Sports Medicine Research: In the Lab & In the Field: Motivation and Academic Profile May Not Predict Concussion Baseline Scores (Sports Med Res)
Tuesday, November 5, 2013

Motivation and Academic Profile May Not Predict Concussion Baseline Scores

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

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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

6 comments:

Jake Marshall said...

The purpose of research and out promise to continue to seek better knoelege and implement the best practices means that what we do will change. This being said, the huge amount of variables that may effect baseline scores does not mean that the testing is not cliniclay relavent. Baseline testing still gives us more of an idea about the athletes basic level of function and greaty improves our ability to make informed return to play decisions. Further research will likely improve our abilities to deal with the multitude of influencing factors, creating more effective testing, but the tests we have now are certainly better than what we have had in the past.

I do not think a motivational test should be inbeded into current testing with out a bit more research on its effect on scores. The impact test is already qite long and I worry that inceases in the test time will have negative effects on the athletes abilities to focus and stay motivated through out the test. This is especially true for younger athletes and those with learning diabilities.

Jacqueline Phillips said...

Jake - I completely agree in that neurocognitive testing can still be a valuable tool when evaluating a concussion, especially because we have very limited objective assessments available to use for such an evaluation.

You also bring up a great point about how adding motivational testing to a neurocognitive test may increase the test time to the point where it may affect focus and motivation of the entire test. More research into motivation tests in this realm should definitely be performed to to see if this could be a viable or helpful option. If it further validates an athlete's score it could be incredibly helpful - maybe it would be more useful to use as a separate test from a neurocognitive test.

Jason Shermer said...

By understanding how little of an importance this study ended with, what are some other factors that may be brought up for future research in this field?

Jacqueline Phillips said...

I think it’s important to understand this study was valuable in that it began to explore certain factors that may predict scores on a commonly used baseline concussion test. Perhaps the limitations of this study obstructed significant results from being found in these important elements. In the future, it may be of value to investigate some of the many other variables that could influence these scores and other baseline concussion tests. Of recent, hydration status and the amount of sleep received the night prior to a baseline test, have been explored.

McClure, D. J., Zuckerman, S. L., Kutscher, S. J., Gregory, A. J., & Solomon, G. S. (2013). Baseline Neurocognitive Testing in Sports-Related Concussions The Importance of a Prior Night’s Sleep. The American journal of sports medicine.

Friedline Weber, A., Mihalik, J. P., Register-Mihalik, J. K., Mays, S., Prentice, W. E., Guskiewicz, K. M. (2013). Dehydration and performance on clinical concussion measures in collegiate wrestlers. Journal of Athletic Training, 48(2): 153-160.

Will Bradley said...

Do you think motivation would increase if some sort of repercussions were placed on athletes? For example, being witheld from play if suspected of non-compliance or not performing to theri full ability in an IMPACT baseline test?

Jacqueline Phillips said...

Introducing repercussions to ensure proper motivation and baseline testing scoring is an interesting concept. I believe athletes would take these baseline tests more seriously if they were withheld from play because of poor scores; however, I’m not sure if coaches and other athletics personnel would be willing to abide by these rules. Perhaps if the athletes were informed they would need to take these tests again, if they did not score appropriately, they would exhibit more motivation throughout the process. But then, because motivation and neurocognitive tests are separate entities, athletes could purposefully sandbag their baseline test while excelling at their motivation test. Clearly more investigation into the best way to administer these baseline tests, with the incorporation of motivation tests, should be performed.

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