The use of the dual-task paradigm in detecting gait performance deficits following a sports-related concussion: A systematic review and meta-analysis
Lee SH., Sullivan SJ., Schneiders AG. Journal of Science and Medicine in Sport. 2013; 16: 2-7.
Forming a clinical decision about whether an athlete should be removed from play or when they can return to play following a sports-related concussion is accomplished following a comprehensive set of single-task tests (e.g., neurocognitive exam, sign and symptom checklist, balance tests). However, there is concern that single-task tests may not be able to detect subtle cognitive and physical impairments. Therefore, the purpose of this systematic review was to determine the practicality of the dual-task paradigm in the evaluation of a sports-related concussion. The authors used 8 electronic databases to identify research articles that evaluated gait performance with and without a secondary task among patients with and without a recent concussion. The authors analyzed 10 studies representing 168 concussed participants and 167 non-concussed participants. Seven out of the ten studies included a physical task that consisted of participants walking on a level surface at a comfortable pace while performing the Modified Mental Status Examination as a cognitive task. Researchers’ found that there were dual-task deficits compared to single-task activities in the concussed and non-concussed groups in several different gait variables (e.g., stride length, stride time). However, the authors detected that 2 days after a concussion patients walked slower and had greater side-to-side sway during dual-task activities compared to single-tasks activities while the non-concussed groups did not show these deficits.
This study supports the notion that dual-task activities may help differentiate patients with and without a concussion better than single-task activities. When 2 tasks are being completed simultaneously the brain’s processing ability may be more challenged than when performing a single task, which can manifest as performance deficits. It may be possible that a brain injury, such as a concussion, would exacerbate these performance deficits to an extent that would result in observable differences such as deficits in gait. Researchers suggest that dual-task changes in gait velocity and the degree of side-to-side sway during the gait can potentially detect patients suffering a sports-related concussion. However, other dual-task tests examining variables like stride length and stride time were not able to distinguish patients with and without concussions, and would not be suitable tests for a concussion evaluation. If we were to use this study to develop new clinical assessments it is important to keep in mind that they will need to be simple to perform and easy to measure. Walking tests are easy to administer, but measuring gait variables may be difficult and could vary between testers. Future research may be needed to determine if simple clinical assessments, like the 20-meter walk test, are sensitive enough to detect subtle changes in walking speed since more advance measurements may not be feasible. Another possibility may be performing a dual-task that includes a balance task and a cognitive task. Previous studies described on SMR indicated that dual-tasks with balance may be beneficial but the choice of optimal tasks may need more research. The researchers found that healthy athletes could maintain their balance but experienced cognitive deficits with dual tasks (Jacob et al, 2011), and in the other study the authors found that the BESS test was more reliable than the NeuroCom Sensory Organization Test (Ross et al., 2011). Research exploring dual-task tests may still be preliminary but may eventually help us better assess our patients. Do you include any dual-tasks tests as part of your concussion evaluation? Do you think that assessing gait while having the athlete focus on a cognitive test would be an appropriate test for a concussion?
Written by: Jane McDevitt, MS, ATC, CSCS
Reviewed: Jeffrey Driban
Related Posts:Lee H, Sullivan SJ, & Schneiders AG (2013). The use of the dual-task paradigm in detecting gait performance deficits following a sports-related concussion: A systematic review and meta-analysis. Journal of Science and Medicine in Sport, 16 (1), 2-7 PMID: 22609052