The Circle Sequencing Task (CST): A novel approach to analysing concussion related cognitive and motor control deficits

Abstract

Current pitchside concussion assessment lacks sensitivity, relies on player self-report, and requires the presence of a healthcare professional. The primary aim of this thesis was to develop a novel solution for pitchside concussion assessment, the Circle Sequencing Task (CST), which is quantitative, sensitive, and reliable. The reasoning, development, reliability, and sensitivity of CST is presented within this thesis.

In Chapter 2, a literature review explores the prevalent issues in sports concussion management, evaluating current concussion assessments, as well as broader tests for identifying neurocognitive changes in clinical settings.

Chapter 3 details the development of CST, a short and simple neurocognitive test that transcends language barriers to directly address the shortcomings of current concussion assessment tools. CST evaluates an individual’s cognitive and motor functions, utilising key metrics such as reaction times, movement pathlength, and measures of inhibitory control.

Chapter 4 assesses CST’s sensitivity to concussion, whilst also considering the effect of local and remote testing procedures (13 concussed individuals, 13 local controls, 13 remote controls). Results demonstrated that half of CST’s metrics showed significant differences between concussed and healthy individuals. No differences were found between remote and local testing.

Chapter 5 investigates the reliability of CST across time (baseline, 10min, 20min, 48hr, 1week; for 36 participants). Results showed that while the majority of metrics displayed excellent reliability, two were identified as poor. Minimal Detectable Change (MDC) and Standard Error of Measurement (SEM) values were established for future research use.

This thesis suggests that CST shows promise as a sensitive and reliable concussion assessment tool for use at pitchside. Subsequent research should seek to expand upon this foundation to advance CST, examining the long-term reliability across a contextually relevant timeframe and the effects of age, sex, and cultural differences, whilst further developing the tool to enhance the efficiency and streamline the test. The novel CST test holds the potential to act as a disruptive technology within the field through improving detection of concussion and accessibility of concussion assessments.