A Clinically Feasible Dual-task Assessment For Concussion Evaluation

Field: Health Professions (Health Sciences)

Context: Dual-task testing (DT) using laboratory equipment has shown to detect post-concussion deficits even after traditional assessment measures returned to normal. However, little evidence supports the efficacy of clinically feasible DT as a concussion assessment tool. Objective: The purpose of this study was to compare the outcomes of clinically feasible DT between concussed and control participants. Modified Balance Error Scoring System single leg stance (mBESS SLS), mBESS tandem stance (TAN), tandem gait (TG), and Expanded Timed Get Up and Go (ETGUG) were the motor tasks and Auditory Pure Switch Task (APST) was the cognitive task. The concussed group completed data collections 7-10 days post-concussion (Time1) and after return to play (Time2). Control group completed two data collections within the same interval. Design: Mixed design. Setting: Local high school athletic training rooms and/or university laboratories. Patients or Other Participants: Concussed athletes were recruited from local high schools and a university after physician diagnosis. Matched control participants were recruited from the same institutions based on the criteria. Main Outcome Measure(s): Two ATs rated mBESS errors separately, and a mean score of the two was utilized. The TG and ETGUG was completion time (sec) and mean of the two trials for each task was utilized for analysis. Response Rate (RR) of APST was recorded as a cognitive task outcome. A mixed-model ANOVA was used with alpha level of p<0.05. Result: Nine concussed athletes and nine matched controls participated in the study. For mBESS SLS, there was no significant difference between groups under ST and DT condition at Time1 (ST: concussed 2.72±2.39 and control 2.72±2.39 , DT: concussed 2.28±3.28 and control 2.28±3.28, p=1.00) and or Time2 (ST: concussed 2.08±2.44 and control 2.08±2.44, DT: concussed 2.44±2.24 and control 2.44±2.24, p=1.00). Concussed athletes made significantly more errors during ST TAN and DT TAN than control group at both time points. Concussed group walked significantly slower than control during DT TG and ETGUG at Time1 and Time2; however, no difference was indicated with ST at both timepoints. There was a significant main effect for time, indicating learning effect for DT tandem gait for both groups; however, no learning effect was indicated for DT ETGUG. For cognitive task, no group difference was observed for all testing conditions. Conclusion: Clinically feasible DT outcomes using TG and ETGUG were significantly different between concussed and control groups at subacute phase and after return to play. In contrast, mBESS SLS and TAN performances were similar at both times in both groups. Concussed athletes took approximately 5 seconds longer to complete both tandem gait DT and ETGUG DT compared to control even after return to play. This indicated that athletes in our study returned to play before post-concussion deficits resolved. Clinically feasible DT should be considered as part of the concussion evaluation battery in addition to traditional concussion assessment. Word Count: 448 Key Words: dual-task, concussion, concussion assessment, ETGUG, tandem gait, mBESS