Clinical Utility of the Dual-Task Assessment of Sport Concussion in Collegiate Athletes

The evaluation and management of sport-related concussion (SRC) relies upon the serial administration of clinical measures to identify cognitive and motor deficits and the presence of concussion-related symptoms. Therefore, clinical measures of SRC must be demonstrated to have acceptable measurement and diagnostic properties. The clinical responsiveness of these measures should be evaluated prior to their implementation into clinical practice. Commonly-used assessment tools (e.g. Standardized Assessment of Concussion [SAC], balance error scoring system [BESS], tandem gait [TG] test) have been reported to have highly variable measurement and diagnostic properties and limited evidence of clinical responsiveness. The independent administration of current clinical measures of SRC limits their generalizability to the demands of sport as athletes typically perform cognitive and motor tasks simultaneously during practice and competition.

A viable solution to the aforementioned limitations is the concurrent administration of cognitive and motor tasks, which is known as a dual-task assessment. A novel approach to dual-task assessment consists of the concurrent administration of the SAC and TG test. The diagnostic properties and the clinical responsiveness of this dual-task assessment and gait metrics recorded during its administration in a clinical sample (e.g. following a diagnosed SRC) have not been previously evaluated.

In the following studies, we determined the most appropriate method for clinical interpretation of the dual-task assessment by evaluating various cutoff scores in a sample of concussed and non-concussed collegiate athletes. We then evaluated and compared the diagnostic properties and clinical responsiveness of the dual-task assessment, SAC, TG test, and the BESS throughout clinical recovery from a SRC. We also evaluated spatiotemporal and plantar pressure gait metrics of the concussed and non-concussed collegiate athletes while completing the dual-task assessment using an instrumented walkway.

Our results demonstrated that the dual-task assessment and TG test were effective at ruling out and ruling in the diagnosis of a SRC in collegiate athletes within the two days of injury, respectively. The TG test had the best clinical responsiveness and diagnostic properties of the administered clinical measures of SRC which further supports its clinical utility. Concussed athletes also had significantly slower cadence and gait velocity while completing the dual-task assessment than the non-concussed athletes throughout clinical recovery. Overall, our results demonstrate and support the clinical utility of the dual-task assessment and TG test in the evaluation of collegiate athletes following SRC.