Global Switch Cost as an Index for Concussion Assessment

Abstract

The current concussion testing models test athletes' cognitive and physical function in isolation. The stability reliability of the global switch cost index obtained under DT conditions suggests that it may be a useful measure for clinicians. The DT paradigm presents another test methodology that may be useful for making return-to-play decisions as part of a comprehensive concussion management plan.

Are Divided Attention Tasks Useful in the Assessment and Management of Sport-Related Concussion?

“…The remaining 4 had a cross sectional design (Broglio et al 2005;Cavanaugh et al 2007;Fait et al 2013;Resch et al 2011); however, two of these studies also included a session where tasks were practiced but not assessed. (Broglio et al 2005; -In this preliminary, small study, concussed athletes had higher dualtask cost to gait variables and more overall errors on the cognitive Stroop task when they were asymptomatic compared to controls Resch et al 2011) Of the 19 studies, 13 compared concussed patients to controls (Catena et al 2007a(Catena et al , b, 2009a(Catena et al , b, 2011Chiu et al 2013;Fait et al 2013;Kleffelgaard et al 2012;Martini et al 2011;Parker et al 2005Parker et al , 2006Parker et al , 2007Parker et al , 2008, whereas 6 used only healthy participants to examine potential paradigms (Broglio et al 2005;Cavanaugh et al 2007;Okumura et al 2013;Resch et al 2011;Ross et al 2011;Teel et al 2013). Only 3 out of the 19 studies examined psychometrics of the paradigms and these articles only included healthy participants (Okumura et al 2013;Resch et al 2011;Teel et al 2013).…”

“…Most studies (n =15) had a longitudinal design with at least two testing/data collection sessions (Catena et al 2007a(Catena et al , b, 2009a(Catena et al , b, 2011Chiu et al 2013;Kleffelgaard et al 2012;Martini et al 2011;Okumura et al 2013;Parker et al 2005Parker et al , 2006Parker et al , 2007Parker et al , 2008Ross et al 2011;Teel et al 2013). The remaining 4 had a cross sectional design (Broglio et al 2005;Cavanaugh et al 2007;Fait et al 2013;Resch et al 2011); however, two of these studies also included a session where tasks were practiced but not assessed.…”

“…The most common measures of divided attention used in the reviewed studies were gait and walking tasks with a cognitive task or an obstacle to avoid task (n =13) (Catena et al 2007a(Catena et al , b, 2009a(Catena et al , b, 2011Chiu et al 2013;Fait et al 2013;Martini et al 2011;Okumura et al 2013;Parker et al 2005Parker et al , 2006Parker et al , 2007Parker et al , 2008 and clinical balance tasks in the presence of a cognitive task (n =6) (Broglio et al 2005;Cavanaugh et al 2007;Kleffelgaard et al 2012;Resch et al 2011;Ross et al 2011;Teel et al 2013). The cognitive tasks included in the reviewed paradigms were simple question and answer tasks with basic mental status questions (Catena et al 2007a(Catena et al , b, 2009aParker et al 2005Parker et al , 2006Parker et al , 2007Parker et al , 2008, complex attention tasks with incongruent Stroop task (Teel et al 2013), global task switching visual (Broglio et al 2005) and auditory task (Okumura et al 2013;Resch et al 2011), modified visual Stroop task (Fait et al 2013), auditory Stroop task (Catena et al 2011), the Attentional Network Test (Chiu et al 2013), basic arithmetic (Kleffelgaard et al 2012), digit span task (Cavanaugh et al 2007), spatial memory task (Martini et al 2011), and visual and auditory choice reaction time tasks (response indicated if the sum of addition problem was greater than 5 or less than 5 via right and left mouse clicks for the visual task with the Sensory Organization Test and orally with the auditory task performed with the Balance Error Scoring System)…”

“…The main outcome measures for the clinical balance assessments included number of errors on the Balance Error Scoring System (Ross et al 2011) and the Sensory Organization Test Equilibrium Scores, which is a measure of general postural sway across balance conditions (Broglio et al 2005;Cavanaugh et al 2007;Resch et al 2011;Ross et al 2011;Teel et al 2013). The Harvard Step Test was used in one of the reviewed studies (Okumura et al 2013). For the forceplate and gait assessments, center of mass displacement in the anterior and medial/lateral directions and peak velocity in those directions, maximum horizontal separation between the center of mass and center of pressure and range of motion in the sagittal and coronal planes, gait velocity, stride length, step width and stride time were the most common outcome measures (Catena et al 2007a(Catena et al , b, 2009a(Catena et al , b, 2011Chiu et al 2013;Parker et al 2005Parker et al , 2006Parker et al , 2007Parker et al , 2008.…”

“…Only three of the articles included psychometric information on the dual-task paradigms incorporated in the studies. Although these three studies examined healthy subjects only, each also examined test reliability across time (Okumura et al 2013;Ross et al 2011;Teel et al 2013). Because the tasks were inherently different, the psychometrics for each set of tasks are presented.…”