Becky Bliss breaks down the BJSM Article – Concussed Athletes Walk Slower than Non-Concussed Athletes During Cognitive-Motor-Dual Task Assessments but not During Single-Task Assessments 2 months after Sports Concussion: A systematic review and Meta-Analysis using Individual Participant Data

Released in January 2020 from Butter, F., Howell, D., et al.

Article Link:

The What

Current concussion assessment tools may not be difficult enough to identify residual neuromotor control deficits in athletes that have sustained a concussion.  Recent evidence has shown that concussed athletes have a 2-3x greater risk of subsequent lower extremity musculoskeletal injury.  This poses to question current return to sport decision making tools and injury mitigation strategies for concussed athletes.  In this systematic review, meta-analysis, slower walking speeds and greater frontal plane CoM displacement was found during dual task activities to include cognitive motor challenges as compared to single task activities up to 2 months following injury.  Gait impairments persist beyond reported clinical recovery timelines and current assessment methods may not be sensitive enough to identify residual deficits prior to return to play.   Dual task assessments (with motion capture) may be a useful clinical assessment method to evaluate higher level motor control following concussion injury.

The Who

Studies that included individuals with sports concussion And non-injured controls

The How

Systematic review looking at inclusion criteria that included concussed and control participants with steady-state walking or static balance task as the primary motor task, and dual-task performance was assessed with the addition of a second cognitive task.

So What?

Dual task motor-cognitive assessment showed residual neuromotor deficits in concussed athletes as compared to matched controls, as single task was not a discriminating condition.  This indicates that current assessment tools may not be sensitive enough to identify residual neuromotor control impairments.

What does it mean?

This confirms that higher level neuromotor control, specifically dual motor-cognitive tasks, may help identify residual deficits following concussion up to 2 months post injury.  This is a potential postulated theory of why these individuals are at risk for subsequent LE MSK injury.

Now What?

Clinicians should be employing dual task, higher level cognitive motor assessments in athletes following concussion and prior to return to play.

What Went Wrong?

Continued investigation of what is the “best” assessment tool is unknown.


Athletes need to be able to cognitively make decisions, react and perform during game play.  Assessment tools that can mirror skills needed for sport may help identify higher level neuromotor control deficits that are currently undetected with static, single task measures and mitigate the risk of subsequent LE MSK injury risk.