1. The Relationship Between Post-Concussion Neurocognitive Performance and Postural Control
K. Grimes, E. Lasko, M.E. Mormile, B.J. Szekely, B.A. Munkasy, D.W. Powell, & N.G. Murray

2. Introduction Executive Function- controlling cognition in new tasks
Attention and Concentration
Shifting awareness, prioritizing
Working Memory
Goal oriented tasks

3. Introduction Executive Function- controlling cognition in new tasks
Attention and Concentration
Shifting awareness and prioritizing
Visuospatial Skills
Working Memory
Ideomotor Disconnect

4. Introduction Speed-Accuracy Trade Off Cognitive Load
Creating a great enough load to challenge executive function
How does concussion affect these?
Decreased Reaction Time
Concentration Problems
Dizziness
Balance Problems
Memory Problems
Nausea

5. Introduction Linking cognitive and physical dysfunctions
Correlations between Romberg and ImPACT domains in concussed athletes.1
Static balance assessments limited to the first 72 hours. 2
Limited reliability
Sport specific and dual task may be a more effective longitudinal assessment. 3,4

6. Purpose
Identify the relationship between neurocognitive and postural control deficits post-concussion
Static Assessment
Using force platform variables
Sport Relevent Postural Control Task
Wii Soccer Heading Game

7. Methods 15 NCAA Division I Athletes Neurocognitive Assessment
11 male, 4 female (20.5± 1.1 yrs. old)
Tested hrs. post-concussion
Neurocognitive Assessment
ImPACT
Postural Control Assessment
Static
Sport specific postural control task

8. Neurocognitive Assessment
ImPACT
Reaction Time
Learning
Verbal Working Memory
Visual Motor Speed
Visual Working Memory
Attentional Processing/ Sequencing

9. Postural Control Assessment
Static Assessment
Sport Relevant Task
Eyes Open (EO)
Eyes Closed (EC)
Wii Soccer Head Game (WS)

10. Statistical Analysis Neurocognitive Variables:
Verbal/ Visual Memory
Visual Motor Speed
Impulse Control
Symptom Severity
Postural Control Variables:
Peak Excursion Velocity (PEV)
95% Confidence Ellipse (CE)
Sample Entropy (SE)
Pearson's Product Correlation
Significance Level
p=0.05

11. Results- EO Verbal Memory Impulse Control
PEV- Medial/Lateral (r=-0.611, p=0.016)
95% Confidence Ellipse (r=-0.555, p=0.016)
Impulse Control
PEV- Anterior/Posterior (r= 0.778, p=0.001)

12. Results- Wii Soccer Verbal Memory Visual Motor Speed
PEV- Medial/Lateral (r=0.532, p=0.041)
Visual Motor Speed
CE (r=.531, p=0.042)
Total Symptom Score
SE- Medial/Lateral (r=-0.582, p=0.023)

13. Discussion Verbal Memory
Testing visual recognition memory, attentional processing, and visual motor response speed
As testing scores increased:
Eyes open: PEV and CE decreased
Decreased Degrees of Freedom
Wii Soccer: PEV increased
Sufficient Cognitive Load

14. Discussion Visual Motor Speed
Testing processing speed, and reaction time (response to stimulus)
As testing scores increased:
Wii Soccer: PEV and CE increased

15. Discussion Impulse Control Total Symptom Score
Testing accuracy by using total incorrect
As testing scores decreased
Eyes open: PEV decreased
Total Symptom Score
As symptom scores increased
Wii Soccer: SE decreased

16. Conclusions
Athletes attempting to "lock-down" during eyes open condition
Using unfamiliar tasks to create a sufficient cognitive load
May better reveal postural instabilities
Sacrificing postural stability for increased attentional processing, visual recognition memory, and visual motor speed

17. Questions?

18. References
Murray NG, Salvatore AP, Tomaka J, Reed-Jones RJ. Relationship between the Romberg test and the Wii Fit basic balance test and cognition in athletes with concussion. Journal of Clinical and Translational Research (1): 39-45
Covassin T, Elbin III J, Stiller-Ostrowski JL, Kontos AP. Immediate post-concussion assessment and cognitive test (ImPACT) practices of sports medicine professionals. Journal of Athletic Training 2009, 44:
Buckley TA, Munkasy BA, Tapia-Lovler TG, Wikstrom EA. Altered Gait Termination Strategies Following a Concussion. Gait & posture. 03/ ;38(3):
Catena RD, van Donkelaar P, Chou LS. Altered balance control following concussion is better detected with an attention test during gait. Gait & Posture DCOM ;25(3):