Utility Of An Incongruent Visual, Cognitive-balance Dual Task To Assess Impairment In Athletes With Concussion

Abstract

Previous research indicates that dual task paradigms- which negate the effectiveness of compensatory strategies- may augment current single task (e.g., balance only, cognitive only) assessments of athletes with SRC. However, most dual task paradigms employ auditory cognitive stimuli that may not sufficiently disrupt compensatory strategies. PURPOSE: To compare athletes with SRC to matched healthy controls on a novel, visual-based, cognitive-balance dual task paradigm and commonly used symptom reports and assessments of balance, cognitive, vestibular, and oculomotor impairment. METHODS: A prospective, case control design was used to compare 21 athletes with SRC (8-F, aged 15.2 ± 1.8 years) to 11 healthy age/sex-matched controls (4-F, aged 15.2 ± 2.7 years). Participants completed a visual, cognitive-balance dual task- involving incongruent stimuli/response patterns- and Balance Error Scoring System (BESS) with force plate data; Immediate Post-concussion Assessment and Cognitive Test (ImPACT); Post-concussion Symptom Scale (PCSS); and Vestibular and Ocular Motor Screening (VOMS) tool with near-point convergence (NPC) distance. Athletes with SRC were tested at 1-10 and 11-21 days post-injury. Controls were tested once. Independent samples t-tests were used to examine differences between groups, and dependent samples t-tests were used to examine change from 1-10 to 11-21 days post-injury. Statistical significance was set at a p < .05 (Bonferroni-corrected). RESULTS: Results revealed worse scores in concussed athletes for the incongruent component of the dual task (p= .03), PCSS (p=.001), visual memory (p=.05), reaction time (p= .05), VOMS (p= .001), and NPC (p= .02). Balance performance on BESS and during the dual task was consistent between groups. Results supported slower performance (57.3 to 44.9 ms) from 1-10 to 11-21 days on the incongruent component of the dual task (p= .01), in spite of improvements (p<.05) on PCSS, ImPACT, and VOMS. CONCLUSIONS: An incongruent visual, cognitive dual-task detected persistent deficits at 11-21 days post injury when other measures demonstrated improvements. Visual-based dual task paradigms involving incongruent stimuli-responses patterns may negate compensatory strategies and help clinicians to identify athletes with SRC and monitor recovery from SRC.