Mil Med. 2025 Jun 19:usaf294. doi: 10.1093/milmed/usaf294. Online ahead of print.ABSTRACTINTRODUCTION: Return-to-duty assessment for service members (SM) following mild traumatic brain injury (mTBI) combining motor and cognitive skills in dual task (DT) scenarios may better approximate the demands of active duty service. The Portable Warrior Test of Tactical Agility (POWAR-TOTAL) is a valid mTBI assessment tool which incorporates DT assessment.MATERIALS AND METHODS: Forty-six SM diagnosed with mTBI and 59 healthy control (HC) SM performed the POWAR-TOTAL. Group differences in relative DT effect were categorized based on performance trade-offs and prioritizations. A paired-sample t-test was performed to examine the relationship between the motor and cognitive relative DT scores for SM with mTBI and HC. Cognitive and motor performance of the mTBI group pre- and post-intervention were compared to the HCs values using an independent t-test. Average pre- and post-intervention relative DT effects were charted on a polar plot.RESULTS: Although cognitive and motor performance differed between the HC and pre-intervention groups, relative DT effects (% change normalized by SM baseline performance) were not significantly different. Relative DT for the pre- and post-intervention mTBI group also were not significantly different. HC group and post-intervention group differences were non-significant, suggesting improvement in performance after therapy. Patterns of interference between the groups differed at mTBI pre-intervention, but were similar at post-intervention.CONCLUSION: Service members prioritized motor performance over cognitive performance, with relative dual-task costs that were small and similar in both groups. Cognitive accuracy changes over multiple trials could be minimized by an improved testing protocol. Since simple single and dual-task measures of cognitive and motor performance captured significant group differences, the calculation of POWAR-TOTAL dual-task effects does not appear to provide critical information for test interpretation.PMID:40577791 | DOI:10.1093/milmed/usaf294