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Background: This study evaluated 2 different dual-task (DT) conditions during tandem gait (TG) to predict sport-related concussion (SRC) diagnosis., Hypothesis: The best (fastest) single-task (ST) gait will differ between groups (controls vs SRC; baseline vs SRC), with auditory pure switching task (APST) response rate being the most important behavioral variable to aid prediction of SRC., Study Design: Cohort design., Level of Evidence: Level 3., Methods: A total of 409 National Collegiate Athletic Association Division I student-athlete controls and 21 team-physician-diagnosed SRC participated. All data were collected at preseason physicals (baseline) and within 7 days of injury for SRC. Each participant completed 3 conditions of TG in a pseudorandomized order: (1) ST, (2) DT with serial-7s (SS) subtractions, and (3) DT with APST. Outcomes of time-to-complete for TG and behavioral (eg, responses per second) for SS and APST were recorded for each trial., Results: ST Trials 2 ( P = 0.03) and 3 ( P = 0.01) were significantly different between controls and SRC. ST Trial 3 ( P = 0.04) was significantly different between baseline and SRC. Average responses per second for APST were significantly different between- ( P < 0.01) and within- ( P = 0.01) group., Conclusion: The results suggest that ST is significantly slower after SRC. However, DT (both SS and APST) time-to-complete are also important variables when predicting the SRC diagnosis. It is advised that both ST and DT be administered when making clinical decisions regarding postural instability after SRC., Clinical Relevance: The best ST TG time to complete gait is an important objective marker of concussion while DT paradigms, specifically SS and APST, are highly variable. DT may be more useful for clinical observable signs of SRC. Both SS and APST have unique usefulness, but APST response rate per second can be relied upon numerically for clinical decisions., Competing Interests: The authors report no potential conflicts of interest in the development and publication of this article.

Objective: To establish the minimal detectable change (MDC) of the subtests that comprise the composite scores from remotely administered Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) baselines., Method: Remote ImPACT baseline data from 172 (male = 45, female = 127) National Collegiate Athletic Association Division I student-athletes from the 2020 and 2021 athletic preseasons were used to calculate the MDC at the 95%, 90%, and 80% confidence intervals (CIs) for all subtest scores used to generate the four core composite scores and the impulse control composite., Results: The MDCs for the verbal memory subtests at the 95% CI were 10.31 for word memory percent correct, 4.68 for symbol match total correct hidden, and 18.25 for three letters percentage correct. Visual memory subtest MDCs were 19.03 for design memory total percent correct and 4.90 for XO total correct memory. Visual motor speed subtest MDCs were 18.89 for XO total correct interference and 5.40 for three letters average counted correctly. Reaction time (RT) MDCs were 0.12 for XO average correct, 0.95 for symbol match average correct RT, and 0.28 for color match average correct. Impulse control MDCs were 5.97 for XO total incorrect and 1.15 for color match total commissions. One-way repeated measures MANOVA, repeated measures ANOVAs, and Wilcoxon signed-ranks test all suggested no significant difference between any subtests across two remote ImPACT baselines., Conclusions: The ImPACT subtest scores did not significantly change between athletic seasons. Our study suggests the subtests be evaluated in conjunction with the composite scores to provide additional metrics for clinical interpretation., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Context: Guardian Caps (GCs) are currently the most popular external helmet add-on designed to reduce the magnitude of head impacts experienced by American football players. Guardian Caps have been endorsed by influential professional organizations; however, few studies evaluating their efficiency are publicly available., Objective: To present preliminary on-field head kinematics data for National Collegiate Athletic Association (NCAA) Division I American football players using instrumented mouthguards through closely matched preseason workouts with and without GCs., Design: Case series., Setting: The 2022 American football preseason., Patients or Other Participants: Twenty-five male NCAA Division I student-athletes participating in American football completed some portion of the 6 workouts included in this study. Of the 25 participants, 7 completed all 6 workouts using their instrumented mouthguards., Main Outcome Measure(s): Peak linear acceleration (PLA), peak angular acceleration (PAA), and total impacts were collected via instrumented mouthguards during 3 preseason workouts using traditional helmets (TRAD condition) and 3 using a TRAD and GCs (GC condition). The TRAD and GC values for PLA, PAA, and total impacts were evaluated using analyses of variance., Results: No difference was present between the collapsed mean values for the entire sample between the TRAD and GC conditions for PLA (TRAD = 16.3g ± 2.0g, GC = 17.2g ± 3.3g, P = .20), PAA (TRAD = 992.1 ± 209.2 rad/s2, GC = 1029.4 ± 261.1 rad/s2, P = .51), or the total number of impacts (TRAD = 9.3 ± 4.7, GC = 9.7 ± 5.7, P = .72). Similarly, no difference was observed between the TRAD and GC conditions for PLA (TRAD = 16.1g ± 1.2g, GC = 17.2g ± 2.79g, P = .32), PAA (TRAD = 951.2 ± 95.4 rad/s2, GC = 1038.0 ± 166.8 rad/s2, P = .29), or total impacts (TRAD = 9.6 ± 4.2, GC = 9.7 ± 5.04, P = .32) between sessions for the 7 players who completed all 6 workouts., Conclusions: These data suggested no difference in head kinematics data (PLA, PAA, and total impacts) when GCs were worn. Therefore, GCs may not be effective in reducing the magnitude of head impacts experienced by NCAA Division I American football players., (© by the National Athletic Trainers' Association, Inc.)

Context: Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) is one of the most widely used computerized neurocognitive assessment batteries in athletics and serves as both a baseline and postinjury assessment. It has become increasingly popular to administer the ImPACT baseline test in an unsupervised remote environment; however, whether the lack of supervision affects the test-retest reliability is unknown., Objective: To establish the minimal detectable change (MDC) of composite scores from the ImPACT test when administered to National Collegiate Athletic Association Division I student-athletes in an unsupervised remote environment before 2 consecutive athletic seasons., Design: Cross-sectional study., Setting: Participants were provided with a unique link and detailed written instructions on how to complete the ImPACT test at home., Patients or Other Participants: Division I student-athletes., Main Outcome Measure(s): Remote baseline ImPACT results from the 2020-2021 and 2021-2022 athletic seasons were analyzed. The MDC was calculated at the 95%, 90%, and 80% CIs for each of the ImPACT composite scores as well as the average and SD., Results: The MDC at the 95% CI was 18.6 for the verbal memory composite score, 24.44 for visual memory, 8.76 for visual motor, 0.14 for reaction time, and 6.13 for impulse control. One-way repeated-measures multivariate analysis of variance, repeated-measures analysis of variance, and Wilcoxon signed ranks tests suggested no difference in the composite scores and impulse control between time points., Conclusions: The ImPACT composite scores and impulse control did not change between the 2 remote testing time points when administered approximately 1 year apart. Our study suggests that the MDC serves as a clinician's guide for evaluating changes in ImPACT baseline scores and in making clinical judgments on sport-related concussion when the test is administered at home., (© by the National Athletic Trainers’ Association, Inc.)

Purpose The objective of this study is to present preliminary on-field head kinematics data for NCAA Division I American football players through closely matched pre-season workouts both with and without Guardian Caps (GCs). Methods 42 NCAA Division I American football players wore instrumented mouthguards (iMMs) for 6 closely matched workouts, 3 in traditional helmets (PRE) and 3 with GCs (POST) affixed to the exterior of their helmets. This includes 7 players who had consistent data through all workouts. Results There was no significant difference between the collapsed mean values for the entire sample between PRE and POST for peak linear acceleration (PLA) (PRE=16.3, POST=17.2Gs; p=0.20), Peak Angular Acceleration (PAA) (PRE=992.1, POST=1029.4rad/s2; p=0.51 and the total amount of impacts (PRE=9.3, POST=9.7; p=0.72). Similarly, no difference was observed between PRE and POST for PLA (PRE=16.1, POST=17.2Gs; p=0.32), PAA (PRE=951.2, POST=1038.0rad/s2; p=0.29 and total impacts (PRE=9.6, POST=9.7; p=0.32) between sessions for the 7 repeated players. Conclusion These data suggest no difference in head kinematics data (PLA, PAA and total impacts) when GCs are worn. This study suggests GCs are not effective in reducing the magnitude of head impacts experienced by NCAA Division I American football players.