Incentivization and cognitive performance in those who sustain mild traumatic brain injury: A series of case studies of aviation-rated army personnel

BACKGROUND: There is much research examining trajectories of cognitive recovery in those who sustain mild traumatic brain injury (mTBI). OBJECTIVE: Although the majority of research indicates a full recovery within months of a single, uncomplicated mTBI there remain few who report cognitive symptoms long after injury. Ample evidence indicates incentives to underperform on cognitive testing can negatively affect cognitive recovery, but there is little to no research on how incentives to perform well may affect recovery. This gap in research should be considered to obtain a full picture of cognitive recovery following mTBI. METHOD: Aeromedical Evaluations present a unique opportunity to study cognitive and functional recovery after mTBI. Three case studies are presented from the Aviation Community of recovery from mTBI. Each case presented is one who was monetarily incentivized to perform well on testing. RESULTS: All three cases passed established guidelines for performance validity testing. Each case recovered to estimated baseline performance, though one case needed additional time. There was some evidence of lowered processing speed on two of the three cases. CONCLUSIONS: Consistent with current literature on mTBI, recovery from injury is considered the rule as opposed to the exception. Though there are many studies examining how incentives to underperform hinder recovery, there is little research on how incentives to perform well may affect cognitive performance after mTBI. Such may be considered a gap in research and should be a focus of future work.