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Phil Dean, Psychology, Uni Surrey: Open Resources

Collection of useful tasks and questionnaires.

  • If you're looking for a specific task, I suggest using the search function in your browser by pressing 'CTRL + F', and entering the name of the task/questionnaire you're searching for.
  • Tasks/questionnaires can be added to the library within your own account using the 'clone' button.
  • References are provided within the version history of each task.

We have endeavoured to gain permission, where possible, to host these tasks and questionnaires. If you believe we are hosting something improperly, please let us know.

For similar repositories see:

ANALYSIS

Gorilla Data, is downloaded as a .csv file, and requires some level of data tidying or analysis. There is a nice tutorial on data processing using R and tidyverse .

In addition, there is also this GitHub repository, which has example R scripts for data processing

CONTENTS

Questionnaires

  1. Cognitive Failures Questionnaire (CFQ)
  2. Edinburgh Handedness Inventory (EHI)
  3. Epworth Sleepiness Scale (ESS)
  4. Hospital Anxiety and Depression Scale (HADS)
  5. Impact of Event Scale - Revised (IES-R)
  6. Karolinska Sleepiness Scale (KSS) V1
  7. Karolinska Sleepiness Scale (KSS) V2
  8. Morningness-Eveningness Questionnaire (MEQ)
  9. Pittsburgh Sleep Quality Index (PSQI)
  10. Rivermead Post-Concussion Symptoms Questionnaire (RPQ)
  11. Rivermead Post-Concussion Symptoms Questionnaire for Controls (RPQ-C)

Tasks

  1. Attentional Network Task
  2. Brief Implicit Association Task (B-IAT)
  3. Digit Span Task (Auditory)
  4. Digit Span Task (Visual & Text Entry)
  5. Emotional Stroop
  6. N-Back Task
  • I also have a Phonological Short Term Memory & Pseudo Word Task used with permission from Franceschini et al 2019, Neuropsychologia, 130, pp100-106. Please email for me to send, and to get permissions from authors.

Example Experiments

  1. Example Experiment: Concussion Screening & Questionnaires/Task

General & Head-Injury Related

  1. Consent to Contact
  2. Debrief
  3. mTBI/Concussion Screening Form: Demographics
  4. mTBI/Concussion Screening Form: Head Injury
  5. mTBI/Concussion Screening Form: Sports-related information
  6. mTBI/Concussion Screening Form: Supplementation and Diet Screening
  7. mTBI/Concussion Screening Form: Post-Season Screen

Back to Open Materials


Cognitive Failures Questionnaire (CFQ)

Built with Questionnaire Builder 1

A questionnaire measure of self-reported failures in perception, memory, and motor function. For more details, see reference

CFQ Score is just summed up:

  • Never = 0
  • Very Rarely = 1
  • Occasionally = 2
  • Quite Often = 3
  • Very Often = 4

For more information on scoring see here

There is an example R Analysis script in this GitHub repository, which (amongst other questionnaires/tasks) codes for the analysis of this task. Look for the CFQ section (should be clearly marked)

Creative Commons Attribution-NonCommercial (CC BY-NC)


Broadbent, D.E., Cooper, P.F., FitzGerald, P., & Parkes, K.R. (1982). The Cognitive Failures Questionnaire (CFQ) and its correlates. British Journal of Clinical Psychology, 21, 1-16.
https://www.ncbi.nlm.nih.gov/pubmed/7126941/


Edinburgh Handedness Inventory (EHI)

Built with Questionnaire Builder 1

A simply applied quantitative assessment of handedness. For more details, see reference.

To score:

  • Total L = Count up number of L's (i.e. L = 1, LL = 2, RL =1)
  • Total R = Count up number of R's (i.e. R = 1, RR = 2, RL =1)
  • Total Both = Total L + Total R
  • Handedness = [(Total R - Total L)/Total Both] x 100

Creative Commons Attribution-NonCommercial (CC BY-NC)


R. C. Oldfield, “The assessment and analysis of handedness: the Edinburgh inventory,” Neuropsychologia, 1971, Vol. 9, No. 1, pp. 97-113.
https://www.sciencedirect.com/science/article/abs/pii/0028393271900674


Epworth Sleepiness Scale (ESS)

Built with Questionnaire Builder 1

A simple, self-administered questionnaire which is shown to provide a measurement of the subject's general level of daytime sleepiness. For more details, see references.

Scoring can be found here.

And initial paper can be found here.

Creative Commons Attribution (CC BY)


Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep, 1991; 14: 50-55.
https://www.ncbi.nlm.nih.gov/pubmed/1798888

Epworth Sleepiness Scale
http://epworthsleepinessscale.com/about-the-ess/


Hospital Anxiety and Depression Scale (HADS)

Built with Questionnaire Builder 1

A self-assessment scale developed for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. For more details, see reference.

Scoring can be found here

To score:

  • Anxiety: use odd number questions (e.g. "I feel tense or 'wound up")
  • Depression: use even number questions (e.g. "I still enjoy the things I used to enjoy")

Scored 3 - 2 - 1 - 0:

  • Questions 1, 3, 5, 6, 8, 10, 11, 13

Scored 0 - 1 - 2 - 3:

  • Questions 2, 4, 7, 9, 12, 14

Creative Commons Attribution-NonCommercial (CC BY-NC)


Zigmond & Snaith (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica. 67 (6): 361-370
https://www.ncbi.nlm.nih.gov/pubmed/6880820


Impact of Event Scale - Revised (IES-R)

Built with Questionnaire Builder 1

A 22-item self-report measure that assesses subjective distress caused by traumatic events. For more details, see reference.

To Score:

  • Avoidance Subscale: Mean of items 5, 7 ,8 ,11 ,12 ,13 ,17 ,22
  • Intrusions Subscale: Mean of items 1, 2, 3, 6, 9, 16, 20
  • Hyperarousal Subscale: Mean of items 4, 10, 14, 15, 18, 19, 21
  • Impact of Events - Revised score: Sum of the above three clinical scales.

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Weiss, D. S., & Marmar, C. R. (1996). The Impact of Event Scale - Revised. In J. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 399-411). New York: Guilford. (NOTE: Includes measure in its entirety.)
https://www.ptsd.va.gov/professional/assessment/adult-sr/ies-r.asp


Karolinska Sleepiness Scale (KSS) V1

Built with Questionnaire Builder 1

To momentarily assess a respondent's propensity to fall asleep. For more details, see reference.

This one has 10 steps and more labels, like in Baulk et al 2001 "Driver Sleepiness—Evaluation of Reaction Time Measurement as a Secondary Task"

Creative Commons Attribution-NonCommercial (CC BY-NC)


Akerstedt T, Gillberg M. Subjective and objective sleepiness in the active individual. Int J Neurosci. 1990 May;52(1-2):29-37
https://www.ncbi.nlm.nih.gov/pubmed/2265922


Karolinska Sleepiness Scale (KSS) V2

Built with Questionnaire Builder 1

To momentarily assess a respondent's propensity to fall asleep. For more details, see reference.

This is the original one that has 9 steps labeled only on odd numbers.

Creative Commons Attribution-NonCommercial (CC BY-NC)


Akerstedt T, Gillberg M. Subjective and objective sleepiness in the active individual. Int J Neurosci. 1990 May;52(1-2):29-37
https://www.ncbi.nlm.nih.gov/pubmed/2265922


Morningness-Eveningness Questionnaire (MEQ)

Built with Questionnaire Builder 1

An English language self-assessment Morningness-Eveningness questionnaire which categorises people into Morning, Evening and Intermediate type. For more details, see reference.

Scoring can be found here

Creative Commons Attribution-NonCommercial (CC BY-NC)


Horne, JA, Östberg O (1976). "A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms". International Journal of Chronobiology. 4 (2): 97–110.
https://www.ncbi.nlm.nih.gov/pubmed/1027738


Pittsburgh Sleep Quality Index (PSQI)

Built with Questionnaire Builder 1

A self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. For more details, see reference.

Scoring can be found here

Creative Commons Attribution-NonCommercial (CC BY-NC)


Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research. 1989;28:193–213.
https://www.ncbi.nlm.nih.gov/pubmed/2748771


Rivermead Post-Concussion Symptoms Questionnaire (RPQ)

Built with Questionnaire Builder 1

A questionnaire to measure the post-concussion symptoms (PCS) often reported by patients after mild traumatic brain injury (mTBI). For more details, see references.

To score, just add up values of each item on 0 - 1 - 2 - 3 - 4 scale:

  • 0= Not experienced at all
  • 1= No more of a problem
  • 2= A mild problem
  • 3= A moderate problem
  • 4= A severe problem

Some studies also look at the answers split into RPQ-3 and RPQ-13. See Eyres et al (2005) Clin Rehab 19(8):878-87.

Example RPQ form here.

There is an example R Analysis script in this GitHub repository, which (amongst other questionnaires/tasks) codes for the analysis of this task. Look for the RPQ section (should be clearly marked)

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King NS, Crawford S, Wenden FJ, Moss NE, Wade DT. The rivermead post concussion symptoms questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol. (1995) 242:587–92.
https://link.springer.com/article/10.1007%2FBF00868811


Rivermead Post-Concussion Symptoms Questionnaire for Controls (RPQ-C)

Built with Questionnaire Builder 1

A questionnaire to measure the post-concussion symptoms (PCS) on control populations without head injury for general population-level symptom report. For more details, see references.

Based on the RPQ (King et al (1995), see references) and used in Sterr et al (2006); Dean et al (2012) (see references)

To score, just add up values of each item on 0 - 1 - 2 - 3 - 4 scale:

  • 0= Not experienced at all
  • 1= No more of a problem
  • 2= A mild problem
  • 3= A moderate problem
  • 4= A severe problem

There is an example R Analysis script in this GitHub repository, which (amongst other questionnaires/tasks) codes for the analysis of this task. Look for the RPQ section (should be clearly marked)

Creative Commons Attribution-NonCommercial (CC BY-NC)


Sterr, A., Herron, K. A., Hayward, C., & Montaldi, D. (2006). Are mild head injuries as mild as we think? Neurobehavioral concomitants of chronic post-concussion syndrome. BMC Neurology, 6, [7].
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1382265/

Dean PJ, O'Neill D, Sterr A. Post-concussion syndrome: prevalence after mild traumatic brain injury in comparison with a sample without head injury. Brain Inj. 2012;26(1):14–26
https://pubmed.ncbi.nlm.nih.gov/22107176/

King NS, Crawford S, Wenden FJ, Moss NE, Wade DT. The rivermead post concussion symptoms questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol. (1995) 242:587–92.
https://link.springer.com/article/10.1007%2FBF00868811


Attentional Network Task

Built with Task Builder 1

2 Blocks of 12 practise trials, one without cueing, one with cueing (making the 24 trial full feedback practise block of Fan et al).

4 Blocks of 48 task trials (12 without cueing, 12 with dual asterisk cue [alerting], 12 with central asterisk [alerting] cue, 12 with one asterisk [orienting]) NB: Fan et al had 3 blocks of 96 trials. We split this to smaller blocks to aid in online delivery/focus

Done within the script tab:

  • The background colour is grey, with the text black.
  • The initial fixation cross (fixation 1) has a random duration of 400-1600ms
  • The last fixation cross (fixation 3) needs to be 3500 - ([fixation1 duration] + [Reaction Time]).

Not yet fully operationalised:

  • The images are not sized accurately according to Fan et al.:
    • "A single arrow or line consisted of 0.55 degrees of visual angle and the contours of adjacent arrows or lines were separated by 0.06 degrees of visual angle. The stimuli (one central arrow plus four flankers) consisted of a total 3.08 degrees of visual angle". This was at 65cm viewing distance so would be 6.240mm stimuli, 0.0681mm gap and 3.950cm in total
    • Controlling for device used, different screen size & resolution, and viewing distance is difficult logistically with remote testing in Gorilla. The Screen Calibration Zone, which is not yet available, may help with this in future.
    • For now, the stimuli are scaled on a 1920 x 1080 screen to be (approximately): 6mm, with 2mm gap, and 3.9cm in total (all 5 flanker stimuli).
    • NB: These stimuli size, gap, and total size will be different on different resolution screens. On the resolution range I tested, the only resolutions with possible issues are: 1280x768; 1360x768 or 1366x768, where the central arrow appears out of line with the rest.

There is an example R Analysis script in this GitHub repository, which (amongst other questionnaires/tasks) codes for the analysis of this task. Look for the ANT section (should be clearly marked)

Creative Commons Attribution-NonCommercial (CC BY-NC)


Fan et al (2002), Testing the Efficiency and Independence of Attentional Networks, Journal of Cognitive Neuroscience, 14:3, pp340-347
https://www.ncbi.nlm.nih.gov/pubmed/11970796

ANT Task Download
https://www.sacklerinstitute.org/cornell/assays_and_tools/ant/jin.fan/


Brief IAT (Example Only)

Built with Task Builder 1

Brief Implicit Association Test (B-IAT) as conceived by Sriram & Greenwald (2009), with class-based stimuli adaptation by Adam McNamara.

NB: This task is only to be used as an example structure/setup for an B-IAT task, and should not be run as an experiment in its current form. The original image stimuli for this task have been removed to prevent over-use of stimuli. They have been replaced with free-to-use images from Pixabay (https://pixabay.com/), and the images used have not been determined to be representative of the categories nor scientifically matched/determined.

Adapted for children to 4 blocks of 20 stimuli (12 Images, 8 words [with sound]).

  • The first 4 images in the block are randomly chosen * 2 from condition 1 (Upper Class), 2 from condition 2 (Lower Class) * These are discounted in the analysis as per Nosek et al 2014.
  • The next 16 stimuli are randomly ordered presentation from the 8 images (4 upper class, 4 lower class) and words (4 positive, 4 negative).

There is a practise block of 16 stimuli. This consists of 2 * 8 stimuli presentations, where the stimuli are randomly picked (without replacement) from the 16 possible stimuli (8 images, 8 words).

  • In the practise block, the image stimuli are Mammals (Condition 1) and Birds (Condition 2).

There is an example R Analysis script in this GitHub repository, which analyses the data according to Nosek et al 2014.

Creative Commons Attribution-NonCommercial (CC BY-NC)


Sriram & Greenwald (2009). The Brief Implicit Association Test. Experimental Psychology, Vol. 56(4):283–294. DOI: 10.1027/1618-3169.56.4.283
https://faculty.washington.edu/agg/pdf/Sriram&Greenwald.BIAT.2009.pdf

Nosek BA et al. (2014) Understanding and Using the Brief Implicit Association Test: Recommended Scoring Procedures. PLoS ONE 9(12): e110938. https://doi.org/10.1371/journal.pone.0110938
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0110938

Nosek, B. A., Greenwald, A. G., & Banaji, M. R. (2007). The Implicit Association Test at age 7: A methodological and conceptual review (Pp. 265–292). In J. A. Bargh (Ed.), Automatic processes in social thinking and behavior. Psychology Press.
https://faculty.washington.edu/agg/pdf/Nosek%20&%20al.IATatage7.2007.pdf

Greenwald et al. (1998). Measuring Individual Differences in Implicit Cognition: The Implicit Association Test. Journal of Personality and Soclal Psychology 1998, Vol. 74, No. 6, 1464-1480
https://faculty.washington.edu/agg/pdf/Gwald_McGh_Schw_JPSP_1998.OCR.pdf


Digit Span Task (Auditory)

Built with Task Builder 1

This test is adapted from Mark Turner & Jacky Ridsdale 2001's assessment procedure for specialist teachers to investigate verbal memory difficulties in children’s learning.

There are two different versions of the spreadsheet/digit lists (List A & List B), so a pre-post intervention task can be run and counterbalanced, without any learning effects.

This task requires the use of Audio (to play the lists) and a microphone (to record your response), and has audio and microphone test screens to ensure participants are aware of this, and have the correct levels to do the task. It also allows participants the ability to "allow" Gorilla permission to use the microphone during the test, so this does not impact recording of the task.

You would ordinarily administer this until a participant fails on both trials at a particular digit span. This online test will collect all digit spans as it records the audio from the participant, and online analysis of whether this is correct or not is not possible. Therefore, *when scoring you need to only count up to the trial where a participant failed both trials, and discount any further trials.

  • NB: This has been solved in the visual/text version of this task by using the script. But yet to be implemented here.
  • NB: It is possible to "cheat" on this task - see Visual/text entry version below for details.

Scoring:

  • Digit Forwards: The individual’s score is the total number of items correctly repeated forwards.
  • Digit Backwards The individual’s score is the total number of items correctly repeated backwards.
  • Combined (Total) Score: Digit Forwards score + Digit Backwards score
  • Digit Span (for both Forwards & Backwards): Maximum length (span) of the lists where the participant recalled both trials

Standard scores & percential equivalents are available from Mark Turner & Jacky Ridsdale 2001

Creative Commons Attribution-NonCommercial (CC BY-NC)


Turner, M., and Ridsdale, J. (2004). The Digit Memory Test. Available online at: https://www.dyslexia-international.org/content/Informal%20tests/Digitspan.pdf (accessed June 25, 2016).
https://www.dyslexia-international.org/content/Informal%20tests/Digitspan.pdf

Turner, M., and Ridsdale, J. (2004). The Digit Memory Test. Available online at: http://www.eleanorhick.co.uk/images/MorningTraining/AMSpring2018/Digitspan.pdf(accessed March 24, 2020).
http://www.eleanorhick.co.uk/images/MorningTraining/AMSpring2018/Digitspan.pdf


Digit Span Task (Visual & Text Entry)

Built with Task Builder 1

This test is adapted from Mark Turner & Jacky Ridsdale 2001's assessment procedure for specialist teachers to investigate verbal memory difficulties in children’s learning.

There are two different versions of the spreadsheet/digit lists (List A & List B), so a pre-post intervention task can be run and counterbalanced, without any learning effects. NB: Digit Forwards is always presented before Digit Backwards in both these lists.

This is a visual & text entry version of the audio one above. Text is on-screen for 500ms, with 500ms "gap" between numbers, meaning numbers presented every 1s as per "bedside" clinical test.

This task goes to the end of the condition (Digit Forwards or Digit Backwards) if a participant fails on both trials at a particular digit span. (Thanks to Dan Brady, University of Reading for starting coding this exit condition)

Scoring:

  • Digit Forwards: The individual’s score is the total number of items correctly repeated forwards.
  • Digit Backwards The individual’s score is the total number of items correctly repeated backwards.
  • Combined (Total) Score: Digit Forwards score + Digit Backwards score
  • Digit Span (for both Forwards & Backwards): Maximum length (span) of the lists where the participant recalled both trials

Standard scores & percential equivalents are available from Mark Turner & Jacky Ridsdale 2001

NB: it is possible to "cheat" on this task (and the audio one above). It has been brought to my attention by another researcher that their participants were writing down the numbers on paper as they came up, to enter in later. Although difficult, this is possible if people are quick at writing whilst looking at the screen. Alternatively, people can type out the numbers for the digit backwards into the text entry box, and then reverse them, deleting the initial part and getting the answer correct as if it was a digit forwards task. Both of these strategies (and likely more) can result in high, if not 100%, performance rates. I can think of no completely satisfactory way of preventing this from happening in such an online task, but it could be screened after collection: please see Jenni Rodd's great talk on data quality online. There might be longer reaction times if people are doing these tactics, but i don't think to the extent where they wouldn't overlap with others who just take a long time to answer correctly. High performance may be an indicator, and you could add longer lists. A "catch" trial/condition where it would be impossible without doing one of these tactics (e.g. a long number to remember at beginning of experiment, and only put in at end), but this might also impact the main experiment. Observing participants when doing this may be an option, but then it might be easier just to do the simple original audio "bedside" clinical version of the task where such cheating is not possible.

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Turner, M., and Ridsdale, J. (2004). The Digit Memory Test. Available online at: https://www.dyslexia-international.org/content/Informal%20tests/Digitspan.pdf (accessed June 25, 2016).
https://www.dyslexia-international.org/content/Informal%20tests/Digitspan.pdf

Turner, M., and Ridsdale, J. (2004). The Digit Memory Test. Available online at: http://www.eleanorhick.co.uk/images/MorningTraining/AMSpring2018/Digitspan.pdf(accessed March 24, 2020).
http://www.eleanorhick.co.uk/images/MorningTraining/AMSpring2018/Digitspan.pdf


Emotional Stroop Task

Built with Task Builder 1

Based on Kahan & Hely (2008).

This allocates colour to the word on a trial by trial basis (i.e. the colour is not strictly counterbalanced across conditions, and number of trials with each colour is not strictly counterbalanced).

Original paper was voice response. This uses keys R, G, B, Y (for Red, Green, Blue, Yellow).

NB: this has not been run on any experiment, and is to be used a first draft version/example to be checked/adapted only.

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Kahan, T.A., Hely, C.D. The role of valence and frequency in the emotional Stroop task. Psychonomic Bulletin & Review 15, 956–960 (2008). https://doi.org/10.3758/PBR.15.5.956
https://link.springer.com/article/10.3758/PBR.15.5.956


N-Back Task

Built with Task Builder 1

Based on versions of the n-Back task made for Dean & Sterr (2013) & Dean at al (2015) [see references], adapting to do just 2-Back and 4-Back.

2 Blocks of 8 practise trials, one for 2-Back (always first), one for 4-Back (always second).

10 Blocks of 30 task trials (10 Target, 20 non-Target), 5 each of 2-Back and 4-Back.

Block order randomised, however, Order/stimuli within each block is hard coded in spreadsheet (see below)

Participants must press for** both** target and non-target.

Done within the script tab:

  • The background colour needs to be black, with the text white.
  • NB: I have not worked out how to fully randomise the order of targets/non-targets and then allocate a stimuli/number yet. So the n-Back order is hard coded for each block, with blocks randomised.

There is an example R Analysis script in this GitHub repository, which (amongst other questionnaires/tasks) codes for the analysis of this task. Look for the n-Back section (should be clearly marked)

Creative Commons Attribution-NonCommercial (CC BY-NC)


Dean & Sterr (2013), Long-term effects of mild traumatic brain injury on cognitive performance, Frontiers in Human Neuroscience, 7:30
https://www.frontiersin.org/articles/10.3389/fnhum.2013.00030/full

Dean at al (2015), Multimodal imaging of mild traumatic brain injury and persistent postconcussion syndrome. Brain and Behaviour, 5(1): 45-61
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321394/


Example Experiment: Concussion Screening & Questionnaires/Task

Built with Experiment

Example experiment containing:

  • mTBI/Concussion Screening Form: Demographics
  • mTBI/Concussion Screening Form: Head Injury
  • Rivermead Post-Concussion Symptoms Questionnaire (RPQ)
  • Rivermead Post-Concussion Symptoms Questionnaire for Controls (RPQ-C)
  • Cognitive Failures Questionnaire (CFQ)
  • Attentional Network Task
  • Consent to Contact
  • Debrief

With an example of branching dependent on previous result.

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Consent to Contact

Built with Questionnaire Builder 1

Consent to contact for taking part in further studies after initial screening

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Debrief

Built with Questionnaire Builder 1

Example debrief, after screening, and before main task.

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mTBI/Concussion Screening Form: Demographics

Built with Questionnaire Builder 1

Demographics for concussion/mild traumatic brain injury (mTBI) study with:

  • Name, Age, Gender, Contact details
  • Occupation, Level of Education
  • Handedness, eyesight, hearing
  • Litigation, Medication, Neurological conditions, dyslexia, chronic pain
  • Every experienced injury to head

NB some of these options are "Personal Data" for GDPR purposes and some are "special category personal data", and you need to have a data management plan for these, and have mentioned them in the information sheet to make sure your participant is aware what you are taking, why, for how long, how you will handle it, whether and how they can remove their data, and who is responsible for the data. See University of Surrey Ethics for more details.

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mTBI/Concussion Screening Form: Head Injury

Built with Questionnaire Builder 1

Head Injury Specific data for concussion/mild traumatic brain injury (mTBI) study with:

  • Number of head injury, Injury within 10 days, Major head injury
  • For most recent injury: date of injury, dizziness, Loss of Consciousness (LOC), Memory loss (PTA), How injury occurred, where injury was on head, Whether injury was rotational or linear
  • Occupation, Level of Education
  • Handedness, eyesight, hearing
  • Litigation, Medication, Neurological conditions, dyslexia, chronic pain
  • Every experienced injury to head

NB these options are "special category personal data" for GDPR purposes, and you need to have a data management plan for these, and have mentioned them in the information sheet to make sure your participant is aware what you are taking, why, for how long, how you will handle it, whether and how they can remove their data, and who is responsible for the data. See University of Surrey Ethics for more details.

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mTBI/Concussion Screening Form: Sports-related information

Built with Questionnaire Builder 1

Sports-related information for concussion/mild traumatic brain injury (mTBI) study with:

  • Regularly play rugby? If yes: Part of team, ever experienced head injury during training/matches, how long playing, what position play
  • Regularly play any sport?
  • Regularly play (American football, football, boxing, mixed martial arts, taekwondo)? If Yes: most regular sport of these: part of team/gym, ever experienced head injury during training/matches, how long playing, what position play
  • Regularly play (Athletics, triathlon, tennis, squash, badmington, cycling, rowing, swimming, Other)? If Yes: most regular sport of these: part of team/gym, how long playing,

NB some of these options are "special category personal data" for GDPR purposes, and you need to have a data management plan for these, and have mentioned them in the information sheet to make sure your participant is aware what you are taking, why, for how long, how you will handle it, whether and how they can remove their data, and who is responsible for the data. See University of Surrey Ethics for more details.

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mTBI/Concussion Screening Form: Supplementation and Diet Screening

Built with Questionnaire Builder 1

Supplement & Diet-related information for concussion/mild traumatic brain injury (mTBI) study with:

  • Do you regularly take creatine?
  • Do you regularly take any other supplement or medication (Protein, Glutamine, BCAAs, Citrulline, Arginine, Beta-Alanine, Caffeine (as supplement), Ginseng, Ginkgo Biloba, Iron, Ribose, Quercetin, Beetroot [& juice], Fish Oil [or Omega 3], Vitamin C, Vitamin E, Co-Enzyme Q10, Acetyl-L-Carnitine, Other Antioxidants, Other)?
  • Do you eat meat (how often)?, Do you eat fish (how often)? Do you eat dairy (inc. milk, cheese, eggs; how often, is this dairy vegan)?
  • Main source of Protein (meat, fish, dairy, beans/legumes [inc Soya & Tofu], nuts/seeds, mushrooms/fungi [inc quorn/mycoprotein], Other)
  • How much coffee/tea per day
  • Do you smoke?
  • Do you drink?

NB some of these options are "special category personal data" for GDPR purposes, and you need to have a data management plan for these, and have mentioned them in the information sheet to make sure your participant is aware what you are taking, why, for how long, how you will handle it, whether and how they can remove their data, and who is responsible for the data. See University of Surrey Ethics for more details.

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mTBI/Concussion Screening Form: Post-Season Screen

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Post-Season head injury screening for concussion/mild traumatic brain injury (mTBI) study with:

  • Hits to head over season
  • How many had: dizziness, Loss of Consciousness (LOC), Memory loss (PTA)
  • How many were within 10 days of each other
  • How many resulted in: being taken off field, medical treatment at pitchside, further treatment (e.g. hospital).

NB these options are "special category personal data" for GDPR purposes, and you need to have a data management plan for these, and have mentioned them in the information sheet to make sure your participant is aware what you are taking, why, for how long, how you will handle it, whether and how they can remove their data, and who is responsible for the data. See University of Surrey Ethics for more details.

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Preferred Citation
Conducted at University of Surrey
Published on 24 March 2020