Visuomotor deficits during locomotion in previously concussed athletes 30 or more days following return to play

Current protocols for returning athletes to play (RTP) center around resolution of physical symptoms of concussion. However, recent research has identified that balance and cognitive deficits persist beyond physical symptom recovery. Protocols that involve testing dynamic balance and visuomotor integration have been recommended as potential tools for better understanding of length of impairment following concussion. A dynamic, visuomotor paradigm was undertaken in the current study to assess decision making in athletes who had sustained a concussion >30 days before study participation and had been cleared to RTP (N = 10). Two obstacles created a gap that varied between 0.6 and 1.8× participants' individual shoulder width in open space. Participants made decisions to navigate through or deviate around the gap created by the two obstacles. The results revealed that previously concussed athletes were highly variable in their decision making and demonstrated variable Medial-Lateral (ML) center of mass (COM) control when approaching the obstacles, when compared with nonconcussed, age-matched controls. As such, they showed poor visuomotor control and decision making, as well as poor dynamic stability compared to controls. Visuomotor deficits were persistent in the sample of previously concussed individuals, well beyond deficits identified by current RTP standards. This study suggests that dynamic, visuomotor integration tasks may be of benefit to increase rigor in RTP protocols and increase safety of athletes returning to sport.