Background: Despite the increased awareness and education to the public, concussions in children continue to ensue without proper concussion education and management in school systems. Whether the child suffers a concussion in school or at home, it is essential for school nurses to have proper concussion education and evidence based management strategies to further monitor post-concussive symptoms in the school setting. Concussion symptoms can affect the student up to 7-10 days following the injury. Concussions can range from mild to severe, with symptoms lasting hours, days, months or longer. Children who experience a concussion can experience academic challenges that will affect them in the classroom. Without proper concussion education for school nurses, concussed youth may experience post-concussive symptoms. School nurses have a significant role, collaborating with the parents, providers, and the student in providing accommodations and support while transitioning back into the classroom. Purpose: To assess the knowledge of Utah school nurses regarding concussion education and management of the concussed student. In addition evaluating the educational intervention, which changed the knowledge base of the participants. Methods: A one group pre-test and post-test design was used. Study materials were emailed via the Utah School Nurse Association listserv to all Utah school nurses. A concussion educational power point was provided to these nurses before having them complete the post-test. Results: The results of the paired sample t-test revealed that there was a significant difference (p= .000) in comparison of the pre-test and post-test results after viewing the concussion educational power point. Conclusion: The results of this study showed that there was a significant difference between pre-test and post-test results after viewing the concussion educational power point. Therefore it can be concluded that providing education and awareness regarding concussion and its management will increase the knowledge and ultimately may change practice which in turn may improve patient outcomes.

No description available.

Objectives: After mild traumatic brain injury (mTBI), psychological factors can contribute to persisting post-concussion symptoms (PCS). Consistent with constructive theories of memory, negative expectations for increased symptoms after mTBI may contribute to misattributing symptoms to the mTBI and underestimating pre-injury symptoms, called the “good old days’ bias” (Gunstad & Suhr, 2001). The good old days’ bias is not thought to be a general retrospective recall bias but studies to date have largely not controlled for normative memory processes including those that lead to a biased, more positive recall of the past. Therefore, the current study examines whether there is a good old days’ bias after mTBI above and beyond normal memory biases. This study also examines how soon after mTBI the good old days’ bias affects recall of pre-injury symptoms in the first month after mTBI in adolescents as well as whether the good old days’ bias causes pre-injury symptom severity to be underestimated or if symptoms are entirely forgotten. Finally, the clinical significance of symptom recall biases is investigated. Method: The sample is 42 adolescents who sustained an mTBI (ages 13-18 years; 24 males) and 42 uninjured adolescents (ages 13-18 years; 24 males, ). The mTBI group rated current and retrospective post-concussion symptom ratings within one week and again, at one month, post-injury. The control group rated current and retrospective post-concussion symptoms at baseline and one month later. Cross-sectional and longitudinal comparisons using non-parametric statistical tests were used. Results: Wilcoxon signed-rank tests showed that, by one month post-mTBI, adolescents report fewer total, physical, and emotional pre-injury symptoms than they had reported within one week of their concussion. The control group did not demonstrate this good old days’ bias. There were no between-group differences in retrospective PCS ratings at either time point. Chi-square analyses found that the mTBI group was as likely as the control group to recall “no” pre-injury/past symptoms one month post-injury after having initially reported some pre-injury symptoms. Only four more adolescents were classified as “recovered” if their one-month PCS ratings were compared with pre-injury PCS ratings made within 1-week post-concussion rather than pre-injury ratings from 1-month post-injury. Discussion: There was mixed evidence for a good old days’ bias by one month post-concussion. This bias was not demonstrated in healthy adolescents, suggesting that the good old days’ bias is found specifically after concussion. During the acute post-injury period, the good old days’ bias may only be apparent by studying changes in concussed individuals’ own PCS ratings. The good old days’ bias leads to underestimating the severity of pre-injury symptoms rather than forgetting them entirely. The good old days’ bias does not greatly affect symptom recovery tracking by one month post-concussion. Future studies should directly examine expectations about concussion and their effect on current and retrospective symptom reporting. / Graduate / 2019-07-10

One of the consequences of traumatic brain injury is the postconcussion syndrome. The symptoms in this syndrome include headache, dizziness, poor memory, poor concentration, easy fatigue, drowsiness, irritability, sensitivity to light, sensitivity to noise, low alcohol tolerance, visual problems, auditory problems, nausea, vomiting, anxiety, and depression. Several factor analytic studies have shown that these symptoms load onto cognitive and noncognitive factors (Bohnen, Twijnstra, & Jolles, 1992). The aim of this study was to determine whether patients who report different symptoms also evidence differences in cognitive deficits, as indexed by reaction time. For this purpose 106 subjects (mean age 25.92 years; SD=6.05) of both sexes were tested on 8 reaction time tasks adapted from Shum, McFarland, Bain, and Humphreys (1990). There were 54 traumatic brain injury patients (mean age 26.40 years; SD=6.23) drawn from three Pretoria hospitals. They were heterogeneous with respect to diagnosis and severity of injury. For the controls (N=52), the mean age was 25.43 years (SD=5.88). The eight reaction time tasks constituted 4 task variables, each with 21evels. From these tasks, 36 reaction time indexes were derived. The indexes were classified into 4 groups, viz., reaction time (RT), movement time (MT), total reaction time (TT), and subtraction scores (SB, the difference between the 2 levels for each task variable). RT reflects the decision component and MT reflects the response execution component of reaction time. Partial correlation coefficients for all symptoms (p0,01) showed that some symptoms were most frequently associated with RT whilst others were most frequently associated with MT. On factor analysis with varimax rotation, symptoms loaded predominantly with SB scores. Symptoms also loaded with different task variablseuiggesting that they correlated with deficits on different stages of information processing. Taking into account possible methodological constraints that were discussed, these results confirm that different symptoms within the postconcussion syndrome correlate with different cognitive deficits. The correlations between symptoms and indices of reaction time are moderated by the characteristics of the symptoms (frequency & intensity), and the duration since injury. These findings have significance for understanding the aetiology of the postconcussion symptoms and for planning treatment. / Psychology / Ph. D. (Psychology)

Background and aims: The provenance of post-concussion symptoms (PCS) and post-traumatic stress (PTSD) after mild traumatic brain injury (mTBI) is controversial. This thesis investigated factors influencing these two conditions separately, as well as the interplay between PCS and PTSD, in individuals with mTBI and a control sample without mTBI (orthopaedic injuries). Method: Consecutive adult attendees of an Emergency Department with mTBI or orthopaedic injury were prospectively recruited and completed the Rivermead Post-concussion Questionnaire (RPQ) and Trauma Screening Questionnaire (TSQ) for PTSD at two weeks (T1) and three months (T2) post-injury. The sample at T1 consisted of 34 with complicated mTBI, 76 with uncomplicated mTBI and 47 with orthopaedic injury, and 18 with complicated mTBI, 43 with uncomplicated mTBI and 33 orthopaedic controls at T2. Results: Although there were no differences in overall PCS symptomology between groups, a subset of PCS symptoms (headaches, dizziness and nausea) was found to be specific to mTBI at both time points. These symptoms are proposed to have a neurological basis, as opposed to a psychological basis. PTSD interacted with PCS, particularly in mTBI, such that PTSD was associated with greater “neurogenic” and “psychogenic” symptomology in this group, but only a moderate increase in psychogenic symptoms for controls. A model of the influence of PTSD on PCS is presented. PTSD was influenced by poor memory quality for the traumatic event and attribution of blame to others, but not by mTBI. Discussion and conclusions: Though mTBI may set the scene for at least neurogenic symptoms of PCS to occur, psychological mechanisms, particularly PTSD, have a significant role in the persistence of PCS. Our findings suggest the need for a clear story and sense of meaning for a traumatic event for good recovery from PTSD. Taken together, the results suggest that psychological interventions, particularly aimed at PTSD, may be most effective after mTBI.

Mild Traumatic Brain injury (mTBI) is one of the most common forms of acquired neurological damage. However, the term 'mild' TBI is misleading because the physical, cognitive and emotional impairments that can follow from mTBI can be significant. In order to provide objective, prognostic measures for diagnosing the severity of mTBI and identifying individuals who may be at risk for poor outcomes a battery of neuropsychological measures for detecting cognitive impairment was evaluated. The Rapid Screen of Concussion (RSC) is a collection of tests assessing verbal recall, orientation, processing speed and speed of language comprehension. Previous studies have demonstrated that the RSC has acceptable reliability, validity and sensitivity to cognitive impairment that arises during the acute stages of injury. However, no studies have investigated the predictive validity of this instrument. Moreover it is unclear what additional patient or post injury variables could assist in identifying those individuals who may be at risk of poor neuropsychological outcomes following mTBI. These were among the main issues that were addressed across the five empirical studies in this thesis. A pragmatic, prospective, longitudinal and cross-sectional study of the sequelae of mTBI in patients presenting to the Department of Emergency Medicine of the Royal Brisbane and Women's hospital was the basis of this project. The first empirical chapter (chapter 2), examined the psychometric properties of two measures of verbal learning and memory and investigated their potential for discriminating between mTBI and orthopaedic controls. The performance of 93 patients with mTBI and 68 participants with orthopaedic injuries was analysed to identify the number of individuals who performed at ceiling on the Hopkins Verbal Learning test (HVLT-R) versus a 5-word test of immediate and delayed recall. While both of these verbal recall measures were effective in separating the mTBI and orthopaedic groups, overall, the HVLT-R was shown to be a more suitable measure for screening for deficits in verbal learning and memory after mTBI. Given the superiority of the HVLT-R as a measure of verbal learning and memory, chapter 3 aimed to examine whether inclusion of this test could improve the sensitivity of the RSC in mTBI compared to orthopaedic and uninjured control samples. Results were generally within the direction predicted. Significant differences were found between groups on the majority of cognitive indices assessed. Both the orthopaedic and mTBI group performed more poorly than the uninjured group on all measures except the Hopkins delayed recognition. Additional performance decrements shown by the mTBI group compared to the orthopaedic group illustrate that factors beyond the general effects of trauma influence performance and may be related to cognitive impairment specific to sustaining mTBI. Overall it was concluded that the revised RSC is a sensitive instrument deserving investigation in assessing the more long term cognitive effects following mTBI. Chapter 4 applied this sensitive battery for investigation of group and individual recovery of neuropsychological test performance and post-concussive symptom reporting up to 3-months after mTBI. A sample of 30 mTBI participants and 30 uninjured controls were serially assessed on cognitive measures and symptom report scales immediately after injury and after 1-week, 1-month and 3-months. Symptom reporting on the Rivermead post-concussive inventory separated the mTBI and control groups after 1-week but diagnostic accuracy was no greater than chance at 1 and 3-months. In contrast the mTBI group performed more poorly than controls on measures on neuropsychological measures acutely, at 1-week and 1-month, with group differences still evident after 3-months. Nonethless, a trend of progressive recovery over time was seen in the mTBI group. In chapter 5, criteria utilising the concepts of reliable and statistically significant change were applied to the data. Overall, 73% of mTBI patients were impaired on one or more tests acutely. Significant recovery was demonstrated by 20% of mTBI participants by 3-months; however recovery remained incomplete for half of the mTBI participants by 3-months. These results highlighted the importance of an individual approach to the assessment of mTBI and support the notion that a proportion of mTBI cases may have protracted difficulties. Chapter 6 extended these findings by showing that the RSC has prognostic ability. It was found that acute neuropsychological performance on the RSC was a significant predictor of performance on an extended battery at 3-months. The final chapter provides a general discussion and synthesis of the findings. In summary, the present dissertation demonstrated that inclusion of a sensitive measure of verbal recall led to improved diagnostic validity of the RSC. Neuropsychological measures rather than symptom reporting were sensitive in detecting cognitive impairment at 3-months. Analysis of individuals showed that up to 50% of the group had failed to – demonstrate reliable recovery – that is, make improvements over and above practice effects after 3-months. Finally, acute neuropsychological performance was predictive of long term performance. Overall, the present thesis has identified a short battery of tests that is suitable for assessment of mTBI within 24 hours and may assist in identifying individuals at risk of poor cognitive outcomes after mTBI.

Mild Traumatic Brain injury (mTBI) is one of the most common forms of acquired neurological damage. However, the term 'mild' TBI is misleading because the physical, cognitive and emotional impairments that can follow from mTBI can be significant. In order to provide objective, prognostic measures for diagnosing the severity of mTBI and identifying individuals who may be at risk for poor outcomes a battery of neuropsychological measures for detecting cognitive impairment was evaluated. The Rapid Screen of Concussion (RSC) is a collection of tests assessing verbal recall, orientation, processing speed and speed of language comprehension. Previous studies have demonstrated that the RSC has acceptable reliability, validity and sensitivity to cognitive impairment that arises during the acute stages of injury. However, no studies have investigated the predictive validity of this instrument. Moreover it is unclear what additional patient or post injury variables could assist in identifying those individuals who may be at risk of poor neuropsychological outcomes following mTBI. These were among the main issues that were addressed across the five empirical studies in this thesis. A pragmatic, prospective, longitudinal and cross-sectional study of the sequelae of mTBI in patients presenting to the Department of Emergency Medicine of the Royal Brisbane and Women's hospital was the basis of this project. The first empirical chapter (chapter 2), examined the psychometric properties of two measures of verbal learning and memory and investigated their potential for discriminating between mTBI and orthopaedic controls. The performance of 93 patients with mTBI and 68 participants with orthopaedic injuries was analysed to identify the number of individuals who performed at ceiling on the Hopkins Verbal Learning test (HVLT-R) versus a 5-word test of immediate and delayed recall. While both of these verbal recall measures were effective in separating the mTBI and orthopaedic groups, overall, the HVLT-R was shown to be a more suitable measure for screening for deficits in verbal learning and memory after mTBI. Given the superiority of the HVLT-R as a measure of verbal learning and memory, chapter 3 aimed to examine whether inclusion of this test could improve the sensitivity of the RSC in mTBI compared to orthopaedic and uninjured control samples. Results were generally within the direction predicted. Significant differences were found between groups on the majority of cognitive indices assessed. Both the orthopaedic and mTBI group performed more poorly than the uninjured group on all measures except the Hopkins delayed recognition. Additional performance decrements shown by the mTBI group compared to the orthopaedic group illustrate that factors beyond the general effects of trauma influence performance and may be related to cognitive impairment specific to sustaining mTBI. Overall it was concluded that the revised RSC is a sensitive instrument deserving investigation in assessing the more long term cognitive effects following mTBI. Chapter 4 applied this sensitive battery for investigation of group and individual recovery of neuropsychological test performance and post-concussive symptom reporting up to 3-months after mTBI. A sample of 30 mTBI participants and 30 uninjured controls were serially assessed on cognitive measures and symptom report scales immediately after injury and after 1-week, 1-month and 3-months. Symptom reporting on the Rivermead post-concussive inventory separated the mTBI and control groups after 1-week but diagnostic accuracy was no greater than chance at 1 and 3-months. In contrast the mTBI group performed more poorly than controls on measures on neuropsychological measures acutely, at 1-week and 1-month, with group differences still evident after 3-months. Nonethless, a trend of progressive recovery over time was seen in the mTBI group. In chapter 5, criteria utilising the concepts of reliable and statistically significant change were applied to the data. Overall, 73% of mTBI patients were impaired on one or more tests acutely. Significant recovery was demonstrated by 20% of mTBI participants by 3-months; however recovery remained incomplete for half of the mTBI participants by 3-months. These results highlighted the importance of an individual approach to the assessment of mTBI and support the notion that a proportion of mTBI cases may have protracted difficulties. Chapter 6 extended these findings by showing that the RSC has prognostic ability. It was found that acute neuropsychological performance on the RSC was a significant predictor of performance on an extended battery at 3-months. The final chapter provides a general discussion and synthesis of the findings. In summary, the present dissertation demonstrated that inclusion of a sensitive measure of verbal recall led to improved diagnostic validity of the RSC. Neuropsychological measures rather than symptom reporting were sensitive in detecting cognitive impairment at 3-months. Analysis of individuals showed that up to 50% of the group had failed to – demonstrate reliable recovery – that is, make improvements over and above practice effects after 3-months. Finally, acute neuropsychological performance was predictive of long term performance. Overall, the present thesis has identified a short battery of tests that is suitable for assessment of mTBI within 24 hours and may assist in identifying individuals at risk of poor cognitive outcomes after mTBI.

Mild Traumatic Brain injury (mTBI) is one of the most common forms of acquired neurological damage. However, the term 'mild' TBI is misleading because the physical, cognitive and emotional impairments that can follow from mTBI can be significant. In order to provide objective, prognostic measures for diagnosing the severity of mTBI and identifying individuals who may be at risk for poor outcomes a battery of neuropsychological measures for detecting cognitive impairment was evaluated. The Rapid Screen of Concussion (RSC) is a collection of tests assessing verbal recall, orientation, processing speed and speed of language comprehension. Previous studies have demonstrated that the RSC has acceptable reliability, validity and sensitivity to cognitive impairment that arises during the acute stages of injury. However, no studies have investigated the predictive validity of this instrument. Moreover it is unclear what additional patient or post injury variables could assist in identifying those individuals who may be at risk of poor neuropsychological outcomes following mTBI. These were among the main issues that were addressed across the five empirical studies in this thesis. A pragmatic, prospective, longitudinal and cross-sectional study of the sequelae of mTBI in patients presenting to the Department of Emergency Medicine of the Royal Brisbane and Women's hospital was the basis of this project. The first empirical chapter (chapter 2), examined the psychometric properties of two measures of verbal learning and memory and investigated their potential for discriminating between mTBI and orthopaedic controls. The performance of 93 patients with mTBI and 68 participants with orthopaedic injuries was analysed to identify the number of individuals who performed at ceiling on the Hopkins Verbal Learning test (HVLT-R) versus a 5-word test of immediate and delayed recall. While both of these verbal recall measures were effective in separating the mTBI and orthopaedic groups, overall, the HVLT-R was shown to be a more suitable measure for screening for deficits in verbal learning and memory after mTBI. Given the superiority of the HVLT-R as a measure of verbal learning and memory, chapter 3 aimed to examine whether inclusion of this test could improve the sensitivity of the RSC in mTBI compared to orthopaedic and uninjured control samples. Results were generally within the direction predicted. Significant differences were found between groups on the majority of cognitive indices assessed. Both the orthopaedic and mTBI group performed more poorly than the uninjured group on all measures except the Hopkins delayed recognition. Additional performance decrements shown by the mTBI group compared to the orthopaedic group illustrate that factors beyond the general effects of trauma influence performance and may be related to cognitive impairment specific to sustaining mTBI. Overall it was concluded that the revised RSC is a sensitive instrument deserving investigation in assessing the more long term cognitive effects following mTBI. Chapter 4 applied this sensitive battery for investigation of group and individual recovery of neuropsychological test performance and post-concussive symptom reporting up to 3-months after mTBI. A sample of 30 mTBI participants and 30 uninjured controls were serially assessed on cognitive measures and symptom report scales immediately after injury and after 1-week, 1-month and 3-months. Symptom reporting on the Rivermead post-concussive inventory separated the mTBI and control groups after 1-week but diagnostic accuracy was no greater than chance at 1 and 3-months. In contrast the mTBI group performed more poorly than controls on measures on neuropsychological measures acutely, at 1-week and 1-month, with group differences still evident after 3-months. Nonethless, a trend of progressive recovery over time was seen in the mTBI group. In chapter 5, criteria utilising the concepts of reliable and statistically significant change were applied to the data. Overall, 73% of mTBI patients were impaired on one or more tests acutely. Significant recovery was demonstrated by 20% of mTBI participants by 3-months; however recovery remained incomplete for half of the mTBI participants by 3-months. These results highlighted the importance of an individual approach to the assessment of mTBI and support the notion that a proportion of mTBI cases may have protracted difficulties. Chapter 6 extended these findings by showing that the RSC has prognostic ability. It was found that acute neuropsychological performance on the RSC was a significant predictor of performance on an extended battery at 3-months. The final chapter provides a general discussion and synthesis of the findings. In summary, the present dissertation demonstrated that inclusion of a sensitive measure of verbal recall led to improved diagnostic validity of the RSC. Neuropsychological measures rather than symptom reporting were sensitive in detecting cognitive impairment at 3-months. Analysis of individuals showed that up to 50% of the group had failed to – demonstrate reliable recovery – that is, make improvements over and above practice effects after 3-months. Finally, acute neuropsychological performance was predictive of long term performance. Overall, the present thesis has identified a short battery of tests that is suitable for assessment of mTBI within 24 hours and may assist in identifying individuals at risk of poor cognitive outcomes after mTBI.

Mild Traumatic Brain injury (mTBI) is one of the most common forms of acquired neurological damage. However, the term 'mild' TBI is misleading because the physical, cognitive and emotional impairments that can follow from mTBI can be significant. In order to provide objective, prognostic measures for diagnosing the severity of mTBI and identifying individuals who may be at risk for poor outcomes a battery of neuropsychological measures for detecting cognitive impairment was evaluated. The Rapid Screen of Concussion (RSC) is a collection of tests assessing verbal recall, orientation, processing speed and speed of language comprehension. Previous studies have demonstrated that the RSC has acceptable reliability, validity and sensitivity to cognitive impairment that arises during the acute stages of injury. However, no studies have investigated the predictive validity of this instrument. Moreover it is unclear what additional patient or post injury variables could assist in identifying those individuals who may be at risk of poor neuropsychological outcomes following mTBI. These were among the main issues that were addressed across the five empirical studies in this thesis. A pragmatic, prospective, longitudinal and cross-sectional study of the sequelae of mTBI in patients presenting to the Department of Emergency Medicine of the Royal Brisbane and Women's hospital was the basis of this project. The first empirical chapter (chapter 2), examined the psychometric properties of two measures of verbal learning and memory and investigated their potential for discriminating between mTBI and orthopaedic controls. The performance of 93 patients with mTBI and 68 participants with orthopaedic injuries was analysed to identify the number of individuals who performed at ceiling on the Hopkins Verbal Learning test (HVLT-R) versus a 5-word test of immediate and delayed recall. While both of these verbal recall measures were effective in separating the mTBI and orthopaedic groups, overall, the HVLT-R was shown to be a more suitable measure for screening for deficits in verbal learning and memory after mTBI. Given the superiority of the HVLT-R as a measure of verbal learning and memory, chapter 3 aimed to examine whether inclusion of this test could improve the sensitivity of the RSC in mTBI compared to orthopaedic and uninjured control samples. Results were generally within the direction predicted. Significant differences were found between groups on the majority of cognitive indices assessed. Both the orthopaedic and mTBI group performed more poorly than the uninjured group on all measures except the Hopkins delayed recognition. Additional performance decrements shown by the mTBI group compared to the orthopaedic group illustrate that factors beyond the general effects of trauma influence performance and may be related to cognitive impairment specific to sustaining mTBI. Overall it was concluded that the revised RSC is a sensitive instrument deserving investigation in assessing the more long term cognitive effects following mTBI. Chapter 4 applied this sensitive battery for investigation of group and individual recovery of neuropsychological test performance and post-concussive symptom reporting up to 3-months after mTBI. A sample of 30 mTBI participants and 30 uninjured controls were serially assessed on cognitive measures and symptom report scales immediately after injury and after 1-week, 1-month and 3-months. Symptom reporting on the Rivermead post-concussive inventory separated the mTBI and control groups after 1-week but diagnostic accuracy was no greater than chance at 1 and 3-months. In contrast the mTBI group performed more poorly than controls on measures on neuropsychological measures acutely, at 1-week and 1-month, with group differences still evident after 3-months. Nonethless, a trend of progressive recovery over time was seen in the mTBI group. In chapter 5, criteria utilising the concepts of reliable and statistically significant change were applied to the data. Overall, 73% of mTBI patients were impaired on one or more tests acutely. Significant recovery was demonstrated by 20% of mTBI participants by 3-months; however recovery remained incomplete for half of the mTBI participants by 3-months. These results highlighted the importance of an individual approach to the assessment of mTBI and support the notion that a proportion of mTBI cases may have protracted difficulties. Chapter 6 extended these findings by showing that the RSC has prognostic ability. It was found that acute neuropsychological performance on the RSC was a significant predictor of performance on an extended battery at 3-months. The final chapter provides a general discussion and synthesis of the findings. In summary, the present dissertation demonstrated that inclusion of a sensitive measure of verbal recall led to improved diagnostic validity of the RSC. Neuropsychological measures rather than symptom reporting were sensitive in detecting cognitive impairment at 3-months. Analysis of individuals showed that up to 50% of the group had failed to – demonstrate reliable recovery – that is, make improvements over and above practice effects after 3-months. Finally, acute neuropsychological performance was predictive of long term performance. Overall, the present thesis has identified a short battery of tests that is suitable for assessment of mTBI within 24 hours and may assist in identifying individuals at risk of poor cognitive outcomes after mTBI.

Mild Traumatic Brain injury (mTBI) is one of the most common forms of acquired neurological damage. However, the term 'mild' TBI is misleading because the physical, cognitive and emotional impairments that can follow from mTBI can be significant. In order to provide objective, prognostic measures for diagnosing the severity of mTBI and identifying individuals who may be at risk for poor outcomes a battery of neuropsychological measures for detecting cognitive impairment was evaluated. The Rapid Screen of Concussion (RSC) is a collection of tests assessing verbal recall, orientation, processing speed and speed of language comprehension. Previous studies have demonstrated that the RSC has acceptable reliability, validity and sensitivity to cognitive impairment that arises during the acute stages of injury. However, no studies have investigated the predictive validity of this instrument. Moreover it is unclear what additional patient or post injury variables could assist in identifying those individuals who may be at risk of poor neuropsychological outcomes following mTBI. These were among the main issues that were addressed across the five empirical studies in this thesis. A pragmatic, prospective, longitudinal and cross-sectional study of the sequelae of mTBI in patients presenting to the Department of Emergency Medicine of the Royal Brisbane and Women's hospital was the basis of this project. The first empirical chapter (chapter 2), examined the psychometric properties of two measures of verbal learning and memory and investigated their potential for discriminating between mTBI and orthopaedic controls. The performance of 93 patients with mTBI and 68 participants with orthopaedic injuries was analysed to identify the number of individuals who performed at ceiling on the Hopkins Verbal Learning test (HVLT-R) versus a 5-word test of immediate and delayed recall. While both of these verbal recall measures were effective in separating the mTBI and orthopaedic groups, overall, the HVLT-R was shown to be a more suitable measure for screening for deficits in verbal learning and memory after mTBI. Given the superiority of the HVLT-R as a measure of verbal learning and memory, chapter 3 aimed to examine whether inclusion of this test could improve the sensitivity of the RSC in mTBI compared to orthopaedic and uninjured control samples. Results were generally within the direction predicted. Significant differences were found between groups on the majority of cognitive indices assessed. Both the orthopaedic and mTBI group performed more poorly than the uninjured group on all measures except the Hopkins delayed recognition. Additional performance decrements shown by the mTBI group compared to the orthopaedic group illustrate that factors beyond the general effects of trauma influence performance and may be related to cognitive impairment specific to sustaining mTBI. Overall it was concluded that the revised RSC is a sensitive instrument deserving investigation in assessing the more long term cognitive effects following mTBI. Chapter 4 applied this sensitive battery for investigation of group and individual recovery of neuropsychological test performance and post-concussive symptom reporting up to 3-months after mTBI. A sample of 30 mTBI participants and 30 uninjured controls were serially assessed on cognitive measures and symptom report scales immediately after injury and after 1-week, 1-month and 3-months. Symptom reporting on the Rivermead post-concussive inventory separated the mTBI and control groups after 1-week but diagnostic accuracy was no greater than chance at 1 and 3-months. In contrast the mTBI group performed more poorly than controls on measures on neuropsychological measures acutely, at 1-week and 1-month, with group differences still evident after 3-months. Nonethless, a trend of progressive recovery over time was seen in the mTBI group. In chapter 5, criteria utilising the concepts of reliable and statistically significant change were applied to the data. Overall, 73% of mTBI patients were impaired on one or more tests acutely. Significant recovery was demonstrated by 20% of mTBI participants by 3-months; however recovery remained incomplete for half of the mTBI participants by 3-months. These results highlighted the importance of an individual approach to the assessment of mTBI and support the notion that a proportion of mTBI cases may have protracted difficulties. Chapter 6 extended these findings by showing that the RSC has prognostic ability. It was found that acute neuropsychological performance on the RSC was a significant predictor of performance on an extended battery at 3-months. The final chapter provides a general discussion and synthesis of the findings. In summary, the present dissertation demonstrated that inclusion of a sensitive measure of verbal recall led to improved diagnostic validity of the RSC. Neuropsychological measures rather than symptom reporting were sensitive in detecting cognitive impairment at 3-months. Analysis of individuals showed that up to 50% of the group had failed to – demonstrate reliable recovery – that is, make improvements over and above practice effects after 3-months. Finally, acute neuropsychological performance was predictive of long term performance. Overall, the present thesis has identified a short battery of tests that is suitable for assessment of mTBI within 24 hours and may assist in identifying individuals at risk of poor cognitive outcomes after mTBI.