Exertion tests offer insight into recovery from youth concussions

by UT Southwestern Medical Center

edited by Lisa Lock, reviewed by Andrew Zinin

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Clinical exams that incorporate gait analysis after physical exertion may provide insight into how youths are recovering after concussions and help determine whether they are ready to return to sports, UT Southwestern Medical Center and Scottish Rite for Children (SRC) researchers found. Their study, published in the Clinical Journal of Sport Medicine, showed significant differences in the walking patterns and cognitive abilities of concussed youths after an experimental protocol.

Between 1 million and 2 million children younger than 18 experience sports-related concussions each year in the U.S. Those who return to physical activities too quickly are at risk of prolonged recovery and higher rates of musculoskeletal injuries because of neurological deficits.

The research team, led by Shane Miller, M.D., FAAP, professor of orthopedic surgery and pediatrics at UT Southwestern and SRC sports medicine physician, tested a pilot protocol that measured movement and cognition after exercise to provide more robust methods of assessing brain function and prevent a premature return to play. The study took place at the Scottish Rite for Children Movement Science Lab (MSL).

"Our key finding is that even in adolescents who have been cleared after a concussion, physical exertion still reveals meaningful changes in cognition and function. We may need to evaluate the brain in different ways when determining whether somebody has recovered and is ready to return to sports," said Miller, who is also the section director of medical sports medicine at Scottish Rite for Children.

Concussions occur after a blow to the head or body results in a traumatic brain injury. Standard physical exams to clear young patients to return to sports activities rely on symptom abatement, but they don't often test the patient's ability to control movements in complex environments—which is necessary for safe sports play.

Study methodology

The researchers tested recently concussed youths to see whether their gait—stability and confidence in walking—or cognition changed after physical exertion. They predicted that the Buffalo Concussion Bike Test, a 10-minute stationary bike ride at 70% of a patient's maximum heart rate, would reveal potential deficiencies in gait and mental functioning.

Thirty young patients who had experienced a sports-related concussion and been cleared to return to play participated in the study. Researchers filmed them performing a simple 10-meter (33-foot) walk, a dual-task 10-meter (33-foot) walk while repeating number sequences backward, and a multitask 10-meter (33-foot) walk while typing sentences into a smart device. Patients performed the bike test, then repeated the gait analysis.

After exertion, participants completed the second simple 10-meter (33-foot) walk significantly more slowly and with shorter steps than the first. Walking speed and step length increased during the dual- and multitask walks, potentially indicating they had become used to the tasks. Participants' multitask sentence completion improved from 77% pre-exertion to 90% post-exertion. Miller explained the difference in cognitive performance could be the result of exercise, which can have a positive effect on brain recovery and performance.

Because participants had been cleared to return to play within two weeks of the study, the researchers did not expect to find severe movement deficits. However, their results indicate post-exertion gait analysis with cognitive tasks could give clinicians greater insight into brain recovery.

"This is an area we absolutely can expand upon in terms of exertion-based testing, simulating the environment that the athlete will be returning to in a safe way and testing for residual deficits so we feel more confident they are safe to return to their sport," Miller said.

This study builds on previous work completed by ConTex, a concussion registry launched by UTSW in 2015 and designed to capture comprehensive longitudinal data on sports-related concussions and other mild traumatic brain injuries across the lifespan, with an emphasis on adolescent injuries.

More information

Ashley L. Erdman et al, The Effect of an Exertion Protocol on Cognitive and Functional Performance in Adolescents After Concussion, Clinical Journal of Sport Medicine (2026). DOI: 10.1097/jsm.0000000000001449

Key medical concepts

ConcussionGait Analysisbrain functionTraumatic Brain Injury

Clinical categories

NeurologyChildren's healthSports medicinePediatrics Provided by UT Southwestern Medical Center Who's behind this story?

Lisa Lock

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