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Chudzik A, Śledzianowski A, Przybyszewski AW. Machine Learning and Digital Biomarkers Can Detect Early Stages of Neurodegenerative Diseases. SENSORS (BASEL, SWITZERLAND) 2024; 24:1572. [PMID: 38475108 DOI: 10.3390/s24051572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/16/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
Neurodegenerative diseases (NDs) such as Alzheimer's Disease (AD) and Parkinson's Disease (PD) are devastating conditions that can develop without noticeable symptoms, causing irreversible damage to neurons before any signs become clinically evident. NDs are a major cause of disability and mortality worldwide. Currently, there are no cures or treatments to halt their progression. Therefore, the development of early detection methods is urgently needed to delay neuronal loss as soon as possible. Despite advancements in Medtech, the early diagnosis of NDs remains a challenge at the intersection of medical, IT, and regulatory fields. Thus, this review explores "digital biomarkers" (tools designed for remote neurocognitive data collection and AI analysis) as a potential solution. The review summarizes that recent studies combining AI with digital biomarkers suggest the possibility of identifying pre-symptomatic indicators of NDs. For instance, research utilizing convolutional neural networks for eye tracking has achieved significant diagnostic accuracies. ROC-AUC scores reached up to 0.88, indicating high model performance in differentiating between PD patients and healthy controls. Similarly, advancements in facial expression analysis through tools have demonstrated significant potential in detecting emotional changes in ND patients, with some models reaching an accuracy of 0.89 and a precision of 0.85. This review follows a structured approach to article selection, starting with a comprehensive database search and culminating in a rigorous quality assessment and meaning for NDs of the different methods. The process is visualized in 10 tables with 54 parameters describing different approaches and their consequences for understanding various mechanisms in ND changes. However, these methods also face challenges related to data accuracy and privacy concerns. To address these issues, this review proposes strategies that emphasize the need for rigorous validation and rapid integration into clinical practice. Such integration could transform ND diagnostics, making early detection tools more cost-effective and globally accessible. In conclusion, this review underscores the urgent need to incorporate validated digital health tools into mainstream medical practice. This integration could indicate a new era in the early diagnosis of neurodegenerative diseases, potentially altering the trajectory of these conditions for millions worldwide. Thus, by highlighting specific and statistically significant findings, this review demonstrates the current progress in this field and the potential impact of these advancements on the global management of NDs.
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Affiliation(s)
- Artur Chudzik
- Polish-Japanese Academy of Information Technology, Faculty of Computer Science, 86 Koszykowa Street, 02-008 Warsaw, Poland
| | - Albert Śledzianowski
- Polish-Japanese Academy of Information Technology, Faculty of Computer Science, 86 Koszykowa Street, 02-008 Warsaw, Poland
| | - Andrzej W Przybyszewski
- Polish-Japanese Academy of Information Technology, Faculty of Computer Science, 86 Koszykowa Street, 02-008 Warsaw, Poland
- UMass Chan Medical School, Department of Neurology, 65 Lake Avenue, Worcester, MA 01655, USA
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Teece AR, Beaven CM, Argus CK, Gill N, Driller MW. Daytime naps improve afternoon power and perceptual measures in elite rugby union athletes-a randomized cross-over trial. Sleep 2023; 46:zsad133. [PMID: 37155971 PMCID: PMC10710987 DOI: 10.1093/sleep/zsad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 03/29/2023] [Indexed: 05/10/2023] Open
Abstract
Daytime naps are used by elite athletes in both training and match-day settings. Currently, there are limited interventional studies on the efficacy of napping on physical performance in elite team-sport athletes. Therefore, the objective was to investigate the effect of a daytime nap (<1 hour) on afternoon performance of peak power, reaction time, self-reported wellness, and aerobic performance in professional rugby union athletes. A randomized cross-over design was carried out among 15 professional rugby union athletes. Athletes performed nap (NAP) and no nap (CON) conditions on two occasions, separated by 1 week. Baseline testing of reaction time, self-reported wellness, and a 6-second peak power test on a cycle ergometer were completed in the morning, followed by 2 × 45-minute training sessions, after which athletes completed the NAP or CON condition at 1200 hours. Following the nap period, baseline measures were retested in addition to a 30-minute fixed-intensity interval cycle and a 4-minute maximal effort cycling test. A significant group × time interaction was determined for 6-second peak power output (+157.6 W, p < 0.01, d = 1.53), perceived fatigue (-0.2 AU, p = 0.01, d = 0.37), and muscle soreness (-0.1 AU, p = 0.04, d = 0.75) in favor of the NAP condition. A significantly lower perceived exertion rating (-1.2 AU, p < 0.01, d = 1.72) was recorded for the fixed-intensity session in favor of NAP. This study highlights that utilizing daytime naps between training sessions on the same day improved afternoon peak power and lowered perceptions of fatigue, soreness, and exertion during afternoon training in professional rugby union athletes.
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Affiliation(s)
- Angus R Teece
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
| | - Christopher M Beaven
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
| | | | - Nicholas Gill
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
- New Zealand Rugby, Wellington, New Zealand
| | - Matthew W Driller
- Sport, Performance, and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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Pumpho A, Kaewsanmung S, Keawduangdee P, Suwannarat P, Boonsinsukh R. Development of a mobile application for assessing reaction time in walking and TUG duration: Concurrent validity in female older adults. Front Med (Lausanne) 2023; 10:1076963. [PMID: 36817771 PMCID: PMC9928965 DOI: 10.3389/fmed.2023.1076963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
Introduction The TUG can be used to distinguish between people who fall and people who don't fall. To evaluate cognitive dual-task performance while walking for fall prediction, TUG-dual was frequently employed. A recent study has created a mobile application that enables simple interaction to provide greater convenience for monitoring the duration of TUG, TUG-subtraction, and reaction time. Objective The research aim was to ascertain the concurrent validity of the mobile application that was developed for the clinical assessment of TUG, TUG-subtraction, and reaction time. Methods Twenty-nine older persons participated in this study. The testing protocol involved the TUG, TUG-subtraction, and reaction time assessment. For TUG and TUG-subtraction, the duration to complete the task was recorded by the APDM Mobility Lab system and the mobile application. For the reaction time tests, the reaction times (msec) were recorded by the Multi Choice Reaction timer and the Mobile application. The TUG durations recorded by the APDM Mobility Lab system were correlated with those recorded by the mobile application to verify the concurrent validity using Pearson's product moment correlation coefficient. Also, the reaction time by the Multi Choice Reaction timer was correlated with the mobile application. Bland-Altman plots were used to explore the existence of any systematic differences between the measurements. Results Our results showed very strong correlations between the TUG and TUG-subtraction duration derived from the APDM Mobility Lab system and the mobile application (r = 0.96 and 0.96, respectively). For the reaction time, the results showed a moderate correlation between the reaction time derived from the mobile application and the Multi Choice Reaction Timer (r = 0.67). Conclusion The mobile application, which allows measurement in TUG and TUG-subtraction, is a highly valid tool for TUG duration assessment. However, this application is capable for assess the reaction time with moderate validity for reaction time assessment.
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Affiliation(s)
- Ampha Pumpho
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Supapon Kaewsanmung
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand,Department of Neurological Rehabilitation, Mae Fah Luang University Hospital, Chiang Rai, Thailand
| | - Petcharat Keawduangdee
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Patcharawan Suwannarat
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Rumpa Boonsinsukh
- Faculty of Physical Therapy, Srinakharinwirot University, Nakhon Nayok, Thailand,*Correspondence: Rumpa Boonsinsukh,
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Wisén N, Larsson G, Risling M, Arborelius U. Is conduct after capture training sufficiently stressful? Front Psychol 2022; 13:795759. [PMID: 35967608 PMCID: PMC9372607 DOI: 10.3389/fpsyg.2022.795759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 07/11/2022] [Indexed: 12/01/2022] Open
Abstract
Conduct after capture (CAC) training is for personnel at risk of being captured. To be effective, it needs to be stressful. But how do we know if it is stressful enough? This study uses biomarkers and cognitive measures to evaluate CAC. Soldiers undergoing CAC were measured by the stress hormone cortisol from saliva samples at baseline and during training. The training consisted of being taken capture and put through a number of realistic and threatening scenarios, targeting survival strategies taught in the preceding week. Between scenarios, the trainees were held in a holding cell where they were monitored by a guard. The saliva samples were taken in conjunction with the scenarios. The whole training took place over a period of ~24 h. Cognitive performance was measured at baseline and after training. Three groups took part Group A (n = 20) was taken after 48 h of intense tasks leaving them in a poor resting state. Group B (n = 23) was well rested at CAC onset. Group C (n = 10) was part of a survival, evasion, resistance, and escape (SERE) instructor course. The CAC training was the same for all groups. Group A exhibited a high increase in cortisol during CAC, compared to baseline levels were multiple times as high as “expected” values. Group B exhibited elevated levels slightly lower than those of group A, they also “dropped” to “normal” levels during the latter part of the exercise. Group C displayed the least increase with only slightly elevated levels. CAC training is stressful and cortisol levels were elevated enough to satisfy the prerequisite for effective stress inoculation. No cognitive performance drop could be identified; however, several participants “froze” during the exercise due to intensive stress.
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Affiliation(s)
- Niclas Wisén
- Department of Experimental Traumatology, Institution of Neuroscience at Karolinska Institute, Stockholm, Sweden
- *Correspondence: Niclas Wisén,
| | - Gerry Larsson
- Department of Leadership and Command and Control, Swedish Defence University, Karlstad, Sweden
| | - Mårten Risling
- Department of Experimental Traumatology, Institution of Neuroscience at Karolinska Institute, Stockholm, Sweden
| | - Ulf Arborelius
- Department of Experimental Traumatology, Institution of Neuroscience at Karolinska Institute, Stockholm, Sweden
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Farley JB, Keogh JWL, Woods CT, Milne N. Physical fitness profiles of female Australian football players across five competition levels. SCI MED FOOTBALL 2022; 6:105-126. [PMID: 35236230 DOI: 10.1080/24733938.2021.1877335] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine physical fitness profiles of female Australian football players and investigate differences according to competition level. METHODS A testing battery of 28 physical fitness assessments was undertaken with 240 players across five competition levels: elite senior (≥18 years), non-elite senior (≥18 years), high-level junior (<18 years), non-elite junior (14-17 years), and non-elite junior (10-13 years). Physical fitness profiles were examined and competition level differences were investigated using multivariate analyses of variance. RESULTS Significant differences (p<0.001) were observed between competition levels in body composition (η2p=0.225), flexibility (η2p=0.071), muscular strength and endurance (η2p=0.238), balance (η2p=0.093), reaction time (η2p=0.103), and whole-body locomotor performance (η2p=0.200). Elite seniors and high-level juniors were stronger (p<0.001-0.043), faster (p=0.001-0.022), more responsive (p<0.001-0.048), and had better cardiorespiratory fitness (p<0.001) compared to the non-elite groups. Additionally, body composition and muscular strength and endurance differences were common between the senior and non-elite junior groups. CONCLUSIONS This is the first study to comprehensively profile physical characteristics of female Australian footballers across a broader development pathway. These preliminary findings may assist sport practitioners to better understand athlete development, provide insight on talent identification and development programs, and injury management in this population.
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Affiliation(s)
- Jessica B Farley
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Justin W L Keogh
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Australia.,Sports Performance Research Centre New Zealand, AUT University, Auckland, New Zealand.,Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of Sunshine Coast, Sunshine Coast, Australia.,Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Carl T Woods
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Nikki Milne
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
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Romdhani M, Souissi N, Dergaa I, Moussa-Chamari I, Abene O, Chtourou H, Sahnoun Z, Driss T, Chamari K, Hammouda O. The Effect of Experimental Recuperative and Appetitive Post-lunch Nap Opportunities, With or Without Caffeine, on Mood and Reaction Time in Highly Trained Athletes. Front Psychol 2021; 12:720493. [PMID: 34589026 PMCID: PMC8473839 DOI: 10.3389/fpsyg.2021.720493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose: To investigate the effects of placebo (PLA), 20 min nap opportunity (N20), 5mg·kg-1 of caffeine (CAF), and their combination (CAF+N20) on sleepiness, mood and reaction-time after partial sleep deprivation (PSD; 04h30 of time in bed; study 1 ) or after normal sleep night (NSN; 08h30 of time in bed; study 2 ). Methods: Twenty-three highly trained athletes ( study 1 ; 9 and study 2 ; 14) performed four test sessions (PLA, CAF, N20 and CAF+N20) in double-blind, counterbalanced and randomized order. Simple (SRT) and two-choice (2CRT) reaction time, subjective sleepiness (ESS) and mood state (POMS) were assessed twice, pre- and post-intervention. Results: SRT was lower (i.e., better performance) during CAF condition after PSD (pre: 336 ± 15 ms vs. post: 312 ± 9 ms; p < 0.001; d = 2.07; Δ% = 7.26) and NSN (pre: 350 ± 39 ms vs. post: 323 ± 32 ms; p < 0.001; d = 0.72; Δ% = 7.71) compared to pre-intervention. N20 decreased 2CRT after PSD (pre: 411 ± 13 ms vs. post: 366 ± 20 ms; p < 0.001; d = 2.89; Δ% = 10.81) and NSN (pre: 418 ± 29 ms vs. post: 375 ± 40 ms; p < 0.001; d = 1.23; Δ% = 10.23). Similarly, 2CRT was shorter during CAF+N20 sessions after PSD (pre: 406 ± 26 ms vs. post: 357 ± 17 ms; p < 0.001; d = 2.17; Δ% = 12.02) and after NSN (pre: 386 ± 33 ms vs. post: 352 ± 30 ms; p < 0.001; d = 1.09; Δ% = 8.68). After PSD, POMS score decreased after CAF (p < 0.001; d = 2.38; Δ% = 66.97) and CAF+N20 (p < 0.001; d = 1.68; Δ% = 46.68). However, after NSN, only N20 reduced POMS (p < 0.001; d = 1.05; Δ% = 78.65) and ESS (p < 0.01; d = 0.71; Δ% = 19.11). Conclusion: After PSD, all interventions reduced sleepiness and only CAF enhanced mood with or without napping. However, only N20 enhanced mood and reduced sleepiness after NSN. Caffeine ingestion enhanced SRT performance regardless of sleep deprivation. N20, with or without caffeine ingestion, enhanced 2CRT independently of sleep deprivation. This suggests a different mode of action of napping and caffeine on sleepiness, mood and reaction time.
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Affiliation(s)
- Mohamed Romdhani
- Physical Activity, Sport and Health, UR18JS01, National Observatory of Sports, Tunis, Tunisia
- High Institute of Sport and Physical Education, Ksar-Said, Manouba University, Manouba, Tunisia
| | - Nizar Souissi
- Physical Activity, Sport and Health, UR18JS01, National Observatory of Sports, Tunis, Tunisia
- High Institute of Sport and Physical Education, Ksar-Said, Manouba University, Manouba, Tunisia
| | | | - Imen Moussa-Chamari
- College of Education, Physical Education Department, Qatar University, Doha, Qatar
| | - Olfa Abene
- Regional Center of Sport Medicine, Kairouan, Tunisia
| | - Hamdi Chtourou
- Physical Activity, Sport and Health, UR18JS01, National Observatory of Sports, Tunis, Tunisia
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Zouheir Sahnoun
- Laboratory of Pharmacology, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Tarak Driss
- Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), University Paris Nanterre, UFR STAPS, Nanterre, France
| | - Karim Chamari
- ASPETAR, Qatar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | - Omar Hammouda
- Laboratory of Pharmacology, Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
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Espinoza TR, Hendershot KA, Liu B, Knezevic A, Jacobs BB, Gore RK, Guskiewicz KM, Bazarian JJ, Phelps SE, Wright DW, LaPlaca MC. A Novel Neuropsychological Tool for Immersive Assessment of Concussion and Correlation with Subclinical Head Impacts. Neurotrauma Rep 2021; 2:232-244. [PMID: 34223554 PMCID: PMC8240822 DOI: 10.1089/neur.2020.0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mild traumatic brain injury (mTBI) remains a diagnostic challenge and therefore strategies for objective assessment of neurological function are key to limiting long-term sequelae. Current assessment methods are not optimal in austere environments such as athletic fields; therefore, we developed an immersive tool, the Display Enhanced Testing for Cognitive Impairment and mTBI (DETECT) platform, for rapid objective neuropsychological (NP) testing. The objectives of this study were to assess the ability of DETECT to accurately identify neurocognitive deficits associated with concussion and evaluate the relationship between neurocognitive measures and subconcussive head impacts. DETECT was used over a single season of two high school and two college football teams. Study participants were instrumented with Riddell Head Impact Telemetry (HIT) sensors and a subset tested with DETECT immediately after confirmed impacts for different combinations of linear and rotational acceleration. A total of 123 athletes were enrolled and completed baseline testing. Twenty-one players were pulled from play for suspected concussion and tested with DETECT. DETECT was 86.7% sensitive (95% confidence interval [CI]: 59.5%, 98.3%) and 66.7% specific (95% CI: 22.3%, 95.7%) in correctly identifying athletes with concussions (15 of 21). Weak but significant correlations were found between complex choice response time (processing speed and divided attention) and both linear (Spearman rank correlation coefficient 0.262, p = 0.02) and rotational (Spearman coefficient 0.254, p = 0.03) acceleration on a subset of 76 players (113 DETECT tests) with no concussion symptoms. This study demonstrates that DETECT confers moderate to high sensitivity in identifying acute cognitive impairment and suggests that football impacts that do not result in concussion may negatively affect cognitive performance immediately following an impact. Specificity, however, was not optimal and points to the need for additional studies across multiple neurological domains. Given the need for more objective concussion screening in triage situations, DETECT may provide a solution for mTBI assessment.
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Affiliation(s)
- Tamara R Espinoza
- Department of Emergency Medicine, Division of Emergency Neurosciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kristopher A Hendershot
- Department of Emergency Medicine, Division of Emergency Neurosciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brian Liu
- Georgia Tech Research Institute (GTRI), Advanced Human Integration Branch, Atlanta, Georgia, USA
| | - Andrea Knezevic
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Breanne B Jacobs
- Department of Emergency Medicine, Division of Emergency Neurosciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Russell K Gore
- Complex Concussion Clinic, Shepherd Center, Atlanta, Georgia, USA
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina, North Carolina, USA
| | - Jeffery J Bazarian
- Department of Emergency Medicine, University of Rochester, Rochester, New York, USA
| | - Shean E Phelps
- Georgia Tech Research Institute (GTRI), Advanced Human Integration Branch, Atlanta, Georgia, USA
| | - David W Wright
- Department of Emergency Medicine, Division of Emergency Neurosciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michelle C LaPlaca
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, Georgia, USA
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Linder SM, Lear A, Linder J, Lake A, Brier C, McGrath M, Cruickshank J, Figler R, Alberts JL. Symptom recovery and the relationship between post-injury symptom scores and neurocognitive performance in athletes with sport-related concussion. JOURNAL OF CONCUSSION 2021. [DOI: 10.1177/20597002211018063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction A multi-domain approach to concussion assessment has been recommended that includes self-reported symptom severity in addition to neurocognitive tests and measures of postural stability. The relationship between subjective self-reported symptoms and objective measures of cognitive function in the post-injury state is not well understood. The aims of the study were to determine symptom severity throughout the post-injury continuum of care and the association between symptom severity and performance on measures of neurocognitive function. Methods An observational cohort study was conducted on 1257 high school and collegiate athletes (67% male and 33% female) who had sustained a concussion. Student-athletes were included in the study if they had a healthy baseline assessment and at least one follow-up injury assessment utilizing the Cleveland Clinic Concussion Application (C3 App). Symptom severity was assessed during the acute (0–7 days post-injury), subacute (8–20 days post-injury), and post-concussive (≥21 days post-injury) phases. Neurocognitive performance was assessed using the following measures: Simple Reaction Time (SRT), Choice Reaction Time (CRT), Processing Speed Test (PST), Trail Making Test A (TMT-A), and Trail Making Test B (TMT-B). To determine the relationship between symptom severity and neurocognitive test performance, athletes were stratified into two groups for comparison: symptom score ≤7 or >7, utilizing the 27-item graded symptom checklist within the C3 App. Neurocognitive performance was analyzed with separate linear mixed effect models for each module to compare within-phase differences. Significance for each module at each phase was tested at P < .05 and adjusted for multiple comparisons. Results Median symptom severity during the acute post-injury phase was 10 declining to 2 during the subacute and post-concussive phases. Performance on each of the C3 App modules (SRT, CRT, PST, Trails A, and Trails B) were significantly better in athletes reporting a symptom score of ≤7 compared to those reporting a symptom score >7 at each of the post-injury phases (P < 0.05 on all comparisons). Conclusions Symptomatic athletes performed worse on all measures of neurocognitive function, regardless of time from injury. While symptoms alone should not be used to determine recovery, our data indicate that symptom severity may aide in deciding when to initiate post-injury neurocognitive testing to determine readiness for treatment progression.
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Affiliation(s)
- Susan M Linder
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Concussion Center, Cleveland Clinic, Cleveland, OH, USA
| | - Aaron Lear
- Cleveland Clinic Akron General Sport Medicine, Akron, OH, USA
| | - Joseph Linder
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Adam Lake
- Cleveland Clinic Concussion Center, Cleveland Clinic, Cleveland, OH, USA
| | - Corey Brier
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Morgan McGrath
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Jason Cruickshank
- Cleveland Clinic Concussion Center, Cleveland Clinic, Cleveland, OH, USA
| | - Richard Figler
- Cleveland Clinic Concussion Center, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Sports Health, Cleveland Clinic, Cleveland, OH, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Concussion Center, Cleveland Clinic, Cleveland, OH, USA
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Linder SM, Koop MM, Tucker D, Guzi K, Gray DC, Alberts JL. Development and Validation of a Mobile Application to Detect Visual Dysfunction Following Mild Traumatic Brain Injury. Mil Med 2021; 186:584-591. [PMID: 33499531 DOI: 10.1093/milmed/usaa360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/11/2020] [Accepted: 09/22/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Following mild traumatic brain injury, visual dysfunction is a common occurrence, yet the condition often goes undiagnosed. A mobile application was developed to measure aspects of visual acuity and oculomotor function. The aim of this project was to validate the newly developed suite of outcomes conducive for use in the field to detect visual dysfunction. MATERIALS AND METHODS A custom mobile application was developed on an Apple iPad using iOS operating system software version 11.0 in Objective C to measure near point of convergence (NPC), distance visual acuity, reading fluency, and self-rated convergence insufficiency (CI). To determine construct validity, 50 healthy young adults were administered NPC and distance visual acuity assessments using the iPad and standard clinical approaches. A ruler measurement was obtained simultaneous to the iPad NPC measurement to determine measurement accuracy. All testing was administered by a licensed optometrist and the order of testing (iPad versus clinical) was randomized. RESULTS The correlation coefficient between the iPad and clinical measurements of NPC was 0.893, while iPad and ruler measurement was 0.947. Modest accordance was found between iPad and wall chart measures assessing distance visual acuity. A ceiling effect was evident with use of a wall chart to determine distance visual acuity. Healthy young adults scored a mean (SD) of 13.0 (7.4) on the Convergence Insufficiency Symptom Survey. Reading fluency was highly variable with a mean (SD) of 291 (119) words per minute. CONCLUSIONS iPad measures of NPC were highly correlated with clinical measures, while visual acuity measured with the iPad showed modest correlation. Nonetheless, the suite of visual assessments provide value as screening tools, and when used in combination with reading fluency assessment and self-reported CI may be effective in identifying visual dysfunction following mild traumatic brain injury.
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Affiliation(s)
- Susan M Linder
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH 44195, USA.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Mandy Miller Koop
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Diane Tucker
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Karen Guzi
- Department of Emergency Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.,Case Western Reserve University School of Nursing, Samson Pavilion, Cleveland, OH 44106, USA
| | - Daniel C Gray
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA.,Department of biomedical engineering and the center for Neurologic Restoration, Cleveland Clinic, Cleveland, OH 44195, USA
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Use of a Smartphone to Gather Parkinson's Disease Neurological Vital Signs during the COVID-19 Pandemic. PARKINSONS DISEASE 2021; 2021:5534282. [PMID: 33868630 PMCID: PMC8035908 DOI: 10.1155/2021/5534282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/25/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022]
Abstract
Introduction To overcome travel restrictions during the COVID-19 pandemic, consumer-based technology was rapidly deployed to the smartphones of individuals with Parkinson's disease (PD) participating in a 12-month exercise trial. The aim of the project was to determine the feasibility of utilizing a combined synchronous and asynchronous self-administered smartphone application to characterize PD symptoms. Methods A synchronous video virtual visit was completed for the administration of virtual Movement Disorder Society-Unified Parkinson's Disease Rating Scale III (vMDS-UPDRS III). Participants asynchronously completed a mobile application consisting of a measure of upper extremity bradykinesia (Finger Tapping Test) and information processing. Results Twenty-three individuals completed the assessments. The mean vMDS-UPDRS III was 23.65 ± 8.56 points. On average, the number of taps was significantly greater for the less affected limb, 97.96 ± 17.77 taps, compared to the more affected, 89.33 ± 18.66 taps (p = 0.025) with a significantly greater number of freezing episodes for the more affected limb (p < 0.05). Correlation analyses indicated the number of errors and the number of freezing episodes were significantly related to clinical ratings of vMDS-UPDRS III bradykinesia (Rho = 0.44, p < 0.01; R = 0.43, p < 0.01, resp.) and finger tapping performance (Rho = 0.31, p = 0.03; Rho = 0.32, p = 0.03, resp.). Discussion. The objective characterization of bradykinesia, akinesia, and nonmotor function and their relationship with clinical disease metrics indicate smartphone technology provides a remote method of characterizing important aspects of PD performance. While theoretical and position papers have been published on the potential of telemedicine to aid in the management of PD, this report translates the theory into a viable reality.
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High intensity aerobic exercise improves information processing and motor performance in individuals with Parkinson's disease. Exp Brain Res 2021; 239:777-786. [PMID: 33394100 DOI: 10.1007/s00221-020-06009-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Parkinson's disease (PD) adversely affects information processing and motor performance. The impact of aerobic exercise on modifying the deleterious effects of PD underlying information and motor control processes is not well established. The primary aim of this project was to determine the effects of an 8-week high intensity exercise intervention on information processing and movement execution in individuals with PD. A secondary aim sought to understand the effects of antiparkinsonian medication relative to exercise on motor control processes. Data were collected at baseline (on- and off-medication) and upon completion of the exercise intervention (off-medication). Information processing and motor execution were evaluated via simple and choice reaction time paradigms (SRT and CRT) performed on a mobile device. Neither exercise nor medication impacted information processing or movement execution under the SRT paradigm. However, under CRT, exercise improved movement execution and information processing: total time was significantly reduced from 814 to 747 ms (p < 0.001), reaction time improved from 543 to 502 ms (p < 0.001), movement time improved from 270 to 246 ms (p = 0.01), and movement velocity improved from 28 cm/sec to 30 cm/sec (p = 0.01). Improvements in total time and reaction time in the CRT paradigm persisted 4 and 8 weeks following exercise cessation. Antiparkinsonian medication improved motor execution, but not information processing. The improvement in information processing following aerobic exercise, but not levodopa administration, suggests high intensity exercise may be enhancing neural processing and non-motor pathways outside those impacted by medication. The persistence of symptom improvement despite exercise intervention cessation indicates exercise is a candidate for disease modification. Trial registration: The trial was first registered at ClinicalTrials.gov on 7/10/2012 under registration number NCT01636297.
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12
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Thornton IM. MILO Mobile: An iPad App to Measure Search Performance in Multi-Target Sequences. Iperception 2020; 11:2041669520932587. [PMID: 32612800 PMCID: PMC7307404 DOI: 10.1177/2041669520932587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/15/2020] [Indexed: 01/18/2023] Open
Abstract
This article introduces a mobile app version of the Multi-Item Localization (MILO) task. The MILO task was designed to explore the temporal context of search through a sequence and has proven useful in both basic and applied research settings. Here, we describe the basic features of the app and how it can be obtained, installed, and modified. We also provide example data files and present two new sets of empirical data to verify that previous findings concerning prospective planning and retrospective memory (i.e., inhibitory tagging) are reproducible with the app. We conclude by discussing ongoing studies and future modifications that illustrate the flexibility and potential of the MILO Mobile app.
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Affiliation(s)
- Ian M. Thornton
- Department of Cognitive Science,
Faculty of Media and Knowledge Sciences, University of
Malta
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McGrath MK, Linder SM, Koop MM, Zimmerman N, Ballantyne MAJ, Ahrendt DM, Alberts JL. Military-Specific Normative Data for Cognitive and Motor Single- and Dual-Task Assessments for Use in Mild Traumatic Brain Injury Assessment. Mil Med 2020; 185:176-183. [PMID: 32074318 DOI: 10.1093/milmed/usz261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Military personnel and civilian athletes are both at risk for mild traumatic brain injury. However, these groups are unique in their training and typical daily activities. A fundamental gap in the evaluation of military personnel following mild traumatic brain injury is the lack of military-specific normative reference data. This project aimed to determine if a separate normative sample should be used for military personnel on their performance of the Cleveland Clinic Concussion application and a recently developed dual-task module. METHODS Data were collected from healthy military personnel (n = 305) and civilians (n = 281) 18 to 30 years of age. Participants completed the following assessments: simple and choice reaction time, Trail Making tests A&B, processing speed test, single-task postural stability, single-task cognitive assessment, and dual-task assessment. RESULTS Civilian participants outperformed military service members on all cognitive tasks under single- and dual-task conditions (P ≤ 0.04). The military group outperformed civilians on all postural stability tasks under single- and dual-task conditions (P ≤ 0.01). CONCLUSION Differences in cognitive performance and postural stability measures may be influenced by demographic differences between military and civilian cohorts. Thus, military-specific normative datasets must be established to optimize clinical interpretation of Cleveland Clinic Concussion assessments.
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Affiliation(s)
- Morgan K McGrath
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - Susan M Linder
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - Mandy Miller Koop
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - Nicole Zimmerman
- Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - Maj Aaron J Ballantyne
- Division of Adolescent and Young Adult Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Dale M Ahrendt
- Division of Adolescent and Young Adult Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
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Lukács G, Kleinberg B, Kunzi M, Ansorge U. Response Time Concealed Information Test on Smartphones. COLLABRA: PSYCHOLOGY 2020. [DOI: 10.1525/collabra.255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Response Time-Based Concealed Information Test (RT-CIT) can reveal when a person recognizes a relevant (probe) item among other, irrelevant items, based on comparatively slower responding to the probe item. Thereby, if a person is concealing the knowledge about the relevance of this item (e.g., recognizing it as a murder weapon), this deception can be revealed. So far, the RT-CIT has been used only on desktop computers. In Experiment 1 (n = 72; within-subject), we compare the probe-irrelevant differences when using the conventional desktop-based CIT to using a smartphone-based CIT, demonstrating practical equivalence. In Experiment 2 (n = 116; within-subject), we demonstrate that using thumbs for responses (while holding the smartphone) leads to equally efficient CIT results as using conventional index finger responses. At the same time, this second experiment also demonstrates how smartphone-based studies may be efficiently run in large groups, using the participants’ own smartphones. Finally, as an interesting addition, here for the first time we also measured keypress durations (i.e., the time durations of holding down the response keys) in the RT-CIT, which we found to be significantly shorter for probe than for irrelevant items.
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Affiliation(s)
- Gáspár Lukács
- Department of Basic Psychological Research and Research Methods, University of Vienna, Vienna, AT
- Department of Psychology, Humboldt University of Berlin, Berlin, DE
| | - Bennett Kleinberg
- Department of Security and Crime Science, University College London, London, UK
| | - Melissa Kunzi
- Department of Basic Psychological Research and Research Methods, University of Vienna, Vienna, AT
| | - Ulrich Ansorge
- Department of Basic Psychological Research and Research Methods, University of Vienna, Vienna, AT
- Vienna Cognitive Science Hub, University of Vienna, Vienna, AT
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Gotow N, Hoshi A, Kobayakawa T. Expanded olfactometer for measuring reaction time to a target odor during background odor presentation. Heliyon 2019; 5:e01254. [PMID: 30828668 PMCID: PMC6383036 DOI: 10.1016/j.heliyon.2019.e01254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/27/2018] [Accepted: 02/14/2019] [Indexed: 11/26/2022] Open
Abstract
Current olfactometers can insert a target odor into the flow of odorless air as a pulse (i.e., replace odorless air with target odor for a very short time), but no previously designed olfactometer can insert a pulse of target odor into a flow of background odor (i.e., replace background odor with target odor for a very short time). To measure reaction time to a target odor during presentation of a background odor, we developed an expanded olfactometer by adding an attachment to an existing olfactometer. We conducted three experiments to evaluate the performance of the expanded olfactometer. Additionally, four volunteers participated in trial measurement of reaction time for detection of the target odor under background odor and odorless air conditions using the expanded olfactometer. We did not observe a significant difference in gas onset time or rise time of the target odor between background and odorless air conditions. Additionally, the gas onset time and rise time of the target odor were on the order of milliseconds, whereas the gas onset time and rise time of the background odor were on the order of seconds. The reaction time was marginally significantly longer under the background odor condition than the odorless air condition. We did not observe a significant difference in gas onset time or rise time of the target odor between the existing olfactometer and our expanded olfactometer. We succeeded in developing an attachment capable of inserting a target odor into a flow of background odor. Our results revealed that performance related to the presentation of the target odor was comparable between the existing and expanded olfactometers. To more rigorously examine the effect of background odor on detection speed of target odor, we intend to increase the number of participants in the near future.
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Affiliation(s)
- Naomi Gotow
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba Central 6, 1-1-1 Higashi, Tsukuba, Ibaraki 305-8566, Japan
| | - Ayaka Hoshi
- Central Laboratories for Key Technologies, Kirin Company, Limited, 1-13-5 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Tatsu Kobayakawa
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba Central 6, 1-1-1 Higashi, Tsukuba, Ibaraki 305-8566, Japan
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Stricker NH, Lundt ES, Edwards KK, Machulda MM, Kremers WK, Roberts RO, Knopman DS, Petersen RC, Mielke MM. Comparison of PC and iPad administrations of the Cogstate Brief Battery in the Mayo Clinic Study of Aging: Assessing cross-modality equivalence of computerized neuropsychological tests. Clin Neuropsychol 2018; 33:1102-1126. [PMID: 30417735 DOI: 10.1080/13854046.2018.1519085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Computerized neuropsychological assessments are increasingly used in clinical practice, population studies of cognitive aging and clinical trial enrichment. Subtle, but significant, performance differences have been demonstrated across different modes of test administration and require further investigation. Method: Participants included cognitively unimpaired adults aged 50 and older from the Mayo Clinic Study of Aging who completed the Cogstate Brief Battery and Cogstate's Groton Maze Learning Test (GMLT) on an iPad or a personal computer (PC) in the clinic. Mode of administration differences and test-retest reliability coefficients were examined across 3 cohorts: a demographically matched test-retest cohort completing PC and iPad administrations the same day (N = 168); a test naïve cohort comparing baseline PC (n = 1820) and iPad (n =605) performance; and a demographically matched longitudinal cohort completing 3 Cogstate visits over 15 months on either the PC (n =63) or iPad (n =63). Results: Results showed a small but statistically significant and consistent finding for faster performance on PC relative to iPad for several Cogstate Brief Battery measures. Measures of accuracy generally did not differ or differences were very small. The GMLT showed faster performance and higher total errors on iPad. Most Cogstate variables showed no difference in the rate of change across PC and iPad administrations. Conclusions: There are small, but significant, differences in performance when giving the same cognitive tests on a PC or an iPad. Future studies are needed to better understand if these small differences impact the clinical interpretation of results and research outcomes.
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Affiliation(s)
- Nikki H Stricker
- a Division of Neurocognitive Disorders, Department of Psychiatry and Psychology , Mayo Clinic , Rochester , MN , USA
| | - Emily S Lundt
- b Division of Biomedical Statistics and Informatics, Department of Health Sciences Research , Mayo Clinic , Rochester , MN , USA
| | - Kelly K Edwards
- b Division of Biomedical Statistics and Informatics, Department of Health Sciences Research , Mayo Clinic , Rochester , MN , USA
| | - Mary M Machulda
- a Division of Neurocognitive Disorders, Department of Psychiatry and Psychology , Mayo Clinic , Rochester , MN , USA
| | - Walter K Kremers
- b Division of Biomedical Statistics and Informatics, Department of Health Sciences Research , Mayo Clinic , Rochester , MN , USA
| | - Rosebud O Roberts
- c Division of Epidemiology, Department of Health Sciences Research , Mayo Clinic , Rochester , MN , USA.,d Department of Neurology , Mayo Clinic , Rochester , MN , USA
| | - David S Knopman
- d Department of Neurology , Mayo Clinic , Rochester , MN , USA
| | | | - Michelle M Mielke
- c Division of Epidemiology, Department of Health Sciences Research , Mayo Clinic , Rochester , MN , USA.,d Department of Neurology , Mayo Clinic , Rochester , MN , USA
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The benefits of adding a brief measure of simple reaction time to the assessment of executive function skills in early childhood. J Exp Child Psychol 2018; 170:30-44. [DOI: 10.1016/j.jecp.2018.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/05/2018] [Accepted: 01/05/2018] [Indexed: 12/18/2022]
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Bernstein JPK, Calamia M, Pratt J, Mullenix S. Assessing the effects of concussion using the C3Logix Test Battery: An exploratory study. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 26:275-282. [PMID: 29308917 DOI: 10.1080/23279095.2017.1416471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The C3Logix is a computerized concussion assessment tool that measures a wider array of symptoms (i.e., balance and oculomotor functioning) than other computerized batteries. Although the C3Logix has been used increasingly by athletic organizations at all levels of play, its utility within the concussion population has not been extensively examined. The current study aimed to determine whether the C3Logix is sensitive to the effects of concussion. A total of 54 student-athletes enrolled at a large southern university completed the C3Logix at baseline and within days following a suspected concussion (mean = 2.93, SD = 3.14). Dependent-samples t-tests revealed that relative to their baselines, following concussion, athletes both reported significantly greater postconcussive symptoms and performed more poorly on measures of reaction time and computer-measured balance. Decrements in processing speed, visual acuity, and clinician-observed errors on tests of balance also trended toward significance. Results suggest that inclusion of measures of balance and oculomotor functioning in the assessment of concussion may provide additional clinical utility above and beyond domains typically measured by computerized concussion assessments.
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Affiliation(s)
- John P K Bernstein
- a Department of Psychology , Louisiana State University , Baton Rouge , Lousiana , USA
| | - Matthew Calamia
- a Department of Psychology , Louisiana State University , Baton Rouge , Lousiana , USA
| | - Joshua Pratt
- b Department of Athletics , Louisiana State University , Baton Rouge , Lousiana , USA
| | - Shelly Mullenix
- b Department of Athletics , Louisiana State University , Baton Rouge , Lousiana , USA
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Parsons TD, McMahan T, Kane R. Practice parameters facilitating adoption of advanced technologies for enhancing neuropsychological assessment paradigms. Clin Neuropsychol 2017; 32:16-41. [DOI: 10.1080/13854046.2017.1337932] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Thomas D. Parsons
- Department of Psychology, University of North Texas, Denton, TX, USA
- Computational Neuropsychology and Simulation Laboratory, University of North Texas, Denton, TX, USA
| | - Timothy McMahan
- Computational Neuropsychology and Simulation Laboratory, University of North Texas, Denton, TX, USA
| | - Robert Kane
- Cognitive Consults and Technology LLC, Washington, DC, USA
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