The use of the
dual-task paradigm in detecting gait performance deficits following a
sports-related concussion: A systematic review and meta-analysis

SH., Sullivan SJ., Schneiders AG. Journal of Science and Medicine in Sport.
2013; 16: 2-7.

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.

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

by: Jane McDevitt, MS, ATC, CSCS
Jeffrey Driban


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