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Does Concussion Affect Perception–Action Coupling Behavior? Action Boundary Perception as a Biomarker for Concussion

Eagle, Shawn R. MAT, ATC*; Nindl, Bradley C. PhD*; Johnson, Caleb D. PhD; Kontos, Anthony P. PhD; Connaboy, Chris PhD*

doi: 10.1097/JSM.0000000000000731
Original Research: PDF Only

Background: After a concussion, athletes may be at increased risk of musculoskeletal injuries. Altered perception of action boundaries (ABP), or the limits of one's action capabilities, is one possible mechanism for this increase in injury risk after concussion.

Objective: To evaluate differences in symptoms, neurocognitive, vestibular/oculomotor, and action boundary function between subjects with no concussion history (NoHx) and concussion history (ConcHX).

Design: Cross-sectional study.

Setting: Laboratory at the University of Pittsburgh.

Participants: ConcHx (n = 22; age: 21.8 ± 3.0 years, height: 174.0 ± 8.3 cm, and mass: 77.8 ± 14.8 kg) and NoHx athletes (n = 24; age: 21.6 ± 2.0 years, height: 176.0 ± 10.0 cm, and mass: 72.0 ± 15.3 kg).

Intervention: Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) and Post-Concussion Symptom Scale (PCSS), Vestibular–Ocular Motor Screening (VOMS) tool, and the Perception–Action Coupling Task (PACT). The PACT measures the accuracy of ABP.

Main Outcome Measures: Neurocognitive domain scores, PCSS, VOMS subdomain symptom gain, ABP accuracy, and actualization.

Results: ConcHx reported 2.7 ± 1.5 previous concussions occurring on average 263.8 ± 228.9 days prior. ConcHx was higher on several VOMS items including vertical/horizontal saccades (P = 0.001; P = 0.05), vertical/horizontal vestibular–ocular reflex (P < 0.001; P = 0.04), and visual motion sensitivity (P < 0.001). Average PACT movement time (P = 0.01) and reaction time (P = 0.01) were longer in ConcHx.

Conclusions: These findings provide preliminary support for impaired vestibular/oculomotor function and ABP in ConcHx compared with NoHx. The current results may enhance our understanding of the mechanisms for increased musculoskeletal injury risk after concussion.

*Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania;

Spaulding National Running Center, Harvard Medical School, Harvard University, Cambridge, MA; and

UPMC Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.

Corresponding Author: Shawn R. Eagle, MAT, ATC, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St, Pittsburgh, PA 15203 (

This study was funded by a National Athletic Trainer's Association Research and Education Foundation grant, #1516DGP003.

The authors report no conflicts of interest.

This study was approved by the institutional review board of the University of Pittsburgh.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Received June 26, 2018

Accepted December 03, 2018

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