Instrumented dual-task tests for concussion assessment in Ice Hockey

Background Sport-related concussions are a public health concern and can lead to long-term health impairment. Nevertheless, assessing concussions in spots such as ice hockey can be challenging during games. Dual-task (DT) tests, quantifying interference between cognitive and motor performance, have been used to detect cognitive impairment after a concussion. Methods in this work, 114 Swiss elite ice hockey players performed DT tests at regular interval during the season and within the days following a diagnosed concussion. The DT test consisted of a static balance and a self-paced walking, both combined with counting backward by 3. In total, 265 DT tests were performed, including 38 tests between 1 day and 2 weeks after the 15 diagnosed concussions. Results Cognitive abilities during gait were mainly affected after a concussion. A DT performance metric was defined based on features significantly associated with worsening DT performance after the concussion ( p < 0.001, effect size d = 1.50). Finally, an individual and a global model were proposed to estimate the risk of concussion based on a DT test outcome. Conclusion These tests provide objective insights to the medical staff, ensuring a secure and trusted decision-making process when deciding if the player should be removed from the game for recovery. Dual-task tests could also improve the return to play evaluation by detecting remaining cognitive deficiencies even in the absence of symptoms.