Duel for Concussion Testing?

Written By: David Burns

Dual tasking? Am I talking about a medieval sword fight? No that is “duel”. A dual task involves performing two things at once, from a clinical standpoint it means to engage or challenge a motor function (e.g. walking) at the same time as you perform a cognitive challenge (e.g. counting backwards by 7’s from 100). One would think that walking is automatic and that thinking would not impact it at all. Walking does take up some of your brain power and if the mental task is too heavy a load for your brain because of a concussion or other brain health reasons, than you might see changes like slowing down, going of course or angulation changes in limbs.

Have you ever walked beside someone who seemed to constantly bump into you while walking and talking, or they slow down every time they spoke? Well those are examples of failure of function while dual tasking. As suggested in the research below dual tasking helps “isolate specific mental processes” and should be part of any concussion evaluation and baseline screening. I’ve used these strategies for years for both brain baseline assessments and brain rehabilitation and if your concussion evaluation did not include this component than a potentially important “window” into your brain function was missed.

Now, let’s take it a step further to try and understand why I do some of the crazy brain training things I do. Last year I asked myself, “If I can help someone return to “normal” by employing dual tasking exercises can I help an athlete go from their “normal” to an improved level of function that entails faster thinking and better performance on the field?” The answer is YES I can. These are strategies that have been employed in military training and with professional players; it is not a completely novel idea. Now the tasks employed should ideally be relevant to you, that is, address your weaker areas of brain. Function is not from symptoms to no symptoms but rather a continuum that continues on past no signs or symptoms toward optimization of function. Simultaneously challenging brain and body builds a stronger, faster brain that may very well be more resilient to injury.


J Athl Train. 2011 Mar-Apr;46(2):170-5. doi: 10.4085/1062-6050-46.2.170.

Balance performance with a cognitive task: a continuation of the dual-task testing paradigm.

Resch JE, May B, Tomporowski PD, Ferrara MS.

St. Mary’s Athletic Training Research and Education Laboratory, Athens, GA, USA. resch@uta.edu



To ensure that concussed athletes return to play safely, we need better methods of measuring concussion severity and monitoring concussion resolution.


To develop a dual-task model that assesses postural stability and cognitive processing in concussed athletes.


Repeated measures study.


University laboratory.


Twenty healthy, college-aged students (10 men, 10 women; age  =  20 ± 1.86 years, height  =  173 ± 4.10 cm, mass  =  71.83 + 35.77 kg).


Participants were tested individually in 2 sessions separated by 2 days. In one session, a balance task and a cognitive task were performed separately. In the other session, the balance and cognitive tasks were performed concurrently. The balance task consisted of 6 conditions of the Sensory Organization Test performed on the NeuroCom Smart Balance Master. The cognitive task consisted of an auditory switch task (3 trials per condition, 60 seconds per trial).


For the balance test, scores for each Sensory Organization Test condition; the visual, vestibular, somatosensory, and visual-conflict subscores; and the composite balance score were calculated. For the cognitive task, response time and accuracy were measured.


Balance improved during 2 dual-task conditions: fixed support and fixed visual reference (t18  =  -2.34, P < .05) and fixed support and sway visual reference (t18  =  -2.72, P  = .014). participants’ response times were longer (F1,18  =  67.77, P < .001, η2  =  0.79) and choice errors were more numerous under dual-task conditions than under single-task conditions (F1,18  =  5.58, P  =  .03, η2  =  0.24). However, differences were observed only during category-switch trials.


Balance was either maintained or improved under dual-task conditions. Thus, postural control took priority over cognitive processing when the tasks were performed concurrently. Furthermore, dual-task conditions can isolate specific mental processes that may be useful for evaluating concussed individuals.

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