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    Development and preliminary testing of the concussion assessment web app tool : a thesis submitted to the Graduate Faculty of Massey University in partial fulfilment of the requirements for the degree Master of Science (MSc) endorsement of Sport and Exercise Science at Massey University, Wellington, New Zealand
    (Massey University, 2018) Sturrock, David
    Introduction: Identifying and monitoring the resolution of cognitive impairment following sport-related concussion and providing objective information for clinical return-to-play decisions is crucial, particularly for contact sports. Many concussion symptoms do not appear immediately, and the sports person would need to be monitored and re-tested over time, however most sport teams do not have the luxury of readily available medical staff. Therefore, this study presents the process of developing a novel web-based neuropsychological test battery App for concussion, and the subsequent determination of sensitivity, reliability, and repeatability as a first step in validity and reliability testing. Subjects and design: Neuropsychological baseline data was collected on 11 healthy male volunteers (mean age = 22 ± 2.5 years). Repeat data was collected pre- and post-fatiguing exercise for sensitivity, and further tests for diurnal variation included three daily repeat assessments (morning: 0700 ± 2 h; afternoon; 1400 ± 2 h; evening: 1900 ± 2 h) over a five-day period. Measurements: The administration of the Concussion Assessment Web-App tool (CAWA) included six tests as a part of a test battery. These included concussion red flag questions, a self-report inventory of neuropsychological symptoms; The Concussion Symptom Inventory (CSI), as well as a series of four cognitive sub-tests: Simple Reaction Time, Complex Reaction Time, Digit Span Backwards, and Auditory Reaction Time. Results: The results indicate that the CAWA battery is sensitive to the effects of treadmill-based maximal exercise, with no diurnal variation in asymptomatic participants. Conclusions: Prior to any field trials, the CAWA preliminary findings indicate that the individual elements are sensitive and are repeatable in an asymptomatic population. The CAWA is an easy, time-efficient, and cost-effective method for individuals to test and re-test multiple times to identify latent signs / symptoms and neurocognitive trauma following sports-related concussion.
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    Provision of information on concussion to patients and families by videotape : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2002) Scoullar, Grahame
    Traumatic brain injury (TBI) is a major health problem in New Zealand that results in death and disability as well as a substantial number of mild injuries. Information provision is an important part of interventions that can help to prevent long­ term difficulties from developing after mild TBI. This study investigated whether information provision by videotape can be a useful part of interventions for mild TBI. The research was in the form of a pilot study in that a videotape and a brochure were produced as part of the study. The participants were clients of a concussion clinic and the people who accompanied them to the clinic and they were divided into three different groups. One group received the videotape and brochure, a second group received the brochure only and the third group received neither of these resources. Specific questions about information provision were developed to gather data for the study which formed part of a larger survey of client satisfaction. The number of responses from people who accompanied the clients was insufficient and that data was therefore omitted from the study. There were no significant differences between the three groups of clients in their satisfaction with information provision or the perceived level of help they received from information provision in understanding concussion. Clients who reported that they received an appropriate rather than an insufficient or excessive amount of information were significantly more satisfied with information provision. The results also suggested that clients who did not receive the resources may not have received enough information. The majority of clients preferred to receive information on both videotape and brochure compared to either resource on its own or other options and most clients who received the information resources referred to them more than once. The findings support the use of videotapes in information provision for clients of concussion clinics when they are used alongside written resources rather than replacing them. Limitations in the study and directions for future research are discussed.
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    Paced Auditory Serial Addition Task : an experimental investigation : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 1982) Irving, Nina
    This study investigated the effects of seven independent variables upon a Paced Auditory Serial Addition Task (PASAT; Gronwall & Sampson, 1974). The main effects found were that arithmetic ability and a short-term memory measure were related to performance on this task. Interactive effects were found for measures of anxiety, sex and the strategy used in performing the PASAT. Theories considered included those of Broadbent (1977), Neisser (1976), Kerr (1973), Kahneman (1973) and Broadbent (1971) with emphasis on the latter two. The findings are most easily interpreted in terms of Kahneman's (1973) theory. Broadbent's (1971) model could not account for the effects of environmental and task conditions upon information-processing capacity. Further research is needed to examine the effects of individual abilities and biases in selective attention. Also it is suggested that perception and the allocation of effort policy (Kahneman, 1973) be studied further from Broadbent's (1977) perspective of global and local analysis of information. Clinical implications for the interpretation of the PASAT are discussed. It is suggested that this test could be used more widely as a measure of selective attention. More specifically it is suggested that the administration instructions could be simplified where necessary; and error scores considered together with rate of performance. These measures give an indication of performance effectiveness.
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    Client satisfaction at the Midcentral Health and Massey University concussion clinic : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Arts in Psychology at Massey University
    (Massey University, 2003) Leach, Roxanne Marie
    The present study intended to evaluate the quality of the service provided by the Midcentral Health and Massey University Concussion Clinic. In doing so, the study first considered the nature of Mild Traumatic Brain Injury and concussion injury and rehabilitation and investigated different methods of measuring quality and weighed up the pros and cons of each method to chose the most appropriate method for this setting. As a result, the present study surveyed service satisfaction at the Concussion Clinic. A standardised measure (the Service Satisfaction Survey – 30) was chosen to counter previous methodological problems common to other studies of satisfaction. The main objective of this study was to provide feedback to the Concussion Clinic regarding satisfaction with aspects of their services and to simultaneously investigate relationships with satisfaction. On a whole, participants were generally satisfied with the Concussion Clinic service; conversely some aspects of the service that could be improved were identified. However caution has to be taken in analysing the results especially when inferring results to the whole population, due to this low response rate (twenty of the seventy-nine clients surveyed returned the survey). The second objective of the study was to evaluate the use of this method of evaluation, and the measure chosen, with this type of service. The measure chosen (the Service Satisfaction Scale –30) proved inappropriate for this service setting due to the length and irrelevant questions. Moreover the use of client satisfaction as a method to evaluate this service, even though it provided some data on satisfaction with services, also may not be justified for the reason that the clients were generally only seen once and the nature of outcome in this setting was unclear. This study demonstrated the need for more research in the area of service satisfaction in the health arena, in particular this type of setting; suggestions for this research are included in this study.
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    A psychometric evaluation of the immediate post-concussion assessment and cognitive test (ImPACT) for sport concussion : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology, Massey University, Albany, New Zealand
    (Massey University, 2014) Martin, Shannon Leigh
    The increasing awareness of concussion in sport and its effect on cognitive functioning has prompted the development of neuropsychological assessments specific to sport concussion. ImPACT is one of the more popular assessment batteries that purports to measure five areas of cognitive functioning, despite a scarcity of empirical support. The current study assessed ImPACT’s factor structure to determine whether its items are accurately measuring the five cognitive domains it claims to measure. Three exploratory factor analyses using a male adolescent sample were computed before the final model, consisting of eight items and two factors, representing Reaction Time and Memory, was reached. The structure was inconsistent with the current ImPACT scoring structure. This model was then successfully validated among a new sample, while a competing model found in the literature was not successfully validated. This model was then assessed for its longitudinal stability over a three year period in addition to its cross-country validity between South African and New Zealand samples. The former was supported, indicating individuals’ memory and reaction time as measured by ImPACT, is relatively stable over time and that ImPACT is not subject to practice effects after a one-year interval. It is of note that cross-country invariance was not supported, therefore emphasising the importance of having population-specific norms. Overall, the present study found that ImPACT, at this stage, has several limitations. It is recommended that, while ImPACT has the potential to be a useful tool, modifications need to be made to increase its efficacy.
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    Parent and teacher knowledge of head injuries : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 2011) McKay, Erin Anne
    This study examined parents and teachers knowledge of aspects of head injury (HI). Part one examined the various sources of information and education parents and teachers have access to that could impact on their knowledge of HI. Part two surveyed 64 parents and 64 teachers of young children (<5 years) from the North Shore, Auckland, to examine the extent of their personal knowledge of HI, and the sources of their knowledge (e.g. media). Participants were asked about the source of their knowledge of HI (i.e. various types of media, personal experiences etc), and the qualifications they hold that could impact on their knowledge (i.e. first aid training, teacher training qualification). Participants were also asked to complete a questionnaire about aspects of head injury - general knowledge, memory, recovery. Results indicated that there is a wealth of information in the public domain regarding HI. First aid courses provide information that can help a person deal with a HI immediately following the incident, but are not compulsory for teachers to have. Various other sources of information such as doctors, Plunketline and the internet also provide information and advice for the public to access. When parents and teachers were surveyed it was found that they have similar levels of knowledge regarding HI, although on average parents had slightly higher scores than teachers. Having a first aid certificate did not mean parents and teachers had higher levels of accuracy - in fact those who did not have a first aid certificate had higher average scores than those who did. Doctors and Plunketline were the most likely source of information for parents and teachers. The most popular media-specific sources were daily newspapers and television news. Further studies could examine the wider public's knowledge of HI. A more complete form of the survey could be used to get a well rounded picture of the current knowledge base of HI.
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    An investigation of mild traumatic brain injury in club-grade rugby : a New Zealand study : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University
    (Massey University, 2002) Wills, Sally Maree
    Mild traumatic brain injury (MTBI) in sports is a relatively common phenomenon, particularly where a high degree of physical contact is a central feature of the sport. While many of the MTBI's incurred by athletes may be innocuous, some result in negative outcomes that are more persistent and disabling. It is important, therefore, to ensure that sporting groups not only have adequate knowledge about the incidence and severity of MTBI and of the factors that typically surround its occurrence, but that they also have adequate guidelines regarding appropriate assessment, management and treatment of this phenomena. Despite numerous studies having been conducted with elite/professional or school grade players in high-contact sports such as American gridiron football and rugby league, very little research has been conducted in the area of club-grade rugby, and to-date, there has been no detailed examination of MTBI incurred at this level. The present investigation sought to rectify this situation. The proposed investigation, incorporating male rugby players participating in a regional club-grade competition, took place in two distinct phases. In the first phase of the research, three questionnaires were administered to players and to those monitoring the sport (i.e., coaches, team management, and referees). The results revealed a high rate of MTBI (14.4%), of which 20.7% of concussions involved a loss of consciousness (LOC). Identified risk factors included: (1) being under 21 years of age; (2) being a forward player, in particular a flanker; (3) the second half of a match; (4) frequent involvement in tackles; and (5) having a history of more than two MTBI. While a relatively high rate of mouthguard use was identified, it unfortunately did not reflect the compulsory use required by mandatory rugby laws. Attitudes relating to mouthguard use indicate that more education surrounding the proven benefits of mouthguard use in MTBI prevention is required at this level. Slightly more than half of the MTBI reported in the current investigation failed to receive any attention, with players involved at the top club-grade level (i.e., Senior I) more likely to have their injury go unrecognised than players in lower grades. Such findings are attributed in part to the subtlety of MTBI symptomology, but more importantly, to an apparent reluctance on the part of players to report these symptoms. While the majority of those monitoring club-grade players reported basic first aid training/qualifications, the need for more specific training in the assessment and management of MTBI is evident on the basis of the research findings. A general lack of knowledge regarding recommendations for periods of abstinence after MTBI (as advised by governing sporting bodies) was also demonstrated, highlighting another area requiring further attention. Phase II of the research involved the administration of three neuropsychological measures sensitive to deficits in information processing speed (Symbol Digit Modalities Test, Digit Symbol-Coding Test and Speed of Comprehension Test) in an attempt to monitor the rate of recovery after MTBI. However, on the basis of players reluctance to report (a phenomenon which appeared endemic at this level), the objectives in relation to this phase of the research were not achieved. The apparent failure of the latter research phase effectively highlights just one of a number of methodological problems associated with conducting research with this particular population, of which other difficulties also primarily relate to the collection of data (i.e., less-than-ideal testing conditions, missing data, etc.). On the basis of the research findings, continuing education and relevant training in relation to MTBI is advocated for all those involved at the club-grade level, particularly in relation to symptom recognition, potential adverse outcomes, protective factors and appropriate assessment and management techniques. Despite the challenges this area presents for research, continued exploration is recommended with careful consideration given to the methodological issues raised in the current investigation.