June 2025

Perceptual-Motor Function:
Integrating Cognitive-Motor Demands in Injury Risk and Return-to-Play Decisions

Traditional return-to-play (RTP) assessments often focus on physical metrics like strength or movement quality. However, many sports injuries occur in high-pressure, unpredictable environments that require real-time processing of visual, auditory, and proprioceptive information.¹ Perceptual-motor function is a domain of neurocognitive function and encompasses visual perception (i.e., ability to interpret and make sense of visual stimuli), visuoconstructional reasoning (i.e., perceive parts and integrate them into a whole), and perceptual-motor coordination (i.e., integration of visual input with motor performance).² Poor perceptual-motor function has been linked to slower reaction times, movement errors, and increased primary musculoskeletal injury risk.^1,3

Elaine Reiche

Doctoral Research Grant: 2024-2025

“Biopsychosocial Assessments of Kinesiophobia and Functional Outcomes Post-ACL Reconstruction”

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Jiho Kang

Masters Research Grant: 2024-2025

"Neurocognitive and Balance Measures in Chronic Ankle Instability: A Novel Approach Using Time between time to boundary and EEG"

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Claire Akard

Masters Research Grant: 2024-2025

“The Role of Baseline Vestibular Ocular Motor Performance as a Predictor of Prolonged Recovery After Concussion in Collegiate Athletes”

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Aleiza Higgins

Doctoral Research Grant: 2024-2025

“Attentional Considerations Regarding the Relationship Between Concussion and Subsequent Musculoskeletal Injury”

"Think outside the box: Incorporating secondary cognitive tasks into return to sport testing after ACL reconstruction" Chaaban et al, 2023. Includes practical recommendations on how to implement cognitive tasks into rehabilitation and functional testing for return to sport after knee injury.

"Open Source, Open Science: Development of OpenLESS as the Automated Landing Error Scoring System" Turner et al, 2025. Open LESS is a tool for automated jump-landing assessment, demonstrating good validity in healthy and post-ACL reconstruction populations, and excellent field reliability, addressing the need for objective movement analysis. OpenLESS uses OpenCap data to grade jump landing quality.

"The Influence of Concussion History and Progressively Increasing Cognitive Load on Jump Landing and Cutting Reaction Time, Biomechanics, and Task Demands" Shumski et al, 2025. Concussion history was not associated with jump landing and cutting biomechanics. Healthy controls and individuals with a history of concussion had slower reaction times during the serial 3 and 7s task compared to the task with no counting. *NATA Foundation Funded Research*

"Individual and Combined Effects of Sport-Related Concussion and Anterior Cruciate Ligament Injury on Neurocognitive and Neuromechanical Reaction Time" Moran and Grooms 2025. Any history of either concussion or ACL reconstruction (ACLR) results in slower reaction times than those without the respective injury (no concussion and no ACLR groups), indicating potential neurological deficits related to spatial scanning and executive function for up to 2 years after injury.

"The Effect of a Neuromuscular-Cognitive Training Program on Static Postural Stability and Hop Test Performance in Collegiate Tennis Athletes" (Porter et al, 2024 ) S-44. Combining neuromuscular exercises with perceptual-cognitive challenges may benefit postural stability.

"Test-Retest Reliability and Visual Perturbation Performance Costs During 2 Reactive Agility Tasks" (Smith et al, 2024 ) S-45. Tasks developed for this study encompassed constructs of reaction time (four-corner agility task), working memory, and path finding (color recall). Both reactive agility tasks demonstrated acceptable test-retest reliability and may be appropriate for return to sport testing after ACLR.

"Relationship Between Single-Leg Memory Hop Distance and Maximum Vertical Jump Height in Healthy U.S. Marines" (Heimark et al, 2024) S-70. Utilizing the single leg memory hop (i.e., performing a single leg hop in response to color) in conjunction with traditional jump testing during field testing may bridge the gap between clinical and performance testing in military settings.

"Known-Groups Validity of the SWAY Balance Mobile Application Inspection Time Test to Detect Mild Traumatic Brain Injury" (Florkiewicz et al, 2024 ) S- 81. The SWAY Inspection Time test is an accessible and portable tool for clinicians assessing patients with suspected mTBI.

Tools:

Reaction Time Lights: BlazePods, FitLights, Rox
Computerized Neurocognitive Testing: ImPACT, Sway
Biomechanics: OpenCap (free software, requires 2 iOS devices)

Podcasts:

References

1. Wilke J, Groneberg DA. Neurocognitive function and musculoskeletal injury risk in sports:A systematic review. J Sci Med Sport. 2022;25(1):41-45. doi:10.1016/j.jsams.2021.07.002

2. Sachdev PS, Blacker D, Blazer DG, et al. Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol. 2014;10(11):634-642. doi:10.1038/nrneurol.2014.181

3. Avedesian JM, Forbes W, Covassin T, Dufek JS. Influence of Cognitive Performance on Musculoskeletal Injury Risk: A Systematic Review. Am J Sports Med. 2022;50(2):554-562. doi:10.1177/0363546521998081

4. Chaaban CR, Turner JA, Padua DA. Think outside the box: Incorporating secondary cognitive tasks into return to sport testing after ACL reconstruction. Front Sports Act Living. 2023;4:1089882. Published 2023 Feb 15. doi:10.3389/fspor.2022.1089882

5. Singh H, Gokeler A, Benjaminse A. Effective Attentional Focus Strategies after Anterior Cruciate Ligament Reconstruction: A Commentary. Int J Sports Phys Ther. 2021;16(6):1575-1585. Published 2021 Dec 2. doi:10.26603/001c.29848

Chaput M, Simon JE, Taberner M, Grooms DR. From Control to Chaos: Visual-Cognitive Progression During Recovery from ACL Reconstruction. J Orthop Sports Phys Ther. 2024;54(7):431-439. doi:10.2519/jospt.2024.12443

This content was developed in part by Elaine Reiche, PhD, ATC, CSCS and the NATA Foundation Educational Resources Committee.

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Perceptual-Motor Function:Integrating Cognitive-Motor Demands in Injury Risk and Return-to-Play Decisions

Perceptual-Motor Function:
Integrating Cognitive-Motor Demands in Injury Risk and Return-to-Play Decisions