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The Effects of Cognitive Loading on Motor Behavior in Injured Individuals: A Systematic Review

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Abstract

Background

Research suggests that individuals with musculoskeletal injury may have difficulty negotiating physical tasks when they are combined with cognitive loads.

Objective

Our objective was to conduct a systematic review to understand the effects of increased cognitive demand on movement patterns among individuals with musculoskeletal injuries.

Methods

A comprehensive search of PubMed, MEDLINE, the Cumulative Index for Nursing and Allied Health Literature (CINAHL), and SPORTDiscus was conducted to find research reports that included a population that had previously experienced an ankle, knee, or low back injury, included an uninjured control group, and assessed a dual-task paradigm.

Results

Forty-five full-text research reports were assessed, of which 28 studies (six ankle injury, nine knee injury, and 13 low back pain studies) were included in the review. Included studies were assessed for methodological quality and the study design extracted for analysis including the participants, cognitive and physical tasks performed, as well as outcome measures (e.g., three-dimensional kinematics, center of pressure, etc.). All studies included were cross-sectional or case–control with methodological quality scores of 17.8 ± 2.2 out of a possible 22. Twenty-five of the 28 studies found changes in motor performance with dual-task conditions compared with single tasks. Furthermore, 54% of studies reported a significant group by task interaction effect, reporting at least one alteration in injured groups’ motor performance under dual-task conditions when compared with an uninjured group.

Conclusion

The results of this systematic review indicate that motor performance is further impaired by placing a cognitive load on individuals in populations with musculoskeletal injury. More demanding tasks such as gait appear to be more affected in injured individuals than simple balance tasks. Future investigators may want to consider the difficulty of the tasks included as well as the impact of dual-task paradigms on rehabilitation programs.

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Data Availability Statement

The authors declare that the data supporting the findings of this review are included in the article and/or its supplementary digital content.

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Authors and Affiliations

  1. School of Health and Kinesiology, University of Nebraska-Omaha, Omaha, NE, USA

    Christopher J. Burcal & Adam B. Rosen

  2. Department of Health and Exercise Science, Appalachian State University, ASU Box 32071, Boone, NC, 28608, USA

    Alan R. Needle

  3. Department of Kinesiology, Towson University, Towson, MD, USA

    Lisa Custer

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  1. Christopher J. Burcal
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  2. Alan R. Needle
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  3. Lisa Custer
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  4. Adam B. Rosen
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Correspondence to Alan R. Needle.

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No sources of funding were used to assist in the preparation of this article.

Conflicts of Interest

Christopher Burcal, Alan Needle, Lisa Custer, and Adam Rosen declare that they have no conflicts of interest relevant to the content of this review. The results of this review are presented clearly, honestly, and without fabrication, falsification, or inappropriate data omission.

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Burcal, C.J., Needle, A.R., Custer, L. et al. The Effects of Cognitive Loading on Motor Behavior in Injured Individuals: A Systematic Review. Sports Med 49, 1233–1253 (2019). https://doi.org/10.1007/s40279-019-01116-7

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