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Article ; Online: Reliable Change Indices for the Serial Administration of the Concussion Clinical Profiles Screening Tool.

Durfee, Kori J / Schatz, Philip / Kontos, Anthony P / Collins, Michael W / Womble, Melissa N / Jennings, Sabrina / Ceola, Madison F / Elbin, R J

Journal of athletic training

2024

Abstract: Context: The Concussion Clinical Profile Screening Tool (CP Screen) self-report concussion symptom inventory that is often administered at weekly intervals. However, 1-week reliable change indices (RCI) for clinical cutoffs and the test-retest ... ...

Abstract	Context: The Concussion Clinical Profile Screening Tool (CP Screen) self-report concussion symptom inventory that is often administered at weekly intervals. However, 1-week reliable change indices (RCI) for clinical cutoffs and the test-retest reliability of the CP Screen is unknown. Objective: Document RCI cutoff scores and 1-week test-retest reliability for each profile and modifier of the CP Screen for males and females. Design: Case Series. Setting: A large US university. Patients or other participants: 173 healthy college students. Main outcome measure(s): Participants completed two administrations of the CP Screen 7 days apart; CP Screen items yield five clinical profiles and two modifiers. Spearman rho coefficients (rs), intraclass correlation coefficients (ICCs) single measures and Unbiased Estimates of Reliability (UER) were used to assess test-retest reliability. Wilcoxon signed-rank tests assessed differences across time. RCI values and cutoff scores are provided at 90%/95% confidence intervals (CI). All analyses were performed for the total sample and separately for males and females. Results: RCI cutoffs for clinically significant change (increase/decrease) at a 90% CI for males were as follows: Ocular, Vestibular >2/>4, Anxiety/Mood, Cognitive/Fatigue, Migraine>3/>3, Sleep >4/>6, and Neck>2/>2. RCI cutoffs for clinically significant change (increase/decrease) at a 90% CI for females were as follows: Anxiety/Mood≥2/≥4; Cognitive/Fatigue, Migraine, Ocular, Vestibular, Sleep≥3/≥3; and Neck≥1/≥1. Correlations for CP ranged from .51 (Migraine) to .79 (Anxiety/Mood) for the total sample, .48 (Migraine) to .84 (Vestibular) for males, and .51 (Migraine) to .77 (Ocular) for females. Test-retest indices for each profile and modifier were moderate to good for the total sample (ICC: .64-.82; UER: .79-.90), males (ICC: .60-.87; UER: .76-.94), and females (ICC: .64-.80; UER: .78-.89). Conclusion: The CP Screen is reliable and stable across a 1-week interval, and established RCIs for males and females can help identify meaningful change throughout recovery.
Language	English
Publishing date	2024-01-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2070051-9
ISSN	1938-162X ; 1062-6050
ISSN (online)	1938-162X
ISSN	1062-6050
DOI	10.4085/1062-6050-0325.23
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Article ; Online: Symptom Provocation Following Post-concussion Computerized Neurocognitive Testing and Its Relationship to Other Clinical Measures of Concussion.

Stephenson, Katie / Womble, Melissa N / Eagle, Shawn / Collins, Michael W / Kontos, Anthony P / Elbin, R J

Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists

2022 Volume 38, Issue 4, Page(s) 548–556

Abstract: Objective: The objective of this study was to document the prevalence of post-computerized neurocognitive test (post-CNT) increases in symptoms in athletes with sport-related concussion, and to examine the effect of post-CNT symptom increases on ... ...

Abstract	Objective: The objective of this study was to document the prevalence of post-computerized neurocognitive test (post-CNT) increases in symptoms in athletes with sport-related concussion, and to examine the effect of post-CNT symptom increases on concussion neurocognitive and vestibular/ocular motor clinical outcomes. Methods: This was a retrospective analysis of medical records from a concussion specialty clinic. Two hundred and three athletes (M = 16.48 ± 1.97 years; 44% [90/203] female) completed a clinical visit for concussion within 30 days of injury (M = 7.73 ± 5.54 days). Computerized neurocognitive testing (the Immediate Post-concussion Assessment and Cognitive Testing: ImPACT), the Post-Concussion Symptom Scale (PCSS), and the Vestibular Ocular Motor Screening (VOMS) were the main outcome measures for the current study. Results: Sixty-nine percent (141/203) of the sample did not report significant increases in PCSS scores following post-concussion CNT and were classified into a No Provocation (NO PROV) group. Thirty-one percent (62/203) of participants did report a significant increase in symptoms following post-concussion CNT and were classified into a Provocation (PROV) group. Neurocognitive performance was similar between groups. However, the PROV group reported significantly higher scores on the VOMS symptom items than the NO PROV group. Conclusions: The majority of adolescent athletes can complete a post-concussion CNT without experiencing significant increases in concussion symptoms. Individuals that report symptom increases from completing a post-concussion CNT are more likely to exhibit increased vestibular/ocular motor symptoms. These findings underscore the relationship between the clinical findings from both CNT and vestibular/ocular motor measures following concussion.
MeSH term(s)	Adolescent ; Humans ; Female ; Athletic Injuries/complications ; Athletic Injuries/diagnosis ; Retrospective Studies ; Neuropsychological Tests ; Brain Concussion/complications ; Brain Concussion/diagnosis ; Post-Concussion Syndrome/diagnosis ; Post-Concussion Syndrome/etiology ; Athletes ; Mental Status and Dementia Tests
Language	English
Publishing date	2022-12-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	632972-x
ISSN	1873-5843 ; 0887-6177
ISSN (online)	1873-5843
ISSN	0887-6177
DOI	10.1093/arclin/acac103
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Article ; Online: Ambulatory Assessment in Concussion Clinical Care and Rehabilitation.

Elbin, R J / Womble, Melissa N / Elbich, Daniel B / Dollar, Christina / Fedor, Sheri / Hakun, Jonathan G

Frontiers in digital health

2022 Volume 4, Page(s) 924965

Abstract: Concussion is a mild traumatic brain injury that is characterized by a wide range of physical, emotional, and cognitive symptoms as well as neurocognitive, vestibular, and ocular impairments that can negatively affect daily functioning and quality of ... ...

Abstract	Concussion is a mild traumatic brain injury that is characterized by a wide range of physical, emotional, and cognitive symptoms as well as neurocognitive, vestibular, and ocular impairments that can negatively affect daily functioning and quality of life. Clinical consensus statements recommend a targeted, clinical profile-based approach for management and treatment. This approach requires that clinicians utilize information obtained via a clinical interview and a multi-domain assessment battery to identify clinical profile(s) (e.g., vestibular, mood/anxiety, ocular, migraine, cognitive fatigue) and prescribe a corresponding treatment/rehabilitation program. Despite this comprehensive approach, the clinical picture can be limited by the accuracy and specificity of patient reports (which often conflate timing and severity of symptomology), as well as frequency and duration of exposure to symptom exacerbating environments (e.g., busy hallways, sitting in the back seat of a car). Given that modern rehabilitation programs leverage the natural environment as a tool to promote recovery (e.g., expose-recover approach), accurate characterization of the patient clinical profile is essential to improving recovery outcomes. Ambulatory assessment methodology could greatly benefit concussion clinical care by providing a window into the symptoms and impairments experienced by patients over the course of their daily lives. Moreover, by evaluating the timing, onset, and severity of symptoms and impairments in response to changes in a patient's natural environment, ambulatory assessments can provide clinicians with a tool to confirm clinical profiles and gauge effectiveness of the rehabilitation program. In this perspective report, we review the motivations for utilizing ambulatory assessment methodology in concussion clinical care and report on data from a pilot project utilizing smart phone-based, ambulatory assessments to capture patient reports of symptom severity, environmental exposures, and performance-based assessments of cognition for 7 days following their initial evaluation.
Language	English
Publishing date	2022-06-23
Publishing country	Switzerland
Document type	Journal Article
ISSN	2673-253X
ISSN (online)	2673-253X
DOI	10.3389/fdgth.2022.924965
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Article ; Online: Sex Differences on Vestibular and Ocular Motor Assessment in Youth Athletes.

Moran, Ryan N / Covassin, Tracey / Elbin, R J

Journal of athletic training

2019 Volume 54, Issue 4, Page(s) 445–448

Abstract: Context: The Vestibular/Ocular Motor Screening (VOMS) is a newly developed measure that evaluates vestibular and ocular motor symptom provocation after sport-related concussion. The effects of sex on baseline VOMS scores in youth athletes have not been ... ...

Abstract	Context: The Vestibular/Ocular Motor Screening (VOMS) is a newly developed measure that evaluates vestibular and ocular motor symptom provocation after sport-related concussion. The effects of sex on baseline VOMS scores in youth athletes have not been established. Objective: To examine sex differences on baseline VOMS assessment among youth athletes. Results: No sex differences were demonstrated between male and female youth athletes on individual VOMS items ( Conclusions: No sex differences were present on baseline VOMS scores in youth athletes, nor was sex a risk factor for an abnormal VOMS score. These findings highlight the need for continual baseline and postconcussion assessments using multifaceted assessment strategies.
MeSH term(s)	Adolescent ; Athletes ; Athletic Injuries/complications ; Athletic Injuries/diagnosis ; Athletic Injuries/physiopathology ; Child ; Female ; Humans ; Male ; Neurologic Examination/methods ; Ocular Motility Disorders/diagnosis ; Ocular Motility Disorders/etiology ; Reproducibility of Results ; Risk Factors ; Sex Factors ; Vestibular Diseases/diagnosis ; Vestibular Diseases/etiology
Language	English
Publishing date	2019-04-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2070051-9
ISSN	1938-162X ; 1062-6050
ISSN (online)	1938-162X
ISSN	1062-6050
DOI	10.4085/1062-6050-220-18
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Article ; Online: Youth Soccer Parents' Perceptions of Long-Term Effects of Concussion .

Schatz, Philip / Corcoran, Mary / Kontos, Anthony P / Elbin, R J

Developmental neuropsychology

2020 Volume 45, Issue 3, Page(s) 110–117

Abstract: Increased focus on sports-related concussion (SRC) in football in the media, and mandatory concussion education for parents of youth sport athletes, may result in parental concern that youth athletes will experience long-term effects from concussion. We ... ...

Abstract	Increased focus on sports-related concussion (SRC) in football in the media, and mandatory concussion education for parents of youth sport athletes, may result in parental concern that youth athletes will experience long-term effects from concussion. We sought to identify beliefs about long-term effects of concussion in parents of youth soccer athletes. Four hundred and eleven parents from soccer leagues in three states completed a survey assessing parents' perceptions and knowledge of long-term effects of SRC. Nearly all youth soccer parents surveyed (96.5%) believe there are long-term effects from SRCs, 76% reported concern their child would sustain a concussion, and 71% had talked with their child about concussion symptoms/reporting. Parents ranked tackle football as having the highest risk for concussion, followed by soccer, ice hockey, cheerleading, and lacrosse. Parents of children that had previously sustained a concussion were 8.3x more likely to be concerned their child would sustain a concussion, and parents with a personal history of concussion were 2x more likely to consider not allowing their child to participate in youth sports. There are wide-spread beliefs among youth soccer parents regarding long-term effects of SRCs, and concerns their children will sustain concussions while participating in youth sports.
MeSH term(s)	Athletic Injuries/complications ; Brain Concussion/complications ; Child ; Female ; Humans ; Male ; Parents/psychology ; Soccer/physiology ; Surveys and Questionnaires
Language	English
Publishing date	2020-05-18
Publishing country	England
Document type	Journal Article
ZDB-ID	632665-1
ISSN	1532-6942 ; 8756-5641
ISSN (online)	1532-6942
ISSN	8756-5641
DOI	10.1080/87565641.2020.1766464
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Article ; Online: Association of Multidomain Assessment Outcomes With Referral for Vestibular Therapy After Concussion.

Eagle, Shawn R / Mucha, Anne / Trbovich, Alicia / Manderino, Lisa / Elbin, R J / Collins, Michael W / Kontos, Anthony P

Journal of athletic training

2022 Volume 58, Issue 5, Page(s) 408–413

Abstract: Context: Multiple aspects of a multidomain assessment have been validated for identifying concussion; however, researchers have yet to determine which components are related to referral for vestibular therapy.: Objective: To identify which variables ... ...

Abstract	Context: Multiple aspects of a multidomain assessment have been validated for identifying concussion; however, researchers have yet to determine which components are related to referral for vestibular therapy. Objective: To identify which variables from a multidomain assessment were associated with receiving a referral for vestibular therapy after a concussion. Design: Retrospective chart review, level of evidence 3. Patients or other participants: Participants (n = 331; age = 16.9 ± 7.2 years; 39.3% female) were diagnosed with a concussion per international consensus criteria by a clinical neuropsychologist after presenting to a concussion specialty clinic. Main outcome measure(s): Medical chart data were extracted from the first clinical visit regarding preinjury medical history, computerized neurocognition, Post-Concussion Symptom Scale, Concussion Clinical Profiles Screen, and Vestibular Ocular Motor Screening within 16.2 ± 46.7 days of injury. We built 5 backwards logistic regression models to associate the outcomes from each of the 5 assessments with referral for vestibular therapy. A final logistic regression model was generated using variables retained in the previous 5 models as potential predictors of referral for vestibular therapy. Results: The 5 models built from individual components of the multidomain assessment predicted referral for vestibular therapy (R2 = 0.01-0.28) with 1 to 6 statistically significant variables. The final multivariate model (R2 = 0.40) retained 9 significant variables, represented by each of the 5 multidomain assessments except neurocognition. Variables that had the strongest association with vestibular therapy referral were motor vehicle accident mechanism of injury (odds ratio [OR] = 15.45), migraine history (OR = 3.25), increased headache when concentrating (OR = 1.81), and horizontal vestibular ocular reflex (OR = 1.63). Conclusions: We demonstrated the utility of a multidomain assessment and identified outcomes associated with a referral for vestibular therapy after a concussion.
MeSH term(s)	Humans ; Female ; Child ; Adolescent ; Young Adult ; Adult ; Male ; Retrospective Studies ; Athletic Injuries/diagnosis ; Brain Concussion/diagnosis ; Brain Concussion/therapy ; Brain Concussion/complications ; Post-Concussion Syndrome/diagnosis ; Referral and Consultation
Language	English
Publishing date	2022-07-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2070051-9
ISSN	1938-162X ; 1062-6050
ISSN (online)	1938-162X
ISSN	1062-6050
DOI	10.4085/1062-6050-0032.22
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Article ; Online: Sex Differences on the Concussion Clinical Profiles Screening in Adolescents With Sport-Related Concussion.

Stephenson, Katie / Womble, Melissa N / Frascoia, Chelsea / Eagle, Shawn R / Covassin, Tracey / Kontos, Anthony P / Collins, Michael W / Elbin, R J

Journal of athletic training

2022 Volume 58, Issue 1, Page(s) 65–70

Abstract: Context: Sex differences influence symptom presentations after sport-related concussion and may be a risk factor for certain concussion clinical profiles.: Objective: To examine sex differences on the Concussion Clinical Profile Screen (CP Screen) in ...

Abstract	Context: Sex differences influence symptom presentations after sport-related concussion and may be a risk factor for certain concussion clinical profiles. Objective: To examine sex differences on the Concussion Clinical Profile Screen (CP Screen) in adolescents after sport-related concussion. Design: Cross-sectional study. Setting: A concussion specialty clinic. Patients or other participants: A total of 276 adolescent (age = 15.02 ± 1.43 years; girls = 152 [55%]) athletes with a recently diagnosed concussion (≤30 days). Main outcome measure(s): The 5 CP Screen profiles (anxiety mood, cognitive fatigue, migraine, vestibular, ocular) and 2 modifiers (neck, sleep), symptom total, and symptom severity scores were compared using a series of Mann-Whitney U tests between boys and girls. Results: Girls (n = 152) scored higher than boys (n = 124) on the cognitive fatigue (U = 7160.50, z = -3.46, P = .001) and anxiety mood (U = 7059, z = -3.62, P < .001) factors but not on the migraine (U = 7768, z = -2.52, P = .01) factor. Girls also endorsed a greater number of symptoms (n = 124; U = 27233, z = -3.33, P = .001) and scored higher in symptom severity (U = 7049, z = -3.60, P < .001) than boys. Conclusions: Among adolescents, symptom endorsement on the CP Screen varied based on sex, and clinicians need to be aware of these differences, especially when evaluating postconcussion presentation in the absence of baseline data.
MeSH term(s)	Adolescent ; Humans ; Female ; Male ; Athletic Injuries/diagnosis ; Cross-Sectional Studies ; Sex Characteristics ; Neuropsychological Tests ; Brain Concussion/diagnosis ; Athletes/psychology ; Migraine Disorders/complications
Language	English
Publishing date	2022-04-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2070051-9
ISSN	1938-162X ; 1062-6050
ISSN (online)	1938-162X
ISSN	1062-6050
DOI	10.4085/1062-6050-0670.21
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Article ; Online: Optimizing VOMS for identifying acute concussion in collegiate athletes: Findings from the NCAA-DoD CARE consortium.

Ferris, Lyndsey M / Kontos, Anthony P / Eagle, Shawn R / Elbin, R J / Clugston, James R / Ortega, Justus / Port, Nicholas L

Vision research

2022 Volume 200, Page(s) 108081

Abstract: The Vestibular/Ocular-Motor Screening (VOMS), an important component in acute (<72 h) sport-related concussion (SRC) assessment, is increasingly used alongside the Sport Concussion Assessment Tool (SCAT) and as part of the Military Acute Concussion ... ...

Abstract	The Vestibular/Ocular-Motor Screening (VOMS), an important component in acute (<72 h) sport-related concussion (SRC) assessment, is increasingly used alongside the Sport Concussion Assessment Tool (SCAT) and as part of the Military Acute Concussion Evaluation 2 (MACE2). VOMS demonstrates clinically useful diagnostic accuracy for acute SRC and improves the overall utility when added to the SCAT3. However, potential overlap among VOMS's vestibular and oculomotor items suggests the possibility of a more efficient version. VOMS and SCAT3 scores were analyzed for 3,958 preseason (47.8% female) and 496 acute-SRC (37.5% female) NCAA-DoD Concussion Assessment, Research, and Education (CARE) consortium collegiate athlete evaluations. Analyses revealed very large effect sizes (d = 2.39-2.45) and high correlations (rho = 0.95-0.99) among all VOMS items except near point of convergence distance (d = 0.79, rho ≤ 0.341). Receiver operating characteristic (ROC) curve analyses showed clinically useful discriminative utility for VOMS Total (AUC = 0.85) and the VOMS Total change score, where pretest symptoms were incorporated (AUC = 0.81). A modified VOMS (mVOMS) consisting of four items (smooth pursuits, horizontal saccades, horizontal vestibulo-ocular reflex, visual motion sensitivity) yielded identical AUCs to VOMS Total. Integer cutoff analyses suggest a score of ≥4 for VOMS Total and ≥4 for mVOMS Total optimizes concussion identification. Incorporating VOMS or mVOMS into SCAT3 (AUC = 0.79) significantly improved the combined tool's acute utility for acute concussion identification by a maximum of 4% (SCAT3+VOMS AUC = 0.84, SCAT3+mVOMS AUC = 0.83). Future versions of SCAT or MACE may want to consider incorporating a more parsimonious VOMS for the purpose of identifying acute concussion.
MeSH term(s)	Athletes ; Athletic Injuries/diagnosis ; Brain Concussion/diagnosis ; Female ; Humans ; Male ; Reflex, Vestibulo-Ocular ; Vestibule, Labyrinth
Language	English
Publishing date	2022-08-01
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	200427-6
ISSN	1878-5646 ; 0042-6989
ISSN (online)	1878-5646
ISSN	0042-6989
DOI	10.1016/j.visres.2022.108081
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Article ; Online: Sport Concussion Assessment Tool Symptom Inventory: Healthy and Acute Postconcussion Symptom Factor Structures.

Anderson, Morgan / Petit, Kyle M / Bretzin, Abigail C / Elbin, R J / Stephenson, Katie L / Covassin, Tracey

Journal of athletic training

2020 Volume 55, Issue 10, Page(s) 1046–1053

Abstract: Context: Previous researchers have examined factor structures for common concussion symptom inventories. However, they failed to discriminate between the acute (<72 hours) and subacute (3 days-3 months) periods after concussion. The Sport Concussion ... ...

Abstract	Context: Previous researchers have examined factor structures for common concussion symptom inventories. However, they failed to discriminate between the acute (<72 hours) and subacute (3 days-3 months) periods after concussion. The Sport Concussion Assessment Tool (SCAT) is an acute assessment that, when compared with other concussion symptom inventories, includes or excludes symptoms that may result in different symptom factors. Objective: The primary purpose was to investigate the symptom factor structure of the 22-item SCAT symptom inventory in healthy, uninjured and acutely concussed high school and collegiate athletes. The secondary purpose was to document the frequency of the unique SCAT symptom inventory items. Design: Case series. Setting: High school and college. Patients or other participants: A total of 1334 healthy, uninjured and 200 acutely concussed high school and collegiate athletes. Main outcome measure(s): Healthy, uninjured participants completed the SCAT symptom inventory at a single assessment. Participants in the acutely concussed sample completed the SCAT symptom inventory within 72 hours after concussion. Two separate exploratory factor analyses (EFAs) using a principal component analysis and varimax extraction method were conducted. Results: A 3-factor solution accounted for 48.1% of the total variance for the healthy, uninjured sample: cognitive-fatigue (eg, feeling "in a fog" and "don't feel right"), migraine (eg, neck pain and headache), and affective (eg, more emotional and sadness) symptom factors. A 3-factor solution accounted for 55.0% of the variance for the acutely concussed sample: migraine-fatigue (eg, headache and "pressure in the head"), affective (eg, sadness and more emotional), and cognitive-ocular (eg, difficulty remembering and balance problems) symptom factors. Conclusions: The inclusion of unique SCAT symptom inventory items did not alter the symptom factor structure for the healthy, uninjured sample. For the acutely concussed sample, all but 1 unique SCAT symptom inventory item (neck pain) loaded onto a factor.
MeSH term(s)	Adolescent ; Adult ; Athletes ; Athletic Injuries/complications ; Athletic Injuries/diagnosis ; Child ; Female ; Humans ; Male ; Mental Recall/physiology ; Neuropsychological Tests ; Post-Concussion Syndrome/diagnosis ; Post-Concussion Syndrome/etiology ; Post-Concussion Syndrome/psychology ; Sports Medicine/methods ; Young Adult
Language	English
Publishing date	2020-10-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2070051-9
ISSN	1938-162X ; 1062-6050
ISSN (online)	1938-162X
ISSN	1062-6050
DOI	10.4085/1062-6050-393-19
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Article ; Online: Comparing Before- and After-School Neurocognitive Performance in High School Athletes: Implications for Concussion Management.

Anderson, Morgan / Elbin, R J / Schatz, Philip / Henry, Luke / Covassin, Tracey

Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine

2020 Volume 31, Issue 1, Page(s) 31–35

Abstract: Objective: To compare before- and after-school neurocognitive performance and total symptoms in a sample of nonconcussed high school athletes.: Design: Repeated-measures, counterbalanced design.: Setting: Midwest high schools.: Participants: ... ...

Abstract	Objective: To compare before- and after-school neurocognitive performance and total symptoms in a sample of nonconcussed high school athletes. Design: Repeated-measures, counterbalanced design. Setting: Midwest high schools. Participants: Thirty-nine nonconcussed high school athletes. Interventions: The Immediate Post-Concussion Assessment and Cognitive Testing battery was administered before and after school in a counterbalanced testing order. Main outcome measures: Neurocognitive and total symptom scores. Results: Paired-sample t tests revealed no significant differences in verbal memory (P = 0.43), visual memory (P = 0.44), processing speed (P = 0.94), reaction time (P = 0.16), or total symptoms (P = 0.52) between before- and after-school testing sessions. Conclusions: The results of this study expand on best practice guidelines for baseline and postinjury concussion computerized neurocognitive testing and symptom report administration. This study suggests that sports medicine professionals can administer computerized neurocognitive testing before or after school without concern of confounding factors affecting performance or total symptoms.
MeSH term(s)	Adolescent ; Athletes ; Athletic Injuries/diagnosis ; Brain Concussion/diagnosis ; Cognition ; Female ; Humans ; Male ; Memory ; Mental Fatigue ; Neuropsychological Tests ; Reaction Time ; Schools ; Time Factors ; Visual Analog Scale
Language	English
Publishing date	2020-12-16
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	1062530-6
ISSN	1536-3724 ; 1050-642X
ISSN (online)	1536-3724
ISSN	1050-642X
DOI	10.1097/JSM.0000000000000685
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