatic brain injury (mTBI). The AMMP was developed to help address known limitations in post concussive return to duty assessment and decision making. Once validated, the AMMP is intended for use in combination with other metrics to inform duty-readiness decisions in Active Duty Service Members following concussion. This study used an iterative process of repeated interrater reliability testing and feasibility feedback to drive modifications to the 9 tasks of the original AMMP which resulted in a final version of 6 tasks with metrics that demonstrated clinically acceptable ICCs of > 0.92 (range of 0.92-1.0) for the 3 dual tasks and > 0.87 (range 0.87-1.0) for the metrics of the 3 multitasks. Three metrics involved in recording subject errors across 2 tasks did not achieve ICCs above 0.85 set apriori for multitasks (0.64) and above 0.90 set for dual-tasks (0.77 and 0.86) and were not used for further analysis. This iterative process involved 3 phases of testing with between 13 and 26 subjects, ages 18-42 years, tested in each phase from a combined cohort of healthy controls and Service Members with mTBI. Study findings support continued validation of this assessment tool to provide rehabilitation clinicians further return to duty assessment methods robust to ceiling effects with strong face validity to injured Warriors and their leaders.

Self-Management of Unreported Musculoskeletal Injuries in a U.S. Army Brigade.

BACKGROUND: There is a paucity of literature describing the accuracy of musculoskeletal injury reporting in the U.S. Army. PURPOSE: To investigate symptom-management behaviors as well as factors associated with seeking medical treatment among active duty Soldiers who reported that they had concealed at least one musculoskeletal injury. METHODS: Anonymous surveys were completed by Soldiers (N = 1,388; 1,269 males, 74 females, and 45 no response) assigned to an Infantry Brigade Combat Team. Soldiers were asked to self-report injuries sustained in the last 12 months and whether or not they reported those injuries to a medical provider. Descriptive statistics were used to analyze treatment alternatives. Chi-square test was used to assess any significant relationships between injury and various demographics. RESULTS: There were 808 (58%) Soldiers who stated they had an injury that they did not report. Over-the-counter pain relief medication (81%) was the most commonly selected alternative treatment. CONCLUSION: Over-the-counter pain medication was frequently used for symptom management among Soldiers who did not report their injury to a medical provider.

Multiplanar wrist joint proprioception: The effect of anesthetic blockade of the posterior interosseous nerve or skin envelope surrounding the joint.

STUDY DESIGN: Randomized clinical trial. PURPOSE: Contribution of the posterior interosseous nerve (PIN) and surrounding skin envelope to wrist proprioception is a topic of debate and the primary focus of this research. METHODS: We performed a double-blinded, placebo control study in which subjects underwent baseline multiplanar testing of wrist proprioception. They were randomized to receive either anesthetic blockade of the PIN within the fourth dorsal compartment, or circumferential topical anesthetic blockade of skin surrounding the wrist. Corresponding opposite wrists underwent placebo intervention with saline injection or inert ultrasound gel. Subjects repeated proprioceptive testing. RESULTS: Eighty subjects, 45 male and 35 female, mean age 33 years (range, 19-64 years), completed testing. The percentage of measurements falling outside a ±18° range did not differ between pre-treatment and post-treatment PIN blockade or for circumferential skin anesthesia. CONCLUSIONS: Wrist proprioception appears to be a multifactorial phenomenon. Surgeons may sacrifice the PIN without concern for effect on joint proprioception. LEVEL OF EVIDENCE: Level I.

Development and preliminary reliability of a multitasking assessment for executive functioning after concussion.

OBJECTIVES. Executive functioning deficits may result from concussion. The Charge of Quarters (CQ) Duty Task is a multitask assessment designed to assess executive functioning in servicemembers after concussion. In this article, we discuss the rationale and process used in the development of the CQ Duty Task and present pilot data from the preliminary evaluation of interrater reliability (IRR). METHOD. Three evaluators observed as 12 healthy participants performed the CQ Duty Task and measured performance using various metrics. Intraclass correlation coefficient (ICC) quantified IRR. RESULTS. The ICC for task completion was .94. ICCs for other assessment metrics were variable. CONCLUSION. Preliminary IRR data for the CQ Duty Task are encouraging, but further investigation is needed to improve IRR in some domains. Lessons learned in the development of the CQ Duty Task could benefit future test development efforts with populations other than the military.