Student-Athletes’ Perceptions of the Serial 7s Dual-Task Concussion Testing Paradigm

Context: Serial 7s is a common cognitive test that is implemented as part of the movement assessment in the 6th Sport Concussion Assessment Tool (SCAT6) and the 6th Sport Concussion Office Assessment Tool (SCOAT6). While the Serial 7s test has proven to be a useful dual-task concussion testing paradigm, increases in math anxiety may limit its ecological validity with current student-athletes. Objective: To assess student-athletes' perceptions of the Serial 7s dual-task concussion testing paradigm as outlined in the SCAT6. Setting: University laboratory setting. Design: Qualitative study. Patients or Other Participants: Fourteen participants, 7 females and 7 males, who had an average age of 20.79 ± 1.05 years. Data Collection and Analysis: Participants completed the Timed Tandem Gait test and Dual Task Gait test as outlined in the SCAT6. Participants then completed a semistructured interview consisting of 4 questions. To establish the credibility of the qualitative data, member checking and data triangulation were used. Each interview was recorded and transcribed. The Colaizzi phenomenological approach was implemented to triangulate the findings. Results: Five dominant themes emerged: (1) student-athletes displayed cognitive load and multitasking difficulties with Serial 7s; (2) student-athletes displayed math anxiety and varying confidence in mental math; (3) student-athletes displayed emotional and psychological reactions to Serial 7s; (4) prior experience and training affected student-athletes' perceptions of Serial 7s; and (5) student-athletes displayed task-specific challenges and strategies to Serial 7s. Conclusions: The Serial 7s dual task proved to be a mentally demanding exercise that elicited a range of positive and negative cognitive, emotional, and behavioral responses. Clinicians should be aware of various factors that may affect patients' ability to complete the task successfully. Future studies are needed to examine how math anxiety and task confidence change during recovery, which may provide methods to develop individualized recovery protocols.