The recent spotlight on concussion has illuminated deficits in the current standard of care with regard to addressing acute and persistent cognitive signs and symptoms of mild brain injury. This stems, in part, from the diffuse nature of the injury, which tends not to produce focal cognitive or behavioral deficits that are easily identified or tracked. Indeed it has been shown that patients with enduring symptoms have difficulty describing their problems; therefore, there is an urgent need for a sensitive measure of brain activity that corresponds with higher order cognitive processing. The development of a neurophysiological metric that maps to clinical resolution would inform decisions about diagnosis and prognosis, including the need for clinical intervention to address cognitive deficits. The literature suggests the need for assessment of concussion under cognitively demanding tasks. Here, a joint behavioral- high-density electroencephalography (EEG) paradigm was employed. This allows for the examination of cortical activity patterns during speech comprehension at various levels of degradation in a sentence verification task, imposing the need for higher-order cognitive processes. Eight participants with concussion listened to true-false sentences produced with either moderately to highly intelligible noise-vocoders. Behavioral data were simultaneously collected. The analysis of cortical activation patterns included 1) the examination of event-related potentials, including latency and source localization, and 2) measures of frequency spectra and associated power. Individual performance patterns were assessed during acute injury and a return visit several months following injury. Results demonstrate a combination of task-related electrophysiology measures correspond to changes in task performance during the course of recovery. Further, a discriminant function analysis suggests EEG measures are more sensitive than behavioral measures in distinguishing between individuals with concussion and healthy controls at both injury and recovery, suggesting the robustness of neurophysiological measures during a cognitively demanding task to both injury and persisting pathophysiology.

Otoacoustic emissions (OAEs) are soft sounds generated by the inner ear and can be recorded within the ear canal. Since OAEs can reflect the functional status of the inner ear, OAE measurements have been widely used for hearing loss screening in the clinic. However, there are limitations in current clinical OAE measurements, such as the restricted frequency range, low efficiency and inaccurate calibration. In this dissertation project, a new method of OAE measurement which used a swept tone to evoke the stimulus frequency OAEs (SFOAEs) was developed to overcome the limitations of current methods. In addition, an in-situ calibration was applied to equalize the spectral level of the swept-tone stimulus at the tympanic membrane (TM). With this method, SFOAEs could be recorded with high resolution over a wide frequency range within one or two minutes. Two experiments were conducted to verify the accuracy of the in-situ calibration and to test the performance of the swept-tone SFOAEs. In experiment I, the calibration of the TM sound pressure was verified in both acoustic cavities and real ears by using a second probe microphone. In addition, the benefits of the in-situ calibration were investigated by measuring OAEs under different calibration conditions. Results showed that the TM pressure could be predicted correctly, and the in-situ calibration provided the most reliable results in OAE measurements. In experiment II, a three-interval paradigm with a tracking-filter technique was used to record the swept-tone SFOAEs in 20 normal-hearing subjects. The test-retest reliability of the swept-tone SFOAEs was examined using a repeated-measure design under various stimulus levels and durations. The accuracy of the swept-tone method was evaluated by comparisons with a standard method using discrete pure tones. Results showed that SFOAEs could be reliably and accurately measured with the swept-tone method. Comparing with the pure-tone approach, the swept-tone method showed significantly improved efficiency. The swept-tone SFOAEs with in-situ calibration may be an alternative of current clinical OAE measurements for more detailed evaluation of inner ear function and accurate diagnosis.