Predicting Clinical Concussion Measures at Baseline Based on Motivation and Academic Profile
Trinidad KJ, Schmidt JD, Register-Mihalik, JK, Groff D, Goto S, Guskiewicz KM. Clinical Journal of Sports Medicine. 2013 March 0:1-8.
Take Home Message: This study found that motivation and an academic profile (SAT scores and high school GPA) are poor predictors of neurocognitive and postural control scores in collegiate athletes; however, they are related.
Neurocognitive testing is a popular tool for concussion assessment, but many factors can affect an athlete’s score, asides from a brain injury. Stress, irregular sleep patterns, caffeine, time of day, motivation, and intelligence may be some variables affecting these scores. By understanding how variables like these influence neurocognitive testing we may be able to ensure that our scores are informative. This study investigated the effects of motivation and academic profile on baseline neurocognitive scores and postural control among 88 NCAA Division I college athletes. Academic profile’s consisted of SAT scores and high school grade point averages (GPA), which the researchers retrieved from the admissions and registrar’s offices. The researchers had issues retrieving certain athlete’s information; therefore, 17 participants self-reported these numbers. For baseline testing, participants completed a neurocognitive test (CNS Vital Signs) and a postural control assessment that involved a moving visual scene and force plate. At the end of the testing session, participants completed the paper-and-pencil Rey Dot Counting Test, which assesses their motivation by determining how accurately and fast they can count dots on cards. Results showed that motivation and GPA predicted the processing speed standard score of neurocognitive testing. Also, participants with higher SAT scores tended to have higher complex attention domain standard scores. Lastly, participants with higher GPA and SAT scores tended to have worse postural control scores. While these findings were statistically significant it appears that motivation and academic profile only represent a small percentage of the variability in neurocognitive or postural control scores. Therefore, these variables may only hold little meaning for baseline scores in the clinical realm.
Overall, although little significance was found in this study, it brings to light important variables that may influence baseline concussion test scores. Past research supported the idea that greater motivation may be related to better neurocognitive testing scores (Bailey et al., 2006; Hunt et al., 2007), but in this investigation the authors found that motivation was not sufficiently related to the test scores to be a good predictor. However, we need to recognize that low motivation and sandbagging, in which athletes purposely perform poorly so as to easily achieve normal or better scores when concussed, is a serious concern for safely returning athletes to play. To protect against adverse influences such as these, understanding variables that can predict performance, such as academic profile, could be very useful for practitioners. Furthermore, this could be especially important in a setting, such as hospital, where baseline scores are unavailable for comparison of post injury scores. This study may have had limitations, such as low number of participants, poor scoring of the motivation test by the researchers, lack of accuracy of high school GPA and SAT scores as representation of their academic profile, which affected its results. Because these variables only accounted for a small portion of the variability in these scores, there should be more exploration into the other possible variables influencing these scores; however, identifying all of these factors may be cumbersome considering these tests could be influenced by so many factors. If this is the case, and numerous variables other than concussion can influence these scores, perhaps we need to reconsider the value we place on these tests.
Questions for Discussion: What variables do you think relate to baseline performance on concussion baseline tests such as neurocognitive testing? Do you think an embedded motivation test in a neurocognitive test would be useful? If neurocognitive and balance tests are influenced by a lot of variables, like GPA, does this cause you to question their clinical value?
Written by: Jacqueline Phillips
Reviewed by: Jeffrey Driban
Trinidad KJ, Schmidt JD, Register-Mihalik JK, Groff D, Goto S, & Guskiewicz KM (2013). Predicting Clinical Concussion Measures at Baseline Based on Motivation and Academic Profile. Clinical Journal of Sport Medicine PMID: 24071664