Global switch cost as an index for concussion assessment: reliability and stability.

PURPOSE: The objective of this study is to determine the stability and sensitivity of a dual-task (DT) methodology that can be used to assess the effects of concussion in athletes. METHODS: Fifty-nine healthy young adults (Mage = 20.32 ± 1.84 yr, 19 males) who volunteered to participate completed auditory switch tasks that varied in length (30, 40, and 60 items) at baseline, 1 wk later, and approximately 7 months later. During sessions 2 and 3, the participants completed one of three switch tasks while concurrently performing a modified Harvard Step Test. Global switch cost indices and percentage error were calculated for each switch task. The stability reliability of the global switch cost indices was assessed under single-task conditions, and the sensitivity of the global switch costs to interference effects was assessed under DT conditions. RESULTS: The stability reliability was 0.64, 0.84, and 0.83 for the 30-, 40-, and 60-item tests, respectively. ANOVA revealed a main effect for condition (single task vs DT) for both global switch costs (F(1,55) = 44.53, P < 0.0001) and percentage error (F(1,56) = 64.69, P < 0.001). The magnitude of the global switch cost interference effects was nearly identical across the three DT conditions. CONCLUSIONS: The current concussion testing models test athletes' cognitive and physical function in isolation. The stability reliability of the global switch cost index obtained under DT conditions suggests that it may be a useful measure for clinicians. The DT paradigm presents another test methodology that may be useful for making return-to-play decisions as part of a comprehensive concussion management plan.

The assessment of attention-deficit/hyperactivity disorder in rural primary care: the portability of the American Academy of Pediatrics guidelines to the "real world".

OBJECTIVE: To examine the implementation of a protocol for the assessment of attention-deficit/hyperactivity disorder (ADHD) in rural pediatric practices. The protocol was designed to provide an efficient means for pediatricians to learn and use the ADHD guidelines put forth by the American Academy of Pediatrics (AAP). METHODS: Primary care staff (physicians, nurses, etc) from 2 rural pediatric practices were trained to use the ADHD-assessment protocol. Medical records for 101 patients were reviewed from 1 to 2 years before the introduction of the protocol and for 86 patients during the subsequent 2 to 3 years to assess compliance with the AAP guidelines. In addition, 34% of the scales scored by the staff were rescored to check for scoring accuracy. RESULTS: Before the availability of the AAP guidelines and the implementation of the assessment protocol, neither primary care site was consistently collecting the comprehensive information that is now recommended for an ADHD assessment. Parent and/or teacher rating scales were collected for only 0% to 21% of assessments across sites. When provided with brief training and supporting materials, medical records reflected significant improvement in the ascertainment of clinically necessary ADHD information, with parent and teacher rating scales present 88% to 100% of the time. Staff demonstrated an ability to score rating scales with a high degree of accuracy. The integrity of protocol collection and management was maintained 2 to 3 years after training. CONCLUSIONS: An efficient system for conducting ADHD assessments according to AAP guidelines in rural pediatrics clinics can be initiated and maintained with integrity. Additional research is needed to determine if this system improves diagnostic decision-making and patient outcomes.