Assessing Concussion with Dual-Tasks

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An Under-Recognised Problem

Mild traumatic brain injury (mTBI) is a prevalent yet understudied health concern in children and youth. As we covered in a recent blog, child concussions can be especially problematic for a few reasons.  Firstly, they are surprisingly common – around 1 in 5 teens in the US reported having been diagnosed with one or more concussions.  Secondly, young brains are developing very quickly making them more vulnerable.  For example, one study showed that playing tackle football before the age of 12 led to behavioral and cognitive problems later in life.  Lastly, teens playing sports can have greater problems in recovery.  Due to these factors youth concussions represents a major problem, with the associated medical costs of mTBIs in the US estimated at $20.7 billion per year.

‘Either-Or’ Assessments

Concussions often cause dysfunction in both motor (movement skills) and cognitive functions.  However, most research or medical assessments either focus on neuropsychological tests to assess cognition, or on physical tasks to assess motor-function (such as balance). However, when it comes to real-world demands, cognitive and motor performance go hand-in-hand.  This is particularly important in sports, where cognitive demands are usually high.  For example, a 2017 study showed that combining physical and cognitive tasks could even reveal injury risks for athletes.  It makes sense then, that to properly assess post-concussion recovery, both motor-skills and cognitive functions should be assessed together.

Founding a New Assessment

In a large collaboration, 7 multi-disciplinary researchers got together to tackle this challenge. The group included scientists from the Bloorview Research Institute, the Rehabilitation Sciences Institute & the Department of Occupational Science and Occupational Therapy (University of Toronto), the Department of Human Kinetics & the Research Group on Neuromusculoskeletal Dysfunctions (Université du Québec).

After determining that combined motor and cognitive tests were important for assessing child concussion recovery, they set out to establish the functional impacts of dual-task performance.  The goal was to establish a normative dataset to be useful for clinical management of post-concussed children.

Dual-Task Loads

To achieve this the researchers assessed 106 healthy children and youth (5-18 years old), on both single-task and dual-task performance. Single-task tests involved a balance exercise with varying degrees of difficulty (motor), and NeuroTracker (cognitive).  The dual-task test involved performing them both at the same time.  The participants focused on maintaining their NeuroTracker levels so the researchers could discover the impact of cognitive load on motor-skill function.

What Was Found

The added load of NeuroTracker significantly reduced postural stability, and this had increasing effects for more difficult balance conditions.  The researchers noted that because NeuroTracker performance remained consistent with and without motor-tasks, that this demonstrated the ability for a dual-task methodology to isolate specific processes. The findings were published in the journal Gait & Posture, with the conclusion that “This study provides a normative dataset to be used during clinical management to identify functional deficits following concussion and acts as a starting point to explore dual-task protocols in children and youth following concussion.”

Timing of Return-to-Play

This new type of assessment could be particularly useful in the later stages of post-concussion recovery.  In competitive sports, a major challenge for concussion specialists is determining Return-to-Play (RTP) readiness.  This is because the main symptoms of mTBI can appear to have cleared, yet the rigorous demands of training and competing can reveal lingering effects which impair performance.  In worst case scenarios, this can lead to repeat concussions, due to the athletes’ situational awareness and response times remaining impaired.

This type of advanced motor-cognitive assessment holds promise for revealing such lingering effects, which may be missed by traditional single-tasks assessments.  Usefully, motor-tasks paired with NeuroTracker can be highly specific to each athlete’s performance demands. This is a key reason why many concussion specialists using NeuroTracker already implement their own dual-task concussion protocols.

This study provides an initial foundation for standardizing this approach with normalized data, which could lead to post-concussion assessments that would be useful even without a pre-existing baseline.


Using a dual-task protocol to investigate motor and cognitive performance in healthy children and youth


If you’re interested in learning more about dual-tasks or concussions, check out some of our other blogs!

How the Brain and Body are Connected in Sports Performance

Can Cognitive Training Limit Sports Injury Risk?

Top 5 Challenging Exercises To Do With NeuroTracker

Mastering the Complexity of Soccer with NeuroTracker

Evolving the Treatment of Concussions (Expert Corner)

NeuroTracker: A Technology Worth Shouting About! (Expert Corner)

7 Ways to Get A Concussion

3 Surprising Effects of Concussions

Child sports concussions – what are the risks?

How to Heal from a Concussion

What’s the Best Way to Recover from a Concussion?

How Concussions Increase Risk of ACL Injury


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The NeuroTracker Team