Author(s): BÜCHEL, D., BLASCHKE, S., KRAMPE, L., PROCKL, V., KLATT, S. & WOLLESEN, B., Institution: GERMAN SPORTS UNIVERSITY COLOGNE, Country: GERMANY, Abstract-ID: 717

INTRODUCTION:
While the majority of patients suffering from concussive symptoms recover within 14 days, around 30 % of cases experience persistent impairments (i.e., post-concussion syndrome PPCS; [1]). In this population, symptoms such as ocular, vestibular and cognitive dysfunctions, fatigue, headache and anxiety [2] persist over weeks to months. Since these symptoms interfere with movement, athletes are often unable to sustain training and competition. While the isolated assessment of motor function does not capture the complex interactions between symptoms and athletic performance, dual-task (DT) paradigms are a promising approach to monitor cognitive-motor interferences (CMIs) in PPCS. This study aimed to review and map the current evidence on DT testing in the subgroup of PPCS with specific regard to the interaction of motor tasks, cognitive tasks, and affected PPCS domains.
METHODS:
This review adheres to the PRISMA-ScR guidelines [3]. Following the PEO framework, we searched three databases (MEDLINE, CINAHL and EMBASE) for original articles focusing on i) adult concussion patients with persistent symptoms > 14 days after injury, ii) assessing cognitive-motor dual-tasks and iii) quantifying CMI using motor and cognitive outcome measures. Of > 3000 identified records, eight articles met inclusion criteria. Alongside data extraction on patient characteristics, DT specifics, and main findings, a conceptual mapping linked PPCS domains with the identified cognitive and motor subtasks.
RESULTS:
All identified studies assessed 197 patients with PPCS (131 females; 37.3 ±12.9 years). Seven studies reported increased CMI in patients compared to healthy controls. Regarding motor tasks, six studies utilized gait, while two studies measured static balance tasks. Regarding cognitive tasks, six studies utilized arithmetic or word recall tasks to induce working memory, while four studies applied visual and auditory stroop tasks to induce inhibition. Conceptual mapping revealed strong connections between gait metrics, generic symptoms, and stroop tasks. Key PPCS domains such as fatigue, ocular dysfunction, and headache were not reflected by current dual-task paradigms.
CONCLUSION:
DT paradigms appear sensitive to persistent cognitive-motor deficits in PPCS and may serve as functional markers of recovery. While gait is the most prominent motor task applied, the use of cognitive tasks is underexplored and excludes cognitive flexibility and response times yet. Based on the extracted concept map of the current evidence, we developed a framework for DT assessments in PPCS in future studies.
[1] Voormolen et al. (2019). The association between post-concussion symptoms and health-related quality of life in patients with mild traumatic brain injury. Injury
[2] Harmon et al. (2019). American Medical Society for Sports Medicine position statement on concussion in sport. BJSM
[3] Tricco et al. (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals Int Med