Dual-task testing in adults with persistent postconcussive symptoms: a scoping review with conceptual mapping approach

BACKGROUND: Persistent postconcussive symptoms (PPCS) affect approximately 30% of individuals following mild traumatic brain injury, resulting in prolonged sensorimotor and cognitive disruptions. While traditional assessments focus on isolated subfunctions, they often fail to capture the complex integration required for daily activities. This scoping review aimed to summarize the evidence on dual-task testing in PPCS, identify frequently used subtasks, and map these paradigms to clinical symptom clusters. METHODS: A systematic search of MEDLINE, CINAHL, and EMBASE was conducted. Studies were included if they involved adults (18-59 years) with persistent symptoms (> 14 days post-injury) performing simultaneous motor and cognitive tasks compared to single-task conditions. Methodological quality was assessed using a modified Downs and Black checklist. Conceptual mapping was employed to visualize the co-occurrence of symptoms and DT subtasks. RESULTS: Eight studies (N = 197) met the eligibility criteria. Seven studies reported significant cognitive-motor interference (CMI) in PPCS cohorts compared to healthy controls. Gait was the primary motor task investigated, while cognitive tasks focused on working memory (e.g., arithmetic) and inhibition (e.g., Stroop). Conceptual mapping revealed that general symptom burden and anxiety were central hubs linked to gait and executive function tasks. However, specific clusters like fatigue, headache, and ocular dysfunction were notably underrepresented. SIGNIFICANCE: Dual-task assessments, particularly combining gait with executive function tasks, are sensitive markers for functional deficits in PPCS. Future research should standardize protocols, include cognitive response times to capture speed-accuracy trade-offs, and utilize neurophysiological applications such as electroencephalography to better understand the underlying neural resource reallocation.