Preliminary Evaluation of the Circle Sequencing Task (CST) as a Cognitive-Motor Tool for Concussion Assessment

Current pitchside concussion assessments are limited by low sensitivity, reliance on player self-report, and the need for on-site healthcare professionals. Impairments in cognitive function and motor control are a key predictor of concussive injury. The Circle Sequencing Task (CST) is a newly developed concussion assessment tool to assess both cognitive function and motor control in one test. Here, we seek to assess the CST's ability to differentiate between healthy and recently concussed individuals relative to existing cognitive tests. Concussed (n = 13; mean age 26 ± 7 yrs) and healthy (n = 13; mean age 28 ± 9 yrs) participants completed the CST, the Trail Making Test, a Go/No-Go task, the Digit Span Test and a simple reaction time task online via a link. Concussed individuals showed significant deficits in inhibitory control (p = 0.01) and memory (p = 0.04) components of the CST compared to healthy controls, with these components showing a larger effect size (d = 1.05 and d = 0.78, respectively) than metrics derived from the existing cognitive tests of Go/No-Go (d = 0.37) and the Digit Span Test (d = 0.52). The findings provide preliminary evidence that CST-derived inhibitory control and memory metrics may differ between recently concussed individuals and healthy controls and warrant further validation in larger clinically controlled studies.