Cambridge Brain Sciences (CBS) is another emerging computerized cognitive assessment tool. It was first developed in 2009 by neuroscientist Dr. Adrian Owen to gain a better understanding of the brain and how it functions, specifically with relation to the effects of neurodegenerative diseases and the optimization of brain health. CBS consists of 12 tasks that evaluate aspects of memory, reasoning, attention and verbal ability, created over the span of 25 years. The tasks are variations of digital game-like problems, that are based off of pen and paper cognitive psychology paradigms. Each task lasts around 1.5-3 minutes and can be added or eliminated to create customized series that is best suited for the target population. CBS has created a task selection guide that lists academic publications and characteristic/historical uses of tasks for different disorders, including concussions.
After testing is complete, results are shown on a health report, composed of an overall summary followed by a breakdown of individual task results. For each task, a raw score is given, along with a percentile (represented as a range on a bell curve and as a numerical value of that midpoint range) and score classifications. The raw score is examined against a group of individuals in the same gender and age group. It is then scaled so that the distribution of scores represents a mean of 100 and a standard deviation of 15. The score classifications are as follows: below average, average and above average, depending on the score percentage difference between the population and the individual. In order for task scores to be recognized, they must meet set parameters. Likewise, fixed conditions need to be met for meaningful change to be identified between two time points.
Owen’s research leading up to the development of CBS, included functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), in which he studied performance on varying tasks with healthy populations and disordered or injured populations. In relation to brain region association, he found that each task did not activate one specific region, but rather a series of networks. The difference was in the degrees to which each network was activated for that specific task. He was able to calculate this degree using factor loading to find the most dominant regions relating to each task. A breakdown of this dominant regions for each task can be found under the Resources tab on their website.
There are two CBS products: CBS Health, designed for healthcare practitioners and CBS research, designed for large-scale academic and commercial studies. With reference to CBS Health, it can be used for both mental health and physical health. Its main aims are validating patient symptoms, supporting diagnoses, recognizing areas of need, long-term intervention tracking and reducing assessment time/manual effort. CBS can also be customized to include subjective data like the General Anxiety Disorder-7 (GAD-7) and Rivermead Post Concussion Symptoms Questionnaire.
CBS has been used in over 300 peer-reviewed studies, does not require supervision and can be completed virtually anywhere. Additionally, it is very customizable, offers numerous resources for both patient, researcher and practitioner, and combines multiple testing measures, which is crucial when referring to concussion testing. However, it is important to be wary of conditions/distractions when taking the test, as well as attributing results solely to brain health and disregarding other factors such as stress, diet, sleep, etc. Another concern is test results improving with familiarization of the tasks. CBS states that there will be an improvement in scores at the beginning, as a result of familiarization with rules and conditions of the tasks. As well, individuals may learn different techniques and/or strategies to best complete the tasks but memorization of specific puzzles will provide no aid as they are randomly generated. Once the tests are fully learnt, these sources of improvement are said to level off. Therefore it is important to be aware of this as a practitioner or researcher. Participants or clients should become accustomed with the tasks before testing in order to produce more accurate results. One way this can be done is by adjusting the testing to include more practice rounds.
Overall, this is another quantifiable testing measure with promise, but as always should be used in conjunction with several other testing measures when assessing concussions.
References
Cambridge Brain Sciences. (n.d.). Online Cognitive Assessment Platform: Cambridge Brain Sciences. https://www.cambridgebrainsciences.com/