A multimodal dynamic visual acuity assessment including standing and walking conditions may be a feasible approach to detect differences in visual-cognitive performance for athletes following clinical recovery of concussion.
Key Findings
Results
Athletes with prior sport-related concussion showed worse dynamic visual acuity change scores during standing and walking compared to controls, but only for random-motion targets.
SRC group (n=14) exhibited worse DVA change scores during standing and walking compared to CONTROL group (n=16) with p < .05
The between-group difference was specific to random walk (R) motion only, not horizontal (H) motion
DVA performance was characterized as a change in DVA score from the Seated condition in logMAR units
A linear mixed-effects model was used to analyze DVA change scores
Results
Both the SRC and control groups responded faster during treadmill walking conditions compared to seated for both motion types.
Both groups responded faster during treadmill walking for both random (R) and horizontal (H) motion (p < .001)
Response time (RT) was measured in milliseconds using a handheld keypad
A generalized mixed effects model was fitted for median RT
This faster response time during walking was observed regardless of concussion history
Results
The vast majority of asymptomatic SRC athletes remained symptom-free during the multimodal DVA protocol.
Only two athletes (14%) in the SRC group experienced mild symptoms during the protocol
These mild symptoms did not affect performance during the protocol
All SRC participants were confirmed asymptomatic prior to testing
This suggests the multimodal protocol was tolerable for post-concussion athletes who had clinically recovered
Methods
The study used a multimodal DVA framework incorporating seated, standing, and low- and moderate-intensity treadmill walking conditions to assess visual-cognitive performance.
A Tumbling 'E' target was presented randomly in either random walk (R) or horizontal (H) motion at 2.31 m/s
The target appeared in one of four orientations and participants responded using a handheld keypad
Conditions included seated (baseline), standing, low-intensity treadmill walking, and moderate-intensity treadmill walking
Participants were 30 interuniversity athletes with mean age 20.9 years ± 1.4
Background
Sport-related concussions commonly affect vision and cognition, but limited understanding exists of how concurrent balance and exertion demands affect visual-cognitive performance beyond symptom resolution.
The study specifically targeted athletes who were asymptomatic following SRC, representing the post-clinical-recovery phase
The SRC group included 14 athletes (6 female) and the control group included 16 athletes (7 female)
The study was motivated by the gap in knowledge about performance under concurrent physical demands after concussion
The addition of postural and exertion demands was hypothesized to unmask residual deficits not apparent at rest
What This Means
This research suggests that athletes who have previously suffered a sport-related concussion, even after they have been cleared medically and report no symptoms, may still show subtle differences in how well they process moving visual information when they are standing or walking. The study tested 30 university-level athletes — 14 with a concussion history and 16 without — by asking them to identify the orientation of a moving letter 'E' on a screen while seated, standing, and walking on a treadmill. The concussion group performed worse only when the target moved in an unpredictable, random pattern (rather than a simple back-and-forth motion), and only when the added physical demands of standing or walking were included.
Interestingly, both groups actually responded more quickly during walking than while seated, suggesting that gentle physical activity does not impair reaction time and may even slightly sharpen it. Almost all concussion-history athletes (86%) remained completely symptom-free throughout the testing, indicating that this kind of multimodal assessment is well-tolerated even in recently recovered athletes.
This research suggests that standard symptom-based clearance protocols may not fully capture all lingering effects of concussion on the brain's ability to handle complex, real-world tasks that combine movement and vision simultaneously. A testing approach that layers physical demands — like standing or walking — onto visual tasks could help clinicians identify athletes who may still have subtle brain function differences even after they feel completely recovered.
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Mitchell K, Dalton K, Cinelli M. (2026). A multimodal framework to assess differences in dynamic visual acuity between athletes with and without recent sport-related concussion.. Experimental brain research. https://doi.org/10.1007/s00221-026-07409-4