Theses and Dissertations

Date of Award

2022

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

College of Psychology

First Advisor

Charles J. Golden

Second Advisor

Lisa Lashley

Third Advisor

Ryan Black

Fourth Advisor

Robert Seifer

Keywords

baseline assessment, cognitive development, concussion, football

Abstract

In recent decades, the increased awareness of the prevalence of concussions has resulted in significant advancements in concussion assessment and treatment, including annual or bi-annual pre-season computerized baseline assessments. However, limited research has focused on the differences in stability of baseline neurocognitive performance among different age groups in adolescence. The main purpose of the present study was to explore the long-term stability of ImPACT baseline assessments across one-year intervals in multiple age groups within a sample of high school football players. Subjects who completed two baseline assessments between the ages of 14 and 17 who had completed two baselines one year apart were selected from a de-identified archival database. Subjects were separated into three groups based on age at first baseline (i.e., 14, 15, and 16). Results indicate differences in baseline performance stability between age groups, with younger athletes demonstrating improvements in performance consistent with ongoing cognitive development and older athletes demonstrating more stability in performance. Importantly, the Reaction Time composite score remained stable among all groups. Results also provide evidence for wide ranging Reliable Change Indices across all age groups, which can make it difficult to interpret meaningful change after injury for those whose baseline was completed one year ago.

These findings indicate younger athletes (i.e., 14- and 15-year-olds) should ideally complete baselines prior to each athletic season (e.g., fall, winter, spring), whereas older athletes (e.g., 16-year-olds) should complete baselines annually. The use of more frequent baselines aims to increase clinicians’ ability to detect clinically meaningful change following concussion, which in turn would lead to increased accuracy in return-to-play decision making. However, it is also important to recognize potential pitfalls of increased baseline testing (e.g., practice effects, lack of available resources), which are discussed. When recent baselines are not available, these results indicate the Reaction Time composite may serve as an important indicator of departure from baseline given its demonstrated stability across groups. In addition to clinical implications, the present results are consistent with Luria’s theory of cognitive development which indicates some cognitive skills continue to develop throughout adolescence along with corresponding cortical areas. Lastly, these results provide some information regarding the cognitive development of high school football players within the context of repeated exposure to sub-concussive impacts, though such conclusions are limited be the absence of a control group.

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