Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Health Sciences


Rehabilitation Sciences

First Advisor

Dr. Matthew C. Hoch

Second Advisor

Dr. Nathan Johnson


In collegiate athletes, approximately one in four injuries require more than seven days before the athlete can return to full participation. Additionally, there are significant long-term consequences associated with these injuries, such as pain and osteoarthritis. Despite the role that the sensorimotor system and cognitive function play in athletic competition, the interaction between these systems in relation to sport-related injury is commonly overlooked. The sensorimotor system integrates and processes sensory, motor, and central mechanisms to produce a motor response. Further, cognition constructs, such as visual attention or processing speed, allow athletes to navigate the chaotic sporting environment. When there are deficits in these systems, there is the potential risk of musculoskeletal injury. There is a continuous process of taking in sensory information from the environment, processing that information, developing a plan of action, and following through on that action. The interplay between sensorimotor function, cognition, and motor execution highlights the need for assessment and training strategies to integrate each component. When a cognitive load with perceptual challenges is added to a neuromuscular task (i.e., hopping or postural stability), there is often a decline in performance. This indicates that the visual processing and cognitive load may take away from the ability to perform physically. Assessments that integrate cognitive challenges with neuromuscular movements (i.e., neuromuscular-cognitive assessments) may provide an ecologically valid approach to identifying those at an increased risk of injury and informing return to play readiness. To ensure safe and successful participation in athletic competitions, it is crucial to train in a way that prepares athletes to handle the inherent challenges of the sport. This includes navigating high-paced and rapidly changing environments with numerous distractions. To address these challenges, interventions that integrate neuromuscular training with visual processing, perceptual challenges, and cognitive load may be effective. Therefore, the primary purpose of this dissertation was to elucidate the impact of sensory processing and cognitive load on neuromuscular assessments and training programs. To achieve this purpose, three aims were investigated. The first aim sought to investigate the relationship between performance on tablet-based cognitive assessments and choice reaction time during a hopping task in healthy participants. The second aim sought to examine the effect of a six-week neuromuscular-cognitive training program on postural stability, hop performance, and agility with and without perceptual-cognitive challenge in a high-level athletic team. The final aim sought to assess the acute effects of a 30-minute neuromuscular-cognitive training session on brain activation and behavioral performance during a task-based functional MRI in healthy, physically active adult females. The dissertation findings will provide evidence for improving clinical approaches to assessment and training. Furthermore, it will aid in future research to determine the effectiveness of neuromuscular-cognitive training programs in reducing injury risk.

Digital Object Identifier (DOI)

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