Action Boundary Perception Accuracy Deficits in Recently Concussed Young Athletes

TLDR: This is the second study to demonstrate decreased ABP accuracy in concussed athletes, using the PACT, and demonstrated the multifactorial nature of ABP, as mental effort during BART, VOMS, and ImPACT, as well as feelings of anxiety and impulsivity, impacted several components ofABP behavior.

Abstract: Following sport-related concussion (SRC), athletes have 2 times increased risk for lower extremity musculoskeletal injury. Perceptual-motor control may be a contributory factor, as motor control deficits have repeatedly been demonstrated in athletes with recent SRC even after clearance for return-to-play. Specifically, deficits in accuracy and actualization of action boundary perception (ABP), or the ability to perceive the limits of available actions to a given athlete, have been demonstrated in collegiate athletes who reported an SRC an average of 264 days prior to testing. The purpose of the present study was to evaluate changes in ABP behavior in more acutely concussed young athletes (Concussed), as well as to further characterize contributing factors to the Perception Action Coupling Task (PACT), a novel test of ABP behavior. Recently concussed (≤21 days prior) 12-18 year old athletes (n=48) and healthy controls (n-24) were recruited to participate in a cross-sectional testing protocol, consisting of the PACT, Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), Vestibular-Ocular Motor Screen (VOMS), Balloon Analog Risk Task (BART), and surveys to measure mental effort for each of the above tests, as well as symptoms of depression, anxiety, impulsivity, and perceived physical development. Concussed was presented the option to return for follow-up testing of all measures after clearance for return-to-play. Concussed demonstrated deficits in ABP accuracy (~5%). Concussed reported significantly higher impulsivity (~9%). At follow-up, Concussed had significantly improved PACT accuracy and response time. Post-hoc analyses revealed an association between higher mental effort for BART and higher anxiety with increased PACT movement time. Conversely, higher impulsivity reduced movement time. Higher effort for VOMS reduced initiation time, whereas higher effort for neurocognition reduced accuracy. This is the second study to demonstrate decreased ABP accuracy in concussed athletes, using the PACT. This study also demonstrated the multifactorial nature of ABP, as mental effort during BART, VOMS, and ImPACT, as well as feelings of anxiety and impulsivity, impacted several components of ABP behavior. ABP accuracy has a relationship with SRC, likely through the constellation of symptoms that result from SRC.