Skip to main content
SpringerLink
Log in

Are Divided Attention Tasks Useful in the Assessment and Management of Sport-Related Concussion?

  • Review
  • Published:
Neuropsychology Review Aims and scope Submit manuscript

Abstract

This article is a systematic review of the literature on divided attention assessment inclusive of a cognitive and motor task (balance or gait) for use in concussion management. The systematic review drew from published papers listed in PubMed, MEDLINE, EMBASE and CINAHL databases. The search identified 19 empirical research papers meeting the inclusion criteria. Study results were considered for the psychometric properties of the paradigms, the influence of divided attention on measures of cognition and postural control and the comparison of divided attention task outcomes between individuals with concussion and healthy controls (all samples were age 17 years or older). The review highlights that the reliability of the tasks under a divided attention paradigm presented ranges from low to high (ICC: 0.1–0.9); however, only 3/19 articles included psychometric information. Response times are greater, gait strategies are less efficient, and postural control deficits are greater in concussed participants compared with healthy controls both immediately and for some period following concussive injury, specifically under divided attention conditions. Dual task assessments in some cases were more reliable than single task assessments and may be better able to detect lingering effects following concussion. Few of the studies have been replicated and applied across various age groups. A key limitation of these studies is that many include laboratory and time-intensive measures. Future research is needed to refine a time and cost efficient divided attention assessment paradigm, and more work is needed in younger (pre-teens) populations where the application may be of greatest utility.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Bell, D. R., Guskiewicz, K. M., Clark, M. A., & Padua, D. A. (2011). Systematic review of the balance error scoring system. Sports Health, 3(3), 287–295.

    Article  PubMed  PubMed Central  Google Scholar 

  • Broglio, S. P., Tomporowski, P. D., & Ferrara, M. S. (2005). Balance performance with a cognitive task: a dual-task testing paradigm. Medicine and Science in Sports and Exercise, 37(4), 689–695.

    Article  PubMed  Google Scholar 

  • Broglio, S. P., Macciocchi, S. N., & Ferrara, M. S. (2007). Sensitivity of the concussion assessment battery. Neurosurgery, 60(6), 1050–1057. discussion 1057–1058.

    Article  PubMed  Google Scholar 

  • Broglio, S. P., Ferrara, M. S., Sopiarz, K., & Kelly, M. S. (2008). Reliable change of the sensory organization test. Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine, 18(2), 148–154.

    Article  Google Scholar 

  • Catena, R. D., van Donkelaar, P., & Chou, L. S. (2007a). Altered balance control following concussion is better detected with an attention test during gait. Gait & Posture, 25(3), 406–411.

    Article  Google Scholar 

  • Catena, R. D., van Donkelaar, P., & Chou, L. S. (2007b). Cognitive task effects on gait stability following concussion. Experimental Brain Research. Experimentelle Hirnforschung. Experimentation Cerebrale, 176(1), 23–31.

    Article  PubMed  Google Scholar 

  • Catena, R. D., van Donkelaar, P., & Chou, L. S. (2009a). Different gait tasks distinguish immediate vs. long-term effects of concussion on balance control. Journal of Neuroengineering and Rehabilitation, 6, 25.

    Article  PubMed  PubMed Central  Google Scholar 

  • Catena, R. D., van Donkelaar, P., Halterman, C. I., & Chou, L. S. (2009b). Spatial orientation of attention and obstacle avoidance following concussion. Experimental Brain Research. Experimentelle Hirnforschung. Experimentation Cerebrale, 194(1), 67–77.

    Article  PubMed  Google Scholar 

  • Catena, R. D., van Donkelaar, P., & Chou, L. S. (2011). The effects of attention capacity on dynamic balance control following concussion. Journal of Neuroengineering and Rehabilitation, 8, 8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cavanaugh, J. T., Guskiewicz, K. M., & Stergiou, N. (2005). A nonlinear dynamic approach for evaluating postural control: new directions for the management of sport-related cerebral concussion. Sports Medicine, 35(11), 935–950.

    Article  PubMed  Google Scholar 

  • Cavanaugh, J. T., Mercer, V. S., & Stergiou, N. (2007). Approximate entropy detects the effect of a secondary cognitive task on postural control in healthy young adults: a methodological report. Journal of Neuroengineering and Rehabilitation, 4, 42.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chiu, S. L., Osternig, L., & Chou, L. S. (2013). Concussion induces gait inter-joint coordination variability under conditions of divided attention and obstacle crossing. Gait & Posture, 38(4), 717–722.

    Article  Google Scholar 

  • Dickin, D. C., & Clark, S. (2007). Generalizability of the sensory organization test in college-aged males: obtaining a reliable performance measure. Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine, 17(2), 109–115.

    Article  Google Scholar 

  • Fait, P., Swaine, B., Cantin, J. F., Leblond, J., & McFadyen, B. J. (2013). Altered integrated locomotor and cognitive function in elite athletes 30 days postconcussion: a preliminary study. The Journal of Head Trauma Rehabilitation, 28(4), 293–301.

    Article  PubMed  Google Scholar 

  • Finnoff, J. T., Peterson, V. J., Hollman, J. H., & Smith, J. (2009). Intrarater and interrater reliability of the Balance Error Scoring System (BESS). PM & R: The Journal of Injury, Function, and Rehabilitation, 1(1), 50–54.

    Article  Google Scholar 

  • Giza, C. C., & Hovda, D. A. (2001). The neurometabolic cascade of concussion. Journal of Athletic Training, 36(3), 228–235.

    PubMed  PubMed Central  Google Scholar 

  • Kleffelgaard, I., Roe, C., Soberg, H. L., & Bergland, A. (2012). Associations among self-reported balance problems, post-concussion symptoms and performance-based tests: a longitudinal follow-up study. Disability and Rehabilitation, 34(9), 788–794.

    Article  PubMed  Google Scholar 

  • Martini, D. N., Sabin, M. J., DePesa, S. A., Leal, E. W., Negrete, T. N., Sosnoff, J. J., et al. (2011). The chronic effects of concussion on gait. Archives of Physical Medicine and Rehabilitation, 92(4), 585–589.

    Article  PubMed  Google Scholar 

  • Neurology Quality Standards Subcommittee. (1997). Practice parameter: the management of concussion in sports (summary statement). Report of the Quality Standards Subcommittee. Neurology, 48(3), 581–585.

    Article  Google Scholar 

  • Okumura, M. S., Cooper, S. L., Ferrara, M. S., & Tomporowski, P. D. (2013). Global switch cost as an index for concussion assessment: reliability and stability. Medicine and Science in Sports and Exercise, 45(6), 1038–1042.

    Article  PubMed  Google Scholar 

  • Parker, T. M., Osternig, L. R., Lee, H. J., Donkelaar, P., & Chou, L. S. (2005). The effect of divided attention on gait stability following concussion. Clinical Biomechanics, 20(4), 389–395.

    Article  PubMed  Google Scholar 

  • Parker, T. M., Osternig, L. R., Van Donkelaar, P., & Chou, L. S. (2006). Gait stability following concussion. Medicine and Science in Sports and Exercise, 38(6), 1032–1040.

    Article  PubMed  Google Scholar 

  • Parker, T. M., Osternig, L. R., van Donkelaar, P., & Chou, L. S. (2007). Recovery of cognitive and dynamic motor function following concussion. British Journal of Sports Medicine, 41(12), 868–873. discussion 873.

    Article  PubMed  PubMed Central  Google Scholar 

  • Parker, T. M., Osternig, L. R., van Donkelaar, P., & Chou, L. S. (2008). Balance control during gait in athletes and non-athletes following concussion. Medical Engineering & Physics, 30(8), 959–967.

    Article  Google Scholar 

  • Prichep, L. S., McCrea, M., Barr, W., Powell, M., & Chabot, R. J. (2013). Time course of clinical and electrophysiological recovery after sport-related concussion. The Journal of Head Trauma Rehabilitation, 28(4), 266–273.

    Article  PubMed  Google Scholar 

  • Register-Mihalik, J. K., Guskiewicz, K. M., Mihalik, J. P., Schmidt, J. D., Kerr, Z. Y., & McCrea, M. A. (2013). Reliable change, sensitivity, and specificity of a multidimensional concussion assessment battery: implications for caution in clinical practice. The Journal of Head Trauma Rehabilitation, 28(4), 274–283.

    Article  PubMed  Google Scholar 

  • Resch, J. E., May, B., Tomporowski, P. D., & Ferrara, M. S. (2011). Balance performance with a cognitive task: a continuation of the dual-task testing paradigm. Journal of Athletic Training, 46(2), 170–175.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ross, L. M., Register-Mihalik, J. K., Mihalik, J. P., McCulloch, K. L., Prentice, W. E., Shields, E. W., et al. (2011). Effects of a single-task versus a dual-task paradigm on cognition and balance in healthy subjects. Journal of Sport Rehabilitation, 20(3), 296–310.

    PubMed  Google Scholar 

  • Slobounov, S. M., Zhang, K., Pennell, D., Ray, W., Johnson, B., & Sebastianelli, W. (2010). Functional abnormalities in normally appearing athletes following mild traumatic brain injury: a functional MRI study. Experimental Brain Research. Experimentelle Hirnforschung. Experimentation Cerebrale, 202(2), 341–354.

    Article  PubMed  PubMed Central  Google Scholar 

  • Teel, E. F., Register-Mihalik, J. K., Troy Blackburn, J., & Guskiewicz, K. M. (2013). Balance and cognitive performance during a dual-task: preliminary implications for use in concussion assessment. Journal of Science and Medicine in Sport/Sports Medicine Australia, 16(3), 190–194.

    Article  PubMed  Google Scholar 

  • Valovich McLeod, T. C., Perrin, D. H., Guskiewicz, K. M., Shultz, S. J., Diamond, R., & Gansneder, B. M. (2004). Serial administration of clinical concussion assessments and learning effects in healthy young athletes. Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine, 14(5), 287–295.

    Article  Google Scholar 

Download references

Acknowledgments

None. No funding sources contributed to the current paper. The authors have no disclosures related to the current paper.

Author information

Authors and Affiliations

  1. Clinical Research Unit, Emergency Services Institute, WakeMed Health and Hospitals, 3000 New Bern Ave., Raleigh, NC, 27610, USA

    Johna K. Register-Mihalik

  2. Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, The University of North Carolina at Chapel Hill, CB# 8700, Chapel Hill, NC, 27599, USA

    Ashley C. Littleton & Kevin M. Guskiewicz

Authors
  1. Johna K. Register-Mihalik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashley C. Littleton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kevin M. Guskiewicz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Johna K. Register-Mihalik.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Register-Mihalik, J.K., Littleton, A.C. & Guskiewicz, K.M. Are Divided Attention Tasks Useful in the Assessment and Management of Sport-Related Concussion?. Neuropsychol Rev 23, 300–313 (2013). https://doi.org/10.1007/s11065-013-9238-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11065-013-9238-1

Keywords

Search

Navigation