title: Further Development of the Assessment of Military Multitasking Performance: Iterative Reliability Testing.
abstract: The Assessment of Military Multitasking Performance (AMMP) is a battery of functional dual-tasks and multitasks based on military activities that target known sensorimotor, cognitive, and exertional vulnerabilities after concussion/mild traumatic brain injury (mTBI). The AMMP was developed to help address known limitations in post concussive return to duty assessment and decision making. Once validated, the AMMP is intended for use in combination with other metrics to inform duty-readiness decisions in Active Duty Service Members following concussion. This study used an iterative process of repeated interrater reliability testing and feasibility feedback to drive modifications to the 9 tasks of the original AMMP which resulted in a final version of 6 tasks with metrics that demonstrated clinically acceptable ICCs of > 0.92 (range of 0.92-1.0) for the 3 dual tasks and > 0.87 (range 0.87-1.0) for the metrics of the 3 multitasks. Three metrics involved in recording subject errors across 2 tasks did not achieve ICCs above 0.85 set apriori for multitasks (0.64) and above 0.90 set for dual-tasks (0.77 and 0.86) and were not used for further analysis. This iterative process involved 3 phases of testing with between 13 and 26 subjects, ages 18-42 years, tested in each phase from a combined cohort of healthy controls and Service Members with mTBI. Study findings support continued validation of this assessment tool to provide rehabilitation clinicians further return to duty assessment methods robust to ceiling effects with strong face validity to injured Warriors and their leaders.
authors.affiliation: Courage Kenny Research Center, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States of America.
authors.forename: Margaret M
authors.identifier: http://orcid.org/0000-0002-8984-5987
authors.initials: MM
authors.lastname: Weightman
authors.affiliation: Division of Physical Therapy, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Karen L
authors.initials: KL
authors.lastname: McCulloch
authors.affiliation: Courage Kenny Research Center, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States of America.
authors.forename: Mary V
authors.initials: MV
authors.lastname: Radomski
authors.affiliation: Courage Kenny Research Center, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States of America.
authors.forename: Marsha
authors.initials: M
authors.lastname: Finkelstein
authors.affiliation: Courage Kenny Research Center, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States of America.|Defense and Veterans Brain Injury Center, Fort Bragg, North Carolina, United States of America.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Cecchini
authors.affiliation: Department of Clinical Research and Leadership, George Washington School of Medicine and Health Sciences, Washington, DC, United States of America.
authors.forename: Leslie F
authors.initials: LF
authors.lastname: Davidson
authors.affiliation: United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States of America.|Boston University School of Public Health, Department of Environmental Health, Boston, Massachusetts, United States of America.
authors.forename: Kristin J
authors.initials: KJ
authors.lastname: Heaton
authors.affiliation: United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States of America.
authors.forename: Laurel B
authors.initials: LB
authors.lastname: Smith
authors.affiliation: Clinical and Rehabilitative Medicine Research Program, Medical Research Materiel Command, Ft Detrick, Maryland, United States of America.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Scherer
mesh_terms: D000328:Adult; D001924:Brain Concussion / Q000503:physiopathology; D001930:Brain Injuries / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008889:Military Personnel; D009483:Neuropsychological Tests; D015203:Reproducibility of Results; D013647:Task Performance and Analysis; D055815:Young Adult