Recovery of Function After Acquired Neurological Injury.

The articles in this Special Issue on Recovery of Function After Neurological Injury include an impressive range of clinical diagnoses, scientific approaches, and theoretical frameworks that demonstrate the breadth and depth of occupational therapy in the restoration of function after neurological injury. An emerging theme throughout is the need for the profession of occupational therapy to identify and use more efficient methods for diagnosing and treating people with neurological injuries to improve their quality of life and the impact of care.

Participants With Acquired Brain Injury Realized They "Could Still Do Things" After a Yoga Intervention: A Qualitative Descriptive Study.

IMPORTANCE: Occupational therapy practitioners use yoga in practice to achieve holistic care, and the American Occupational Therapy Association has provided guidance on the use of yoga in occupational therapy. For people with acquired brain injury (ABI), however, it is unknown whether yoga affects occupational performance. OBJECTIVE: To explore the perceived impact of an adapted yoga intervention on occupational performance using the Occupational Therapy Practice Framework: Domain and Process (4th ed.; OTPF-4) for participants with ABI. DESIGN: Qualitative descriptive study using virtual, semistructured interviews. An inductive, holistic, open-coding process, followed by a deductive process to map open codes to the OTPF-4. PARTICIPANTS: Nine individuals with ABI were recruited from a yoga intervention study. RESULTS: The theme generated from the data-"Yoga participants with ABI realized that they could still do quite a bit"-was supported by two major categories from the OTPF-4: Occupations and Performance Skills. Participants described improvements in their functional performance (i.e., motor skills, process skills) and how these factors were synergistically connected to their occupational performance (i.e., self-care, leisure). CONCLUSIONS AND RELEVANCE: This study provides novel insight into how functional performance improved so participants could "still do things," such as engaging in occupations. When participants described improved performance skills, they simultaneously described re-engagement with their meaningful occupations. Participants also perceived an improvement in their mind-body connection, which should be further explored in future studies. This study generated original findings about participants' perceptions of an adapted yoga intervention as they relate to the OTPF-4. Plain-Language Summary: This study reports individuals' perceptions of their re-engagement with occupations and changes in occupational performance skills after participating in an adaptive yoga intervention. We highlight the distinct contribution that adaptive yoga-an intervention modality that can be used by occupational therapy practitioners-may have, using the OTPF-4 to connect the participants' perceptions about their improvements in occupational performance.

Executive Function After Yoga: Adults With Acquired Brain Injury-A Pilot Study.

IMPORTANCE: Acquired brain injury (ABI) may result in deficits in executive function (EF), which affects engagement in occupations. OBJECTIVE: To explore the impact of group yoga on EF in people with ABI. DESIGN: Single-arm pilot study with preyoga assessments and postyoga assessments (after 8 wk of yoga). SETTING: Yoga classes and assessments were completed within university buildings on a college campus. PARTICIPANTS: Twelve participants with chronic ABI (>6 mo post-ABI) were recruited through convenience and purposive strategies from the local community. INTERVENTION: An 8-wk adaptive group yoga intervention was provided by an adaptive yoga specialist. Yoga classes were 60 min and occurred once per week. OUTCOMES AND MEASURES: EF was assessed before and after the yoga intervention using the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) self-report form. Normative data were analyzed with paired sample t tests. RESULTS: Nine participants completed all study procedures. Results from paired sample t tests showed significant improvements on the Behavioral Regulation Index of the BRIEF-A (p = .046). No significant improvements were found on individual EF scales, the Metacognition Index, or the Global Executive Composite (ps > .05). CONCLUSIONS AND RELEVANCE: Group-based yoga may improve some aspects of EF for adults with chronic ABI; however, further research with larger sample sizes is needed. Plain-Language Summary: Yoga, an intervention increasingly used in occupational therapy practice, may be beneficial in improving behavioral regulation (an executive function) for adults with acquired brain injury.

Corrigendum: Adaptive yoga versus low-impact exercise for adults with chronic acquired brain injury: a pilot randomized control trial protocol.

[This corrects the article DOI: 10.3389/fnhum.2023.1291094.].

Adaptive yoga versus low-impact exercise for adults with chronic acquired brain injury: a pilot randomized control trial protocol.

Background: Each year, millions of Americans sustain acquired brain injuries (ABI) which result in functional impairments, such as poor balance and autonomic nervous system (ANS) dysfunction. Although significant time and energy are dedicated to reducing functional impairment in acute phase of ABI, many individuals with chronic ABI have residual impairments that increase fall risk, decrease quality of life, and increase mortality. In previous work, we have found that yoga can improve balance in adults with chronic (i.e., ≥6 months post-injury) ABI. Moreover, yoga has been shown to improve ANS and brain function in healthy adults. Thus, adults with chronic ABI may show similar outcomes. This protocol details the methods used to examine the effects of a group yoga program, as compared to a group low-impact exercise, on primary and secondary outcomes in adults with chronic ABI. Methods: This study is a single-blind randomized controlled trial comparing group yoga to group low-impact exercise. Participants must be ≥18 years old with chronic ABI and moderate balance impairments. Group yoga and group exercise sessions occur twice a week for 1 h for 8 weeks. Sessions are led by trained adaptive exercise specialists. Primary outcomes are balance and ANS function. Secondary outcomes are brain function and structure, cognition, quality of life, and qualitative experiences. Data analysis for primary and most secondary outcomes will be completed with mixed effect statistical methods to evaluate the within-subject factor of time (i.e., pre vs. post intervention), the between-subject factor of group (yoga vs. low-impact exercise), and interaction effects. Deductive and inductive techniques will be used to analyze qualitative data. Discussion: Due to its accessibility and holistic nature, yoga has significant potential for improving balance and ANS function, along with other capacities, in adults with chronic ABI. Because there are also known benefits of exercise and group interaction, this study compares yoga to a similar, group exercise intervention to explore if yoga has a unique benefit for adults with chronic ABI.Clinical trial registration:ClinicalTrials.gov, NCT05793827. Registered on March 31, 2023.

Feasibility of Acquiring Neuroimaging Data from Adults with Acquired Brain Injuries before and after a Yoga Intervention.

BACKGROUND: To date, no one has prospectively evaluated yoga intervention-induced changes in brain structure or function in adults with acquired brain injuries (ABI). Thus, this study was conducted to test the feasibility of acquiring neuroimaging data from adults with ABI before and after a yoga intervention. METHODS: This was a single-arm intervention feasibility study that included 12 adults with chronic (i.e., greater than 6 months post-injury) ABI and self-reported limitations in balance. Neuroimaging data were acquired before and after yoga. The yoga intervention was completed once per week for eight weeks. Feasibility objectives and benchmarks were established a priori. RESULTS: Most feasibility objectives and benchmarks were achieved. The goal of recruiting 12 participants was successfully achieved, and 75% of participants were retained throughout the study (goal of 80%). All imaging feasibility benchmarks were met; rs-fMRI and fNIRS data were acquired safely, data were of acceptable quality, and data pre-processing procedures were successful. Additionally, improvements were detected in balance after yoga, as group-level balance was significantly better post-yoga compared to pre-yoga, p = 0.043. CONCLUSIONS: These findings indicate it is feasible to acquire neuroimaging data from adults with ABI before and after a yoga intervention. Thus, future prospective studies are warranted.

Evaluating Dual Task Neurological Costs with Functional Near-Infrared Spectroscopy: A Preliminary Report in Healthy Athletes.

BACKGROUND: Dual task assessments, which simultaneously challenge and assess cognitive and motor performance, have been used to improve the assessment of athletes with sports-related concussions (SRC). Our lab created a Dual Task Screen (DTS) to evaluate athletes with SRCs, and we have established that it is a valid behavioral measure, as it consistently elicits poorer behavioral performance under dual, compared to single, task conditions. Here, we used a Neuroimaging-Compatible (NC) version of the DTS, named the NC-DTS, which uses portable functional near-infrared spectroscopy (fNIRS) to assess behavioral performance and neural recruitment during single and dual tasks. Our study objective was to evaluate healthy athletes and establish whether the NC-DTS is a valid dual task neurological assessment that can elicit different patterns of neural recruitment during dual versus single task conditions. METHODS: Twenty-five healthy collegiate athletes completed the NC-DTS in a single laboratory visit. The NC-DTS includes a lower and upper extremity subtask; both include single motor, single cognitive, and dual task conditions. The NC-DTS was administered in a block design, where conditions (i.e., single motor, single cognitive, and dual task) were repeated five times to generate average behavioral performance and task-dependent neural recruitment in superficial cortical regions including: prefrontal cortex, bilateral primary motor and sensory cortices, and posterior parietal cortex. Neural recruitment was measured with fNIRS and quantified using oxygenated hemoglobin (HbO) and deoxygenated hemoglobin (HbR) metrics. A single-tailed, within subject t-test was used to compare average dual task behavioral performance to average single task behavioral performance. Pairwise comparisons, that were family-wise-error (FWE) corrected, were used to compare localized neural recruitment during dual versus single task conditions. RESULTS: As observed in previous studies, the NC-DTS elicited significantly poorer behavioral performance under dual, compared to single, task conditions. Additionally, dual task conditions of the NC-DTS elicited significantly greater neural recruitment in regions of the brain associated with attention allocation and task-specific demands in three of four comparisons. CONCLUSIONS: These preliminary results suggest that the NC-DTS is a valid dual task neurological assessment which warrants future work using the NC-DTS to evaluate athletes with SRCs.

Revised Dual Task Screen is a Valid Measure of Dual Task Performance: Developing a Motor and Cognitive Dual Task Measure with Healthy Female Athletes.

Multitasking measures, such as dual task assessments, are particularly useful in detecting subtle deficits that can influence occupational performance after injuries, like sports-related concussion (SRC). In past work, our research team developed and revised a dual task assessment, the Dual Task Screen (DTS). Here, we evaluated nineteen healthy athletes using the revised DTS to address two specific research objectives. First, to replicate pilot study findings and demonstrate that the revised DTS is sensitive to dual task motor costs (i.e. poorer motor performance under dual task conditions, compared to single task conditions). Second, to evaluate if the revised DTS is sensitive to dual task cognitive costs (i.e. poorer cognitive performance under dual task conditions, compared to single task conditions). We confirmed that the revised DTS was sensitive to both dual task motor and cognitive costs; thus it is a valid measure of dual task performance. These positive findings support its prospective, future use by occupational therapists to evaluate multitasking performance after injuries, like SRC, or other injuries and illnesses that elicit deficits affecting optimal occupational performance.

Rethinking recovery in adolescent concussions: Network-level functional connectivity alterations associated with motor deficits.

Adolescents who are clinically recovered from concussion continue to show subtle motor impairment on neurophysiological and behavioral measures. However, there is limited information on brain-behavior relationships of persistent motor impairment following clinical recovery from concussion. We examined the relationship between subtle motor performance and functional connectivity of the brain in adolescents with a history of concussion, status post-symptom resolution, and subjective return to baseline. Participants included 27 adolescents who were clinically recovered from concussion and 29 never-concussed, typically developing controls (10-17 years); all participants were examined using the Physical and Neurologic Examination of Subtle Signs (PANESS). Functional connectivity between the default mode network (DMN) or dorsal attention network (DAN) and regions of interest within the motor network was assessed using resting-state functional magnetic resonance imaging (rsfMRI). Compared to controls, adolescents clinically recovered from concussion showed greater subtle motor deficits as evaluated by the PANESS and increased connectivity between the DMN and left lateral premotor cortex. DMN to left lateral premotor cortex connectivity was significantly correlated with the total PANESS score, with more atypical connectivity associated with more motor abnormalities. This suggests that altered functional connectivity of the brain may underlie subtle motor deficits in adolescents who have clinically recovered from concussion. More investigation is required to understand the persistence and longer-term clinical relevance of altered functional connectivity and associated subtle motor deficits to inform whether functional connectivity may serve as an important biomarker related to longer-term outcomes after clinical recovery from concussion.

Interdisciplinary views of fNIRS: Current advancements, equity challenges, and an agenda for future needs of a diverse fNIRS research community.

Functional Near-Infrared Spectroscopy (fNIRS) is an innovative and promising neuroimaging modality for studying brain activity in real-world environments. While fNIRS has seen rapid advancements in hardware, software, and research applications since its emergence nearly 30 years ago, limitations still exist regarding all three areas, where existing practices contribute to greater bias within the neuroscience research community. We spotlight fNIRS through the lens of different end-application users, including the unique perspective of a fNIRS manufacturer, and report the challenges of using this technology across several research disciplines and populations. Through the review of different research domains where fNIRS is utilized, we identify and address the presence of bias, specifically due to the restraints of current fNIRS technology, limited diversity among sample populations, and the societal prejudice that infiltrates today's research. Finally, we provide resources for minimizing bias in neuroscience research and an application agenda for the future use of fNIRS that is equitable, diverse, and inclusive.

Revised Dual Task Screen is a Valid Measure of Dual Task Performance: Developing a Motor and Cognitive Dual Task Measure with Healthy Female Athletes.

Multitasking measures, such as dual task assessments, are particularly useful in detecting subtle deficits that can influence occupational performance after injuries, like sports-related concussion (SRC). In past work, our research team developed and revised a dual task assessment, the Dual Task Screen (DTS). Here, we evaluated nineteen healthy athletes using the revised DTS to address two specific research objectives. First, to replicate pilot study findings and demonstrate that the revised DTS is sensitive to dual task motor costs (i.e. poorer motor performance under dual task conditions, compared to single task conditions). Second, to evaluate if the revised DTS is sensitive to dual task cognitive costs (i.e. poorer cognitive performance under dual task conditions, compared to single task conditions). We confirmed that the revised DTS was sensitive to both dual task motor and cognitive costs; thus it is a valid measure of dual task performance. These positive findings support its prospective, future use by occupational therapists to evaluate multitasking performance after injuries, like SRC, or other injuries and illnesses that elicit deficits affecting optimal occupational performance.

Developmental trends of auditory novelty oddball P3 while accounting for N2 in 7- to 25-year-olds.

Many previous studies examining developmental trends in P3 amplitude or latency have used a two-stimulus (standard and target) oddball paradigm. Fewer studies exist using the novelty oddball paradigm, a three-tone (standard, target, and novel) paradigm. In this study with 204 typically developing participants aged 7-25 years, the influence of participant traits-age and sex-on the developmental trends of P3 peak-to-peak amplitude and latency were examined. Additionally, interactions between the three tones of the novelty oddball paradigm and scalp sites on P3 amplitude and latency were evaluated. While previous studies using baseline-to-peak measures have shown smaller P3 amplitude in children compared with adults, this study, using peak-to-peak measures (P3 minus N2 amplitude), found the opposite effect with children having larger P3 amplitudes than adults. This finding is explained by further analyses of N2, representing discrimination. N2 baseline-to-peak amplitude significantly predicted P3 baseline-to-peak amplitude; a mediation effect such that as N2 becomes less negative, P3 becomes larger. Regression analyses revealed that developmental trends of the P3 amplitude were primarily linear, but trends in P3 latency were mostly non-linear. Sex differences were observed, although limited to latency measures. Results from ancovas found significant interactions between the three tones and between frontal (Fz) and parietal (Pz) sites, with larger P3 amplitude during target and novel tones at Pz than Fz, and larger amplitudes during frequent tones at Fz than Pz. These findings highlight the importance of considering more than P3 amplitude in understanding developmental trends in cognitive processing during oddball paradigms.

Personality Predictors of Sports-Related Concussion Incidence: Analysis of Data From a Large, Heterogeneous Undergraduate Sample.

OBJECTIVE: Studies investigating the associations between personality and sports-related concussion are limited. The current study aimed to address this gap by examining whether specific personality dimensions predicted self-reported sports-related concussion outcomes. DESIGN: This study included 1141 undergraduate students ( Mage = 19.47, SD = 2.14, female = 64.5%) who completed a battery of online personality measures and self-reported sports-related concussion items. The self-reported sports-related concussion outcomes included a single diagnosed sports-related concussion incident (i.e., "diagnosed sports-related concussion incidence") and incidents of multiple diagnosed sports-related concussions (i.e., "multiple diagnosed sports-related concussion incidents"). Analyses included splitting data randomly into training and validation data sets. Multivariate logistic regression models were then fit to each data set to determine predictors of sports-related concussion. RESULTS: In both training and validation data sets, extraversion and experience seeking were found to be positively and most strongly associated with both sports-related concussion outcomes, whereas motor inhibition was found to be negatively associated with both outcomes. Additional personality dimensions showed differential relations with each sports-related concussion outcome. CONCLUSIONS: The current study highlights the importance of considering personality dimensions in the context of self-reported sports-related concussion outcomes, as there are differential relations between personality dimensions and these outcomes. Thus, prevention efforts for sports-related concussion may benefit from evaluating additional athlete factors, like personality traits.

Personality Predictors of Time to Return to Play After Sports-Related Concussion: Analysis of Survey Data From an Undergraduate Sample.

OBJECTIVE: This study aimed to address a gap in concussion literature by investigating the relation between personality and return to play. It is important to know that earlier return to play places individuals at higher risk of sustaining a new concussion after an initial concussion. DESIGN: Participants were undergraduate students recruited from psychology courses in 2019 who reported medically confirmed sports-related concussion and medically advised return to play (N = 202). Participants completed an online battery in a supervised laboratory setting that included self-report survey measures, concussion history items, and behavioral impulsivity tasks. Kaplan-Meier analysis and Cox proportional hazards models were used to analyze time to return to play after participants' first reported sports-related concussion. RESULTS: Results showed that one subdimension of sensation seeking, experience seeking, and two subdimensions of self-reported impulsivity, attentional and motor impulsivity, were positively associated with earlier return to play after a sports-related concussion. In contrast, higher levels of conscientiousness were associated with later return to play. CONCLUSIONS: Despite a heterogeneous sample, significant relations were found between timing of return to play and sensation seeking, impulsivity, and conscientiousness. Because earlier return to play can heighten the risk of sustaining a new concussion after an initial concussion, it is important to identify characteristics-such as personality traits-that influence individuals' return-to-play behaviors. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Distinguish between personality traits that resulted in earlier versus later return to play in this sample; (2) Describe why certain personality traits might be related to an earlier or later return-to-play timeline; and (3) List practical ways that these study results could be used to reduce adverse outcomes related to early return to play. LEVEL: Advanced. ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Non-invasive brain stimulation to assess neurophysiologic underpinnings of lower limb motor impairment in multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is a neuroinflammatory disease resulting in axonal demyelination and an amalgamation of symptoms which commonly result in decreased quality of life due to mobility dysfunction and limited participation in meaningful activities. NEW METHOD: The use of non-invasive brain stimulation (NIBS) techniques, specifically transcranial magnetic and transcranial direct current stimulation, have been essential in understanding the pathophysiological decrements related to disease progression, particularly with regard to motor impairments. Although the research in this area has primarily focused on the upper extremities, new interest has arisen in understanding the neurophysiological underpinnings of lower limb impairment. Therefore, the purpose of this review is to: first, provide an overview of common NIBS techniques used to explore sensorimotor neurophysiology; second, summarize lower limb neuromuscular and mobility impairments typically observed in PwMS; third, review the current knowledge regarding interactions between TMS-assessed neurophysiology and lower limb impairments in PwMS; and fourth, provide recommendations for future NIBS studies based on current gaps in the literature. RESULTS: PwMS exhibit reduced excitability and increased inhibitory neurophysiologic function which has been related to disease severity and lower limb motor impairments. Comparison with existing methods: Moreover, promising results indicate that the use of repetitive stimulation and transcranial direct current stimulation may prime neural adaptability and prove useful as a therapeutic tool in ameliorating lower limb impairments. CONCLUSIONS: While these studies are both informative and promising, additional studies are necessary to be conclusive. As such, studies assessing objective measures of lower limb impairments associated with neurophysiological adaptations need further evaluation.

The ENIGMA sports injury working group:- an international collaboration to further our understanding of sport-related brain injury.

Sport-related brain injury is very common, and the potential long-term effects include a wide range of neurological and psychiatric symptoms, and potentially neurodegeneration. Around the globe, researchers are conducting neuroimaging studies on primarily homogenous samples of athletes. However, neuroimaging studies are expensive and time consuming, and thus current findings from studies of sport-related brain injury are often limited by small sample sizes. Further, current studies apply a variety of neuroimaging techniques and analysis tools which limit comparability among studies. The ENIGMA Sports Injury working group aims to provide a platform for data sharing and collaborative data analysis thereby leveraging existing data and expertise. By harmonizing data from a large number of studies from around the globe, we will work towards reproducibility of previously published findings and towards addressing important research questions with regard to diagnosis, prognosis, and efficacy of treatment for sport-related brain injury. Moreover, the ENIGMA Sports Injury working group is committed to providing recommendations for future prospective data acquisition to enhance data quality and scientific rigor.

Revised and Neuroimaging-Compatible Versions of the Dual Task Screen.

Dual task paradigms simultaneously assess motor and cognitive abilities, and they can detect subtle, residual impairments in athletes with recent mild traumatic brain injury (mTBI). However, past dual task paradigms have focused solely on lower extremity skills and have relied on cumbersome, expensive laboratory equipment - thus limiting their practicality for everyday mTBI evaluation. Subsequently, we developed the Dual Task Screen (DTS), which takes <10 minutes to administer and score, uses low-cost portable equipment, and includes lower extremity (LE) and upper extremity (UE) subtasks. The purpose of this manuscript was twofold. First, we describe the administration protocol for the revised DTS, which we revised to address the limitations of the original DTS. Specifically, the revisions included additions of smart devices to acquire more detailed gait data and inclusion of single cognitive conditions to test for disrupted cognitive performance under dual task conditions. Importantly, the revised DTS is a measure intended for future clinical use, and we present representative results from three male athletes to illustrate the type of clinical data that can be acquired from the measure. Importantly, we have yet to evaluate the sensitivity and specificity of the revised DTS in athletes with mTBI, which is the next research initiative. The second purpose of this manuscript is to describe a neuroimaging-compatible version of the DTS. We developed this version so we could evaluate the neural underpinnings of single and dual task performance, for a better empirical understanding of the behavioral deficits associated with mTBI. Thus, this manuscript also describes the steps we took to enable simultaneous functional near-infrared spectroscopy (fNIRS) measurement during the DTS, along with how we acquired and completed first-level processing of the fNIRS data.

Test-Retest Reliability of Electroencephalographic Measures of Performance Monitoring in Children and Adults.

This study examined the test-retest reliability of the error-related negativity (ERN) and error positivity (Pe) amplitudes using a Flanker task in 118 neurotypical children and 53 adults before and after latency jitter adjustments. The reliability of the ERN and Pe amplitudes was moderate for children and moderate to strong for adults. The latency variability adjustment did not improve the reliability of the ERN and Pe amplitudes for either group, suggesting that latency variability may be a trait-like measure. For comparison purposes, the reliability of the stimulus-locked ERPs was strong for correct trials, yet the reliability was weak for incorrect trials.

Pilot Use of the Adapted Fresno Test for Evaluating Evidence-Based Practice Knowledge in Occupational Therapy Students.

IMPORTANCE: A core tenet of occupational therapy is that practitioners should use evidence in their practice. Nevertheless, many occupational therapy practitioners feel limited in their evidence-based practice (EBP) knowledge. Conceivably, improving EBP knowledge in students would facilitate their greater knowledge as practitioners. Other researchers have modified teaching methods and content to enhance knowledge in students but did not empirically evaluate the acquisition of knowledge. OBJECTIVE: To empirically evaluate EBP knowledge acquisition. DESIGN: Descriptive, mixed-methods pilot study. SETTING: A graduate occupational therapy program. PARTICIPANTS: Fifty-one second-year occupational therapy students. OUTCOMES AND MEASURES: We used the Adapted Fresno Test of Competence in Evidence-Based Practice to measure evidence-based practice knowledge. We also qualitatively assessed students' perceptions of what influenced their development of EBP knowledge and how they felt after completing the posttest. RESULTS: We found significant improvements in EBP knowledge. We also found the following qualitative themes regarding influences on students' EPB knowledge development: helpful supports, learning activities, and the context of doing with others. CONCLUSIONS AND RELEVANCE: We observed significant gains in EBP knowledge, as measured by the Adapted Fresno Test, after occupational therapy students completed an EBP course. We theorize that students' gains in EBP knowledge will support their ability to successfully use evidence in their future occupational therapy practice. WHAT THIS ARTICLE ADDS: Our findings on the Adapted Fresno Test indicate that our course successfully promoted acquisition of EBP knowledge. We theorize that students' gains in evidence-based practice knowledge will support their ability to successfully use evidence in their future occupational therapy practice.

Evaluating Motor Control Improves Discrimination of Adolescents with and without Sports Related Concussion.

Disrupted motor performance is increasingly recognized as a critical sequela of concussion which may have relevance for diagnosis and treatment. In 17 adolescents with recent concussion and 20 never-concussed controls, we evaluated the discriminant ability of a commonly used neurocognitive measure compared to a motor subtle sign exam, which evaluates gait, balance, and fine and gross motor control. We found that the motor subtle sign exam had better discriminant ability than the neurocognitive measure, but combining both measures was superior to analyses with individual measures (Wilks' ƛ = .297, p < .001). This supports that there is an added benefit of evaluating motor control along with neurocognitive capacities after suspected concussion to enhance diagnosis and treatment of injury.