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.

The authors have declared no competing interest.

This study was funded by Innosuisse (grant number 100.098 IP-ICT)

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