Elevated risk for musculoskeletal injury after concussion may relate to impaired responsiveness to changing environmental conditions, which might be identified by appropriately designed clinical screening tests.

A retrospective cohort study involved 48 elite athletes at an Olympic training center (34 males: 23.8±4.4 years; 14 females: 25.4±4.5 years). A 60-second test of dual-task visuomotor reaction time (VMRT) involved rapid manual contact with illuminated target buttons while simultaneously providing verbal responses to identify the right or left direction indicated by the center arrow of 20 successive trials of the Eriksen flanker test. A whole-body reactive agility (WBRA) test measured side-shuffling movements in response to 20 virtual reality targets that randomly appeared in right or left positions on a large computer monitor. A meaningful association was defined as having a 90% confidence interval lower limit>1.0.

Concussion occurrence prior to testing (2.0±2.3 years) was reported by 44% of the athletes (21/48). Strong univariable associations with concussion history were found for dual-task VMRT asymmetry (left minus right visual field difference≥15ms; OR=7.14) and time required to complete the WBRA test (≥73seconds; OR=6.40). A VMRT asymmetry X WBRA time interaction effect demonstrated 81% sensitivity and 75% specificity (OR=13.00). A substantial bivariate correlation was also evident between the two continuous variables (r=.454; P=.001). The occurrence of a lower extremity sprain or strain within the previous 12 months was reported by 67% of the athletes (32/48), which demonstrated an association with concussion history (53% sensitivity, 75% specificity; OR=3.40).

A cause-effect relationship cannot be inferred from retrospective analysis, but the results of both clinical tests suggest that impaired visuospatial performance capabilities may explain the previously reported elevation of musculoskeletal injury risk following concussion.