{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T06:57:44Z","timestamp":1781161064173,"version":"3.54.1"},"reference-count":92,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: Sport-related injuries are common, and often recurrent, among female college soccer players. This exploratory cohort study investigated whether perceptual decision efficiency and sleep quality could discriminate between injured and uninjured players. Methods: Twenty-seven NCAA Division I women\u2019s soccer players (19.5 \u00b1 1.3 years) completed a perceptual response training program, administered through an immersive virtual reality system, across a 13-week season. Players completed 11 training sessions progressing through four levels of task difficulty, with conjugate eye movements, neck rotation, and whole-body lunge-reach responses measured for each trial. Four metrics, elapsed time, rate correct per second, across-trials variability, and an efficiency index, were calculated for each of three defined time segments: perceptual decision, action initiation, and perceptual\u2013motor response. The Pittsburgh Sleep Quality Index (PSQI) and Global Well-Being Index (GWBI) were administered prior to the first practice session, and all subsequent time-loss injuries were documented. Receiver operating characteristic analyses, Kaplan\u2013Meier survival analysis, and classification tree modeling were used to evaluate injury discrimination. Results: Twelve time-loss injuries, including five concussions and seven lower extremity musculoskeletal injuries, were sustained by 10 of the 27 players. Optimal discrimination between injured and uninjured players was derived from the perceptual decision efficiency (PDE) metric for the most difficult perceptual response training task (AUC = 0.682\u20130.794), with a binary cut point of \u22646.02 yielding an odds ratio of 5.60 (95% CI: 1.02, 30.90; Mantel\u2013Cox log rank p = 0.025). All five concussions occurred in players classified as high-risk by a suboptimal PDE value. Pre-participation PSQI demonstrated an AUC of 0.735. Notably, no player with both an optimal PDE value and a favorable sleep quality score (PSQI &lt; 4) sustained a time-loss injury. Moderate-to-large training-related improvements in perceptual decision metrics were observed for the least challenging task from early- to late-season sessions. Conclusions: Optimal values for PDE and sleep quality together characterized female college soccer players who avoided injury. Both factors appear to be modifiable, suggesting that perceptual response training combined with interventions to enhance sleep quality may enhance injury resistance. Independent validation in larger, diverse athlete cohorts is warranted.<\/jats:p>","DOI":"10.3390\/brainsci16060624","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:50:58Z","timestamp":1781157058000},"page":"624","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perceptual Decision Efficiency and Optimal Sleep Quality Are Associated with Female College Soccer Injury Avoidance"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8433-7329","authenticated-orcid":false,"given":"Gary B.","family":"Wilkerson","sequence":"first","affiliation":[{"name":"Department of Health & Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN 37403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2880-1613","authenticated-orcid":false,"given":"Marisa A.","family":"Colston","sequence":"additional","affiliation":[{"name":"Department of Health & Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN 37403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison R.","family":"Ekas","sequence":"additional","affiliation":[{"name":"Graduate Athletic Training Education Program, University of Tennessee at Chattanooga, Chattanooga, TN 37403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MacKenzie L.","family":"Perkins","sequence":"additional","affiliation":[{"name":"Graduate Athletic Training Education Program, University of Tennessee at Chattanooga, Chattanooga, TN 37403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca L.","family":"Rinehart","sequence":"additional","affiliation":[{"name":"Graduate Athletic Training Education Program, University of Tennessee at Chattanooga, Chattanooga, TN 37403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7210-9879","authenticated-orcid":false,"given":"Lynette M.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Health & Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN 37403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1477-9428","authenticated-orcid":false,"given":"Jennifer A.","family":"Hogg","sequence":"additional","affiliation":[{"name":"Department of Health & Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN 37403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shellie N.","family":"Acocello","sequence":"additional","affiliation":[{"name":"Department of Health & Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN 37403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1007\/s12471-023-01839-3","article-title":"An ounce of prevention is worth a pound of cure","volume":"32","author":"Spee","year":"2024","journal-title":"Neth. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1136\/bjsports-2012-091651","article-title":"Injury patterns in Swedish elite athletics: Annual incidence, injury types and risk factors","volume":"47","author":"Jacobsson","year":"2013","journal-title":"Br. J. Sports Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1097\/JSM.0000000000000502","article-title":"Effects of recent concussion and injury history on instantaneous relative risk of lower extremity injury in Division I collegiate athletes","volume":"29","author":"Fino","year":"2017","journal-title":"Clin. J. Sport Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3256","DOI":"10.1177\/0363546519872502","article-title":"Multiple concussions increase odds and rate of lower extremity injury in National Collegiate Athletic Association athletes after return to play","volume":"47","author":"Harada","year":"2019","journal-title":"Am. J. Sports Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1177\/0363546518785901","article-title":"Musculoskeletal injury risk after sport-related concussion: A systematic review and meta-analysis","volume":"47","author":"McPherson","year":"2018","journal-title":"Am. J. Sports Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Oldham, J.R., Bowman, T.G., Walton, S.R., Beidler, E., Campbell, T.R., Smetana, R.M., Munce, T.A., Larson, M.J., Cullum, C.M., and Bushaw, M.A. (2024). Sport type and risk of subsequent injury in collegiate athletes following concussion: A LIMBIC MATARS Consortium investigation. Brain Inj., 1\u20139.","DOI":"10.1080\/02699052.2024.2310782"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"23259671251361489","DOI":"10.1177\/23259671251361489","article-title":"From head to toe: Investigating postconcussion risks for lower extremity injuries in young athletes","volume":"13","author":"Woodrow","year":"2025","journal-title":"Orthop. J. Sports Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1136\/bjsports-2013-092734","article-title":"Risk factors for sports concussion: An evidence-based systematic review","volume":"48","author":"Abrahams","year":"2014","journal-title":"Br. J. Sports Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1093\/arclin\/acy006","article-title":"Risk factors associated with sustaining a sport-related concussion: An initial synthesis study of 12,320 student-athletes","volume":"33","author":"Brett","year":"2018","journal-title":"Arch. Clin. Neuropsychol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1080\/02699052.2023.2203521","article-title":"Traumatic brain injury history and baseline symptoms outweigh sex differences for risk of concussion in a sample of collegiate athletes","volume":"37","author":"Race","year":"2023","journal-title":"Brain Inj."},{"key":"ref_11","first-page":"1","article-title":"A cohort study to identify and evaluate concussion risk factors across multiple injury settings: Findings from the CARE Consortium","volume":"6","author":"Allred","year":"2019","journal-title":"Inj. Epidemiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"651","DOI":"10.4085\/1062-6050-372-20","article-title":"Epidemiology of injuries in National Collegiate Athletic Association women\u2019s soccer: 2014\u20132015 through 2018\u20132019","volume":"56","author":"Chandran","year":"2021","journal-title":"J. Athl. Train."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1177\/03635465211060340","article-title":"Epidemiology of concussions in National Collegiate Athletic Association (NCAA) sports: 2014\/15-2018\/19","volume":"50","author":"Chandran","year":"2022","journal-title":"Am. J. Sports Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2654","DOI":"10.1177\/0363546515599634","article-title":"Epidemiology of sports-related concussion in NCAA athletes from 2009-2010 to 2013-2014: Incidence, recurrence, and mechanisms","volume":"43","author":"Zuckerman","year":"2015","journal-title":"Am. J. Sports Med."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kakavas, G., Malliaropoulos, N., Skarpas, G., and Forelli, F. (2025). The impact of concussions on neuromuscular control and anterior cruciate ligament injury risk in female soccer players: Mechanisms and prevention\u2014A narrative review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14093199"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Parr, J.V., Uiga, L., Marshall, B., and Wood, G. (2023). Soccer heading immediately alters brain function and brain-muscle communication. Front. Hum. Neurosci., 17.","DOI":"10.3389\/fnhum.2023.1145700"},{"key":"ref_17","first-page":"267","article-title":"Quantifying the magnitude and longevity of the effect of repetitive head impacts in adolescent soccer players: Deleterious effect of long headers extend beyond a month","volume":"4","author":"Shamloo","year":"2023","journal-title":"Neurotrauma Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.jshs.2020.11.005","article-title":"Impaired motor control after sport-related concussion could increase risk for musculoskeletal injury: Implications for clinical management and rehabilitation","volume":"10","author":"Chmielewski","year":"2021","journal-title":"J. Sport Health Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s00221-024-06981-x","article-title":"Long-term effects of concussion on attention, sensory gating and motor learning","volume":"243","author":"Dolman","year":"2025","journal-title":"Exp. Brain Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s40279-019-01144-3","article-title":"Increased risk of musculoskeletal injury following sport-related concussion: A perception\u2013action coupling approach","volume":"50","author":"Eagle","year":"2020","journal-title":"Sports Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s00221-024-06964-y","article-title":"Persistent adaptations in sensorimotor interneuron circuits in the motor cortex with a history of sport-related concussion","volume":"243","author":"Hayes","year":"2025","journal-title":"Exp. Brain Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1007\/s40279-018-0871-y","article-title":"Neuromuscular control deficits and the risk of subsequent injury after a concussion: A scoping review","volume":"48","author":"Howell","year":"2018","journal-title":"Sports Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"103219","DOI":"10.1016\/j.msksp.2024.103219","article-title":"The state of the science for potential contributors to musculoskeletal Injury following concussion: Mechanisms, gaps, and clinical considerations","volume":"75","author":"Lempke","year":"2025","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jsams.2021.07.002","article-title":"Neurocognitive function and musculoskeletal injury risk in sports: A systematic review","volume":"25","author":"Wilke","year":"2022","journal-title":"J. Sci. Med. Sport"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1007\/s40279-019-01116-7","article-title":"The effects of cognitive loading on motor behavior in injured individuals: A systematic review","volume":"49","author":"Burcal","year":"2019","journal-title":"Sports Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2331","DOI":"10.1177\/0363546511413375","article-title":"The influence of musculoskeletal injury on cognition: Implications for concussion research","volume":"39","author":"Hutchison","year":"2011","journal-title":"Am. J. Sports Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jsams.2017.06.016","article-title":"Less efficient oculomotor performance is associated with increased incidence of head impacts in high school ice hockey","volume":"21","author":"Kiefer","year":"2018","journal-title":"J. Sci. Med. Sport"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s40798-020-00283-6","article-title":"The effects of anticipation and visual and sensory performance on concussion risk in sport: A review","volume":"6","author":"Kung","year":"2020","journal-title":"Sports Med. Open"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Wilkerson, G.B., Colston, M.A., Acocello, S.N., Hogg, J.A., Carlson, L.M., Lunt, E.N., Palk, A.R., and Smith, H.N. (2025). Introspective ratings of biopsychosocial status are associated with sport-related injuries. J. Athl. Train., Epub ahead of print.","DOI":"10.4085\/1062-6050-0613.25"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1080\/02640414.2020.1851901","article-title":"The association between perceptual-cognitive processes and response time in decision making in young soccer players","volume":"39","author":"Cardoso","year":"2021","journal-title":"J. Sports Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1038\/s41583-018-0045-9","article-title":"Decision-making in sensorimotor control","volume":"19","author":"Gallivan","year":"2018","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"262","DOI":"10.4085\/1062-6050-0209.22","article-title":"Neurocognitive errors and noncontact anterior cruciate ligament injuries in professional male soccer players","volume":"59","author":"Gokeler","year":"2024","journal-title":"J. Athl. Train."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"zsae006","DOI":"10.1093\/sleep\/zsae006","article-title":"The effect of total sleep deprivation on working memory: Evidence from diffusion model","volume":"47","author":"Li","year":"2024","journal-title":"Sleep"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1037\/xhp0001180","article-title":"Sleep deprivation affects interference control: A diffusion model analysis","volume":"50","author":"Luo","year":"2024","journal-title":"J. Exp. Psychol. Hum. Percept. Perform."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"101077","DOI":"10.1016\/j.asmr.2025.101077","article-title":"Sleep quality and cognitive skills impact neurocognitive function and reduce sports-related injury risk","volume":"7","author":"Haskell","year":"2025","journal-title":"Arthrosc. Sports Med. Rehabil."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"11285","DOI":"10.1073\/pnas.1100483108","article-title":"Diffusion model for one-choice reaction-time tasks and the cognitive effects of sleep deprivation","volume":"108","author":"Ratcliff","year":"2011","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"305","DOI":"10.5935\/1984-0063.20220055","article-title":"The sleep as a predictor of musculoskeletal injuries in adolescent athletes","volume":"15","author":"Viegas","year":"2022","journal-title":"Sleep Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.1111\/sms.12855","article-title":"Multiple factors explain injury risk in adolescent elite athletes: Applying a biopsychosocial perspective","volume":"27","author":"Frohm","year":"2017","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.sleep.2019.03.008","article-title":"Insomnia and daytime sleepiness: Risk factors for sports-related concussion","volume":"58","author":"Raikes","year":"2019","journal-title":"Sleep Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"414","DOI":"10.4085\/1062-6050-0078.22","article-title":"Prospective implications of insufficient sleep for athletes","volume":"58","author":"Riegler","year":"2023","journal-title":"J. Athl. Train."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.smrv.2015.12.006","article-title":"Sleep and emotion regulation: An organizing, integrative review","volume":"31","author":"Palmer","year":"2017","journal-title":"Sleep Med. Rev."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"E284","DOI":"10.1097\/HTR.0000000000000663","article-title":"Research letter: Sleep mediates the association between prior concussion and depressive symptoms","volume":"36","author":"Brett","year":"2021","journal-title":"J. Head. Trauma Rehabil."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.sleh.2024.04.005","article-title":"The relationship between multiple concussions and multidimensional sleep quality in collegiate-aged, active athletes","volume":"10","author":"Hamill","year":"2024","journal-title":"Sleep Health"},{"key":"ref_44","unstructured":"Grandner, M.A. (2019). Sleep, stress, and immunity. Sleep and Health, Academic Press. [1st ed.]."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1038\/s42003-025-08448-3","article-title":"Infra-slow scale-free dynamics modulate the connection of neural and behavioral variability during attention","volume":"8","author":"Ao","year":"2025","journal-title":"Commun. Biol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"14883","DOI":"10.1038\/s41598-021-94161-0","article-title":"Variable rather than extreme slow reaction times distinguish brain states during sustained attention","volume":"11","author":"Yamashita","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_47","first-page":"597","article-title":"The effect of virtual and augmented reality training on soccer players: A systematic review of cognitive-motor performance","volume":"43","author":"Paludo","year":"2026","journal-title":"Biol. Sport"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1016\/j.jclinepi.2015.10.001","article-title":"Is the \u2018Evidence-Pyramid\u2019now dead?","volume":"68","author":"Tugwell","year":"2015","journal-title":"J. Clin. Epidemiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1186\/s40798-024-00788-4","article-title":"On leveraging machine learning in sport science in the hypothetico-deductive framework","volume":"10","author":"Rodu","year":"2024","journal-title":"Sports Med. Open"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1093\/occmed\/kqae121","article-title":"The Pittsburgh sleep quality index: A brief review","volume":"75","author":"Carpi","year":"2025","journal-title":"Occup. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.5664\/jcsm.6050","article-title":"Psychometric evaluation of the PSQI in US college students","volume":"12","author":"Dietch","year":"2016","journal-title":"J. Clin. Sleep Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"142","DOI":"10.5195\/jmla.2018.319","article-title":"Research electronic data capture (REDCap)","volume":"106","author":"Patridge","year":"2018","journal-title":"J. Med. Libr Assoc."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Wilkerson, G.B., Gullion, A.J., McMahan, K.L., Brooks, L.T., Colston, M.A., Carlson, L.M., Hogg, J.A., and Acocello, S.N. (2025). Perceptual decision efficiency Is modifiable and associated with decreased musculoskeletal injury risk among female college soccer players. Brain Sci., 15.","DOI":"10.3390\/brainsci15070721"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Wilkerson, G.B., Mether, K.S., Perrin, Z.A., Emberton, S.L., Carlson, L.M., Hogg, J.A., and Acocello, S.N. (2024). Perceptual response training for reduction of injury risk among high school girls\u2019 soccer players. Brain Sci., 14.","DOI":"10.3390\/brainsci14111091"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Wilkerson, G.B., Fleming, L.R., Adams, V.P., Petty, R.J., Carlson, L.M., Hogg, J.A., and Acocello, S.N. (2024). Assessment and training of perceptual-motor function: Performance of college wrestlers associated with history of concussion. Brain Sci., 14.","DOI":"10.3390\/brainsci14010068"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"863","DOI":"10.3389\/fpsyg.2013.00863","article-title":"Calculating and reporting effect sizes to facilitate cumulative science: A practical primer for t-tests and ANOVAs","volume":"4","author":"Lakens","year":"2013","journal-title":"Front Psychol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"5","DOI":"10.11613\/BM.2026.010101","article-title":"Effect sizes for nonparametric tests","volume":"36","year":"2026","journal-title":"Biochem Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1001\/jama.2017.12126","article-title":"Discrimination and calibration of clinical prediction models: Users\u2019 guides to the medical literature","volume":"318","author":"Alba","year":"2017","journal-title":"JAMA"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"6774","DOI":"10.1080\/03610926.2015.1134575","article-title":"Relative effect sizes for measures of risk","volume":"46","author":"Olivier","year":"2017","journal-title":"Commun. Stat. Theory Methods"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1038\/s42003-025-08212-7","article-title":"Neurogenetic phenotypes of learning-dependent plasticity for improved perceptual decisions","volume":"8","author":"Lee","year":"2025","journal-title":"Commun. Biol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1384713","DOI":"10.3389\/frbhe.2024.1384713","article-title":"Unraveling information processes of decision-making with eye-tracking data","volume":"3","author":"Ting","year":"2024","journal-title":"Front Behav. Econ."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"5644","DOI":"10.1038\/s41598-024-55508-5","article-title":"Decision-making processes in perceptual learning depend on effectors","volume":"14","author":"Ivanov","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12984-025-01844-0","article-title":"REAsmash-ET: A methodological framework for combined cognitive and motor assessment through eye-tracking and kinematic metrics in immersive VR search-and-reach task","volume":"23","author":"Sorrentino","year":"2025","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e568-72","DOI":"10.1097\/JSM.0000000000001042","article-title":"Incremental effects of subsequent concussions on cognitive symptoms in the sport concussion assessment tool","volume":"32","author":"Chen","year":"2022","journal-title":"Clin. J. Sport Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"761","DOI":"10.3389\/fnins.2020.00761","article-title":"Assessment of long-term effects of sports-related concussions: Biological mechanisms and exosomal biomarkers","volume":"14","author":"Ledreux","year":"2020","journal-title":"Front Neurosci."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"van Vugt, M.K., Simen, P., Nystrom, L., Holmes, P., and Cohen, J.D. (2014). Lateralized readiness potentials reveal properties of a neural mechanism for implementing a decision threshold. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0090943"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1038\/s42003-024-06732-2","article-title":"Antagonistic behavior of brain networks mediated by low-frequency oscillations: Electrophysiological dynamics during internal\u2013external attention switching","volume":"7","author":"Hammer","year":"2024","journal-title":"Commun. Biol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"5478","DOI":"10.1002\/hbm.26024","article-title":"Default mode network mediates low-frequency fluctuations in brain activity and behavior during sustained attention","volume":"43","author":"Zhang","year":"2022","journal-title":"Hum. Brain Mapp."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1038\/s41583-025-00916-3","article-title":"Disentangling sources of variability in decision-making","volume":"26","author":"Duffy","year":"2025","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1016\/j.neubiorev.2013.02.015","article-title":"Moment-to-moment brain signal variability: A next frontier in human brain mapping?","volume":"37","author":"Garrett","year":"2013","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"556","DOI":"10.3389\/fnhum.2017.00556","article-title":"Executive functions and performance variability measured by event-related potentials to understand the neural bases of perceptual decision-making","volume":"11","author":"Perri","year":"2017","journal-title":"Front Hum. Neurosci."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1016\/j.neuron.2021.01.023","article-title":"Behavior needs neural variability","volume":"109","author":"Waschke","year":"2021","journal-title":"Neuron"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"2907","DOI":"10.1038\/s41467-018-05319-w","article-title":"Saccade metrics reflect decision-making dynamics during urgent choices","volume":"9","author":"Seideman","year":"2018","journal-title":"Nat. Commun."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"572938","DOI":"10.3389\/fpsyt.2020.572938","article-title":"Assessing saccadic eye movements with head-mounted display virtual reality technology","volume":"11","author":"Imaoka","year":"2020","journal-title":"Front Psychiatr."},{"key":"ref_75","unstructured":"Klein, C., and Ettinger, U. (2019). Saccades: Fundamentals and neural mechanisms. Eye Movement Research: An Introduction to Its Scientific Foundations and Applications, Springer International Publishing."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.bandc.2008.08.016","article-title":"Neurophysiology and neuroanatomy of reflexive and volitional saccades: Evidence from studies of humans","volume":"68","author":"McDowell","year":"2008","journal-title":"Brain Cogn."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"167","DOI":"10.3758\/s13428-020-01388-2","article-title":"The saccade main sequence revised: A fast and repeatable tool for oculomotor analysis","volume":"53","author":"Gibaldi","year":"2021","journal-title":"Behav. Res. Methods"},{"key":"ref_78","unstructured":"England, J.D. (2025). Saccades. Encyclopedia of the Neurological Sciences, Academic Press. [3rd ed.]."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Aksum, K.M., Brotangen, L., Bj\u00f8rndal, C.T., Magnaguagno, L., and Jordet, G. (2021). Scanning activity of elite football players in 11 vs. 11 match play: An eye-tracking analysis on the duration and visual information of scanning. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0244118"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1167\/jov.22.8.7","article-title":"Visual search training benefits from the integrative effect of enhanced covert attention and optimized overt eye movements","volume":"22","author":"Zhang","year":"2022","journal-title":"J. Vis."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s40279-024-02141-x","article-title":"Limited evidence is NOT no evidence: A rebuttal to Fransen, 2024","volume":"55","author":"Appelbaum","year":"2025","journal-title":"Sports Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"2717","DOI":"10.1007\/s40279-024-02060-x","article-title":"There is no supporting evidence for a far transfer of general perceptual or cognitive training to sports performance","volume":"54","author":"Fransen","year":"2024","journal-title":"Sports Med."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1038\/npp.2016.148","article-title":"Sleep health: Reciprocal regulation of sleep and innate immunity","volume":"42","author":"Irwin","year":"2017","journal-title":"Neuropsychopharmacology"},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Lezama, E., and Trevi\u00f1o, M. (2025). Visuomotor processing in the superior colliculus. Acad. Neurosci. Brain Res., 1.","DOI":"10.20935\/AcadNeurosci8046"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"He, B.J., and Zempel, J.M. (2013). Average is optimal: An inverted-U relationship between trial-to-trial brain activity and behavioral performance. PLoS Comput Biol., 9.","DOI":"10.1371\/journal.pcbi.1003348"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1177\/21677026241233262","article-title":"Psychological mediators of reduced distress: Preregistered analyses from a randomized controlled trial of a smartphone-based well-being training","volume":"13","author":"Hirshberg","year":"2025","journal-title":"Clin. Psychol. Sci."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1093\/scan\/nsz050","article-title":"Mindfulness-based stress reduction-related changes in posterior cingulate resting brain connectivity","volume":"14","author":"Kral","year":"2019","journal-title":"Soc. Cogn. Affect Neurosci."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1001\/jama.2014.9440","article-title":"Multiple comparison procedures","volume":"312","author":"Cao","year":"2014","journal-title":"JAMA"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/00001648-199001000-00010","article-title":"No adjustments are needed for multiple comparisons","volume":"1","author":"Rothman","year":"1990","journal-title":"Epidemiology"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1136\/bmj.320.7247.1468","article-title":"The odds ratio","volume":"320","author":"Bland","year":"2000","journal-title":"BMJ"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"2484","DOI":"10.1177\/00315125231205322","article-title":"Test-retest reliability of immersive virtual reality measures of perceptual-motor performance","volume":"130","author":"Wilkerson","year":"2023","journal-title":"Percept. Mot. Ski."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.sleh.2018.02.005","article-title":"Poor sleep quality and insufficient sleep of a collegiate student-athlete population","volume":"4","author":"Mah","year":"2018","journal-title":"Sleep Health"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/6\/624\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T06:16:00Z","timestamp":1781158560000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/6\/624"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":92,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["brainsci16060624"],"URL":"https:\/\/doi.org\/10.3390\/brainsci16060624","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]}}}