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.

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.

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?

by: Jacqueline Phillips
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