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Patterns of Dual-Task Interference in Service Members With Mild Traumatic Brain Injury Using the Portable Warrior

Crystal R Ramsey^1,2, Courtney H Harrison², Rachana R Gangwani²

¹Department of Physical Therapy Education, School of Health Sciences, Elon University, Elon, North Carolina, 27244, United States.

Military Medicine

|June 27, 2025

Summary

Service members with mild traumatic brain injury (mTBI) showed similar dual-task costs to healthy controls, prioritizing motor over cognitive skills. The POWAR-TOTAL test

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Area of Science:

Neuroscience
Sports Medicine
Rehabilitation Science

Background:

Mild traumatic brain injury (mTBI) assessment for service members (SM) requires evaluating combined motor and cognitive skills under dual-task (DT) conditions.
The Portable Warrior Test of Tactical Agility (POWAR-TOTAL) is a validated tool for mTBI assessment, incorporating DT scenarios.

Purpose of the Study:

To compare dual-task performance and prioritization between SM with mTBI and healthy controls (HC) using the POWAR-TOTAL.
To evaluate the effectiveness of an intervention for SM with mTBI by comparing pre- and post-intervention performance to HC.

Main Methods:

Forty-six SM with mTBI and 59 HC SM completed the POWAR-TOTAL, which includes DT assessment.
Group differences in relative DT effects were analyzed, examining performance trade-offs and prioritization.
Paired-sample and independent t-tests were used to compare motor and cognitive DT scores and pre-/post-intervention performance.

Main Results:

Relative DT effects were not significantly different between HC and pre-intervention mTBI groups, nor between pre- and post-intervention mTBI groups.
Post-intervention mTBI performance approached HC levels, suggesting therapeutic improvement.
Interference patterns differed at pre-intervention but normalized post-intervention, indicating improved dual-task processing.

Conclusions:

SM prioritize motor over cognitive performance in DT scenarios, with similar relative DT costs observed in both mTBI and HC groups.
The POWAR-TOTAL's dual-task effect calculation may not offer critical interpretive information beyond simple single and DT measures.
Further refinement of testing protocols could minimize cognitive accuracy changes over multiple trials.