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Lavoie G, Bolduc M, Sicard V, Lepore F, Ellemberg D. Maintaining Cognitive Performance at the Expense of Gait Speed for Asymptomatic Concussed Athletes: A Novel Dual-Task and Post-Exercise Assessment. Brain Sci 2024; 14:715. [PMID: 39061455 PMCID: PMC11274567 DOI: 10.3390/brainsci14070715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/09/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Our goal was to evaluate persisting deficits in gait and executive functioning in asymptomatic athletes with a history of concussion using a novel approach combining a dual-task paradigm and post-exercise exertion. Thirty-eight athletes aged 17 to 25 years old participated in the study, including 18 with a history of concussion. The dual-task paradigm required walking continuously at a predetermined self-paced target speed of 6.5 km/h while executing a complex switch task. Athletes completed two conditions, each on separate days: (1) dual task alone and (2) dual task following 20 min of running on a non-motorized treadmill. The statistical analyses revealed a significant reduction in gait speed exclusively for athletes with a history of concussion and only following the post-exercise condition (p = 0.008). These findings suggest that although asymptomatic concussed athletes maintain a cognitive performance comparable to non-concussed athletes, this appears to be achieved at the expense of gait speed. Our results underscore the importance of incorporating gait assessments and post-exercise exertion into concussion evaluation protocols in both research and clinical settings.
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Affiliation(s)
- Gabriel Lavoie
- Psychology, University of Montreal, Montréal, QC H3T 1J4, Canada; (G.L.); (M.B.); (F.L.)
| | - Mathieu Bolduc
- Psychology, University of Montreal, Montréal, QC H3T 1J4, Canada; (G.L.); (M.B.); (F.L.)
| | | | - Franco Lepore
- Psychology, University of Montreal, Montréal, QC H3T 1J4, Canada; (G.L.); (M.B.); (F.L.)
| | - Dave Ellemberg
- Kinesiology, University of Montreal, Montréal, QC H3T 1J4, Canada
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Mitchell C, Cronin J. The variability of dual-task walking parameters using in-shoe inertial sensors in nonconcussed individuals: A randomized within-subject repeated measures design. Health Sci Rep 2023; 6:e1660. [PMID: 37900093 PMCID: PMC10600336 DOI: 10.1002/hsr2.1660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/31/2023] Open
Abstract
Background and Aims There is a need for high utility and portability, and cost-effective technologies that are suitable for assessing dual-task gait after experiencing a concussion. Current technologies utilized such as 3D motion capture and force plates are too complex and expensive for most practitioners. The aim of this study was to quantify the variability of dual-task walking gait parameters using in-shoe inertial sensors in nonconcussed individuals. Methods This was a randomized within-subject repeated measures design conducted within a sports laboratory. Twenty healthy, uninjured, nonconcussed participants were recruited for this study. Gait variables of interest were measured across three 2-min continuous walking protocols (12 m, 30 m, 1 min out and back) while performing a cognitive task of counting backward in sevens from a randomly generated number between 300 and 500. Testing was completed over three occasions separated by 7 days, for a total of nine walking trials. Participants completed the testing protocols in a randomized, individual order. The primary outcome was to determine the variability of dual-task walking gait parameters using in-shoe inertial sensors in nonconcussed individuals across three protocols. Results Three to four participants were allocated to each randomized protocol order. Regarding the absolute consistency (coefficient of variation [CV]) between testing occasions, no gait measure was found to have variability above 6.5%. Relative consistency (intraclass correlation coefficient [ICC]) was acceptable (>0.70) in 95% of the variables of interest, with only three variables < 0.70. Similar variability was found across the three testing protocols. Conclusion In-shoe inertial sensors provide a viable option for monitoring gait parameters. This technology is also reliable across different testing distances, thus offering various testing options for practitioners. Further research needs to be conducted to examine the variability with concussed subjects.
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Affiliation(s)
- Courtney Mitchell
- Sport Performance Research in New Zealand (SPRINZ)AUT Millennium Institute, AUT UniversityAucklandNew Zealand
- Department of Sport and RecreationToi Ohomai Institute of TechnologyTaurangaNew Zealand
| | - John Cronin
- Sport Performance Research in New Zealand (SPRINZ)AUT Millennium Institute, AUT UniversityAucklandNew Zealand
- Athlete Training and HealthKatyTexasUSA
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Mitchell CJ, Cronin J. Methodological Critique of Concussive and Non-Concussive Dual Task Walking Assessments: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5227. [PMID: 36982135 PMCID: PMC10048786 DOI: 10.3390/ijerph20065227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To understand the methodological approaches taken by various research groups and determine the kinematic variables that could consistently and reliably differentiate between concussed and non-concussed individuals. METHODS MEDLINE via PubMed, CINAHL Complete via EBSCO, EBSCOhost, SPORTDiscus, and Scopus were searched from inception until 31 December 2021, using key terms related to concussion, mild traumatic brain injury, gait, cognition and dual task. Studies that reported spatiotemporal kinematic outcomes were included. Data were extracted using a customised spreadsheet, including detailed information on participant characteristics, assessment protocols, equipment used, and outcomes. RESULTS Twenty-three studies involving 1030 participants met the inclusion criteria. Ten outcome measures were reported across these articles. Some metrics such as gait velocity and stride length may be promising but are limited by the status of the current research; the majority of the reported variables were not sensitive enough across technologies to consistently differentiate between concussed and non-concussed individuals. Understanding variable sensitivity was made more difficult given the absence of any reporting of reliability of the protocols and variables in the respective studies. CONCLUSION Given the current status of the literature and the methodologies reviewed, there would seem little consensus on which gait parameters are best to determine return to play readiness after concussion. There is potential in this area for such technologies and protocols to be utilised as a tool for identifying and monitoring concussion; however, improving understanding of the variability and validity of technologies and protocols underpins the suggested directions of future research. Inertial measurement units appear to be the most promising technology in this aspect and should guide the focus of future research. IMPACT Results of this study may have an impact on what technology is chosen and may be utilised to assist with concussion diagnosis and return to play protocols.
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Affiliation(s)
- Courtney Jade Mitchell
- Sport Performance Research in New Zealand (SPRINZ), AUT Millennium Institute, AUT University, Auckland 1010, New Zealand
- Department of Sport and Recreation, Toi Ohomai Institute of Technology, Tauranga 3112, New Zealand
| | - John Cronin
- Sport Performance Research in New Zealand (SPRINZ), AUT Millennium Institute, AUT University, Auckland 1010, New Zealand
- Athlete Training and Health, 23910 Katy Freeway, Suite 101, Katy, TX 77494, USA
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Static and Dynamic Cognitive Performance in Youth and Collegiate Athletes With Concussion. Clin J Sport Med 2021; 31:442-447. [PMID: 31860545 DOI: 10.1097/jsm.0000000000000779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if individuals with a concussion demonstrate altered cognitive performance while standing still or while walking relative to uninjured controls. DESIGN Cross-sectional. SETTING Sports-medicine clinic. PARTICIPANTS Youth and collegiate athletes diagnosed with a concussion, assessed within 10 days of injury, and a group of uninjured control subjects. INDEPENDENT VARIABLES Concussion and control groups. MAIN OUTCOME MEASURES Participants stood still for 30 seconds while completing a cognitive task (spelling words backward, serial subtraction, or reverse month recitation) and completed a similar set of cognitive tasks while walking. Our primary outcome variables were (1) overall cognitive task performance (accuracy) and (2) the total number of task items completed during testing (completion rate) during standing and walking conditions. RESULTS One hundred ninety-one participants completed the study: 94 with concussion (tested mean = 5.1 ± 2.9 days postconcussion; 51% female; mean age = 17.1 ± 3.3 years) and 97 control subjects (40% female; mean age = 17.5 ± 2.1 years). The concussion group completed significantly fewer responses than the control group while standing still (37.3 ± 14.5 vs 45.1 ± 17.6 responses; P = 0.03) and while walking (22.7 ± 7.5 vs 33.6 ± 13.4 responses; P < 0.001). They were also significantly less accurate at spelling words backward (81.2 ± 28.6% correct vs 89.8 ± 15.0% correct; P = 0.049) and reciting months in reverse order (95.8 ± 10.4% correct vs 98.2 ± 4.2% correct; P = 0.034) while walking. CONCLUSIONS Athletes displayed lower cognitive task accuracy rates after concussion compared with control subjects during backward spelling and reverse month recitation tasks while walking but similar levels of accuracy while standing. Assessment of cognitive performance during dynamic tasks may be a clinically viable method to evaluate post-concussion deficits.
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Martini DN, Parrington L, Stuart S, Fino PC, King LA. Gait Performance in People with Symptomatic, Chronic Mild Traumatic Brain Injury. J Neurotrauma 2020; 38:218-224. [PMID: 32495691 DOI: 10.1089/neu.2020.6986] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
There is a dearth of knowledge about how symptom severity affects gait in the chronic (>3 months) mild traumatic brain injury (mTBI) population despite up to 53% of people reporting persisting symptoms after mTBI. The aim of this investigation was to determine whether gait is affected in a symptomatic, chronic mTBI group and to assess the relationship between gait performance and symptom severity on the Neurobehavioral Symptom Inventory (NSI). Gait was assessed under single- and dual-task conditions using five inertial sensors in 57 control subjects and 65 persons with chronic mTBI (1.0 year from mTBI). The single- and dual-task gait domains of Pace, Rhythm, Variability, and Turning were calculated from individual gait characteristics. Dual-task cost (DTC) was calculated for each domain. The mTBI group walked (domain z-score mean difference, single-task = 0.70; dual-task = 0.71) and turned (z-score mean difference, single-task = 0.69; dual-task = 0.70) slower (p < 0.001) under both gait conditions, with less rhythm under dual-task gait (z-score difference = 0.21; p = 0.001). DTC was not different between groups. Higher NSI somatic subscore was related to higher single- and dual-task gait variability as well as slower dual-task pace and turning (p < 0.01). Persons with chronic mTBI and persistent symptoms exhibited altered gait, particularly under dual-task, and worse gait performance related to greater symptom severity. Future gait research in chronic mTBI should assess the possible underlying physiological mechanisms for persistent symptoms and gait deficits.
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Affiliation(s)
- Douglas N Martini
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,Veterans Affairs Portland Healthcare System, Portland, Oregon, USA
| | - Lucy Parrington
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,Veterans Affairs Portland Healthcare System, Portland, Oregon, USA
| | - Samuel Stuart
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,Veterans Affairs Portland Healthcare System, Portland, Oregon, USA.,Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Peter C Fino
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, Utah, USA
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,Veterans Affairs Portland Healthcare System, Portland, Oregon, USA
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Pitt W, Chou LS. A case-control study of gait balance control in veterans with chronic symptoms following mTBI. Gait Posture 2020; 76:188-192. [PMID: 31862668 DOI: 10.1016/j.gaitpost.2019.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/27/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Numerous investigations suggest mild traumatic brain injury (mTBI) may result in persistent gait balance control deficits. Furthermore, military Veterans with symptoms of chronic mTBI often present with physical symptoms that may be associated with impaired gait balance control which may lead to prolonged recovery, difficulty performing activities of daily living, and increased disability. It is therefore important to objectively quantify gait balance deficits in Veterans with chronic mTBI. RESEARCH QUESTION Is gait balance control impaired in a group of Veterans with chronic symptoms of mTBI when compared to healthy matched Veterans? METHODS Eight Veterans with symptoms of chronic mTBI (1 F/7 M) and eight healthy matched Veterans (1 F/7 M) completed a gait balance assessment under single- (ST) and dual-task (DT) conditions. Gait balance control was quantified with whole body center of mass (COM) total medial-lateral (ML) displacement and peak ML velocity, which were calculated from camera-based motion capture. RESULTS Veterans with chronic mTBI walked with greater ML COM displacement (approximately 25 % increase) in both ST and DT walking (main effect of group, p = 0.018) when compared to healthy Veterans. The peak ML COM velocity was affected for both groups by performing a concurrent cognitive task (interaction effect, p = .012). Slower ML COM velocities in healthy Veterans suggest the adoption of a conservative balance control strategy, while faster ML COM velocities for Veterans with chronic mTBI may indicate a diminished ability to control ML momentum. SIGNIFICANCE Increased frontal plane COM motion under both ST and DT walking was observed in Veterans with chronic mTBI symptoms many years after injury. This suggests gait balance control may be adversely affected during divided attention gait and highlights the need for comprehensive gait analysis in the management of these individuals.
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Affiliation(s)
- Will Pitt
- Motion Analysis Laboratory, Department of Human Physiology, University of Oregon, Eugene, OR 97403, USA; Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, United States Military Academy, West Point, NY, 10966, USA
| | - Li-Shan Chou
- Motion Analysis Laboratory, Department of Human Physiology, University of Oregon, Eugene, OR 97403, USA; Department of Kinesiology, Iowa State University, Ames, IA 50011, USA.
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Stuart S, Parrington L, Morris R, Martini DN, Fino PC, King LA. Gait measurement in chronic mild traumatic brain injury: A model approach. Hum Mov Sci 2020; 69:102557. [DOI: 10.1016/j.humov.2019.102557] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 01/04/2023]
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Howell DR, Lynall RC, Buckley TA, Herman DC. Neuromuscular Control Deficits and the Risk of Subsequent Injury after a Concussion: A Scoping Review. Sports Med 2018; 48:1097-1115. [PMID: 29453743 DOI: 10.1007/s40279-018-0871-y] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
An emerging area of research has identified that an increased risk of musculoskeletal injury may exist upon returning to sports after a sport-related concussion. The mechanisms underlying this recently discovered phenomenon, however, remain unknown. One theorized reason for this increased injury risk includes residual neuromuscular control deficits that remain impaired despite clinical recovery. Thus, the objectives of this review were: (1) to summarize the literature examining the relationship between concussion and risk of subsequent injury and (2) to summarize the literature for one mechanism with a theorized association with this increased injury risk, i.e., neuromuscular control deficits observed during gait after concussion under dual-task conditions. Two separate reviews were conducted consistent with both specified objectives. Studies published before 9 December, 2016 were identified using PubMed, Web of Science, and Academic Search Premier (EBSCOhost). Inclusion for the objective 1 search included dependent variables of quantitative measurements of musculoskeletal injury after concussion. Inclusion criteria for the objective 2 search included dependent variables pertaining to gait, dynamic balance control, and dual-task function. A total of 32 studies were included in the two reviews (objective 1 n = 10, objective 2 n = 22). According to a variety of study designs, athletes appear to have an increased risk of sustaining a musculoskeletal injury following a concussion. Furthermore, dual-task neuromuscular control deficits may continue to exist after patients report resolution of concussion symptoms, or perform normally on other clinical concussion tests. Therefore, musculoskeletal injury risk appears to increase following a concussion and persistent motor system and attentional deficits also seem to exist after a concussion. While not yet experimentally tested, these motor system and attentional deficits may contribute to the risk of sustaining a musculoskeletal injury upon returning to full athletic participation.
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Affiliation(s)
- David R Howell
- Department of Orthopedics, Sports Medicine Center, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Avenue B060, Aurora, CO, 80045, USA. .,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.
| | - Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.,Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, USA
| | - Daniel C Herman
- Divisions of Physical Medicine and Rehabilitation, Sports Medicine, and Research, Department of Orthopaedics and Rehabilitation, Orthopaedics and Sports Medicine Institute, University of Florida, Gainesville, FL, USA
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Adams R, Lau GK, Dai JB, Li AY, Cheung KP, Haider S, Gometz A, Post AF, Choudhri TF. Evaluation of Concussion Incidence and Modulating Factors in the 2013-2017 Australian Football League. Cureus 2018; 10:e3465. [PMID: 30585281 PMCID: PMC6300188 DOI: 10.7759/cureus.3465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction The increasing awareness and popularization of concussions in the research realm over the last few years have begun to shed more light on the detrimental effects associated with repetitive head trauma. While the majority of the current literature focuses on the National Football League (NFL) and National Hockey League (NHL), several other high-impact sports have been implementing concussion management protocols to protect their players. The Australian Football League (AFL) is a prime example of a major contact sport that has undertaken recent changes to its concussion assessment and management modalities. We recognize the benefit of reporting potential changes in concussion rates over the 2013-2017 AFL seasons. We were interested in some of the factors not yet evaluated before, which may contribute to the overall concussion incidence such as “style-of-play” factors” (home/away, win/loss, points scored, time of season). We hope the results of this analysis shed light on the mechanisms by which concussion rates can be mitigated across major contact sports. Methods Data were obtained from the weekly injury list published by the AFL, a publicly available website. Details of players listed with concussions were collected from regular season games (890 games total) of 18 AFL teams from 2013 to 2017. Weekly injury lists were retrospectively compared using THE AGE, a publicly available newspaper published and owned by Fairfax Media. Data were analyzed utilizing GraphPad Prism 6 (GraphPad Software Inc., CA, US). In addition to descriptive statistics, Fisher's exact tests, Welch’s two-tailed t-tests, and correlation tests were used. Alpha level < 0.05 was considered significant for all tests. Results The dataset comprised 236 total concussions between the 2013 and 2017 AFL seasons. We noted a significant increase in the concussion rate (p = 0.0010) between the 2013 and 2017 seasons. This result was complemented by a significant increase in average games missed between the 2014 and 2015 seasons (p = 0.0002); however, this trend was not significant when evaluating the 2013 and 2017 seasons directly (p = 0.0951). Further analysis into the "style of play" factors on concussion incidence, such as average points scored, win/loss, home/away, and time of season, produced non-significant results. Conclusion Our study identified a significant increasing trend in concussion rate and average games missed that correlate to the data analysis in other high-impact sports such as the NFL and NHL. However, further research is necessary to determine if these findings indicate the improvement in concussion management and player safety measures beginning to develop in high-impact sports. We also noted that certain “style of play” factors (points scored, win/loss, home/away, and time of season) have no significant implication on concussion rate during the 2013-2017 AFL seasons. While we consider our data source to be reliable in the reporting of concussions from the AFL, the ideal data set would comprise a medical diagnosis from the team of doctors. It may be possible that our data set is underreporting the total amount of concussions between the 2013 and 2017 AFL seasons. Return-to-play times were not ascertained directly from the team doctor for the clearance date. It may be possible that this data collection modality led to missed cases of head injury or return to play times, which could impact the reliability of our dataset.
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Affiliation(s)
- Ryan Adams
- Neurosurgery, The Icahn School of Medicine at Mount Sinai, New York, USA
| | - George K Lau
- Miscellaneous, Touro College of Medicine, Bronx, USA
| | - Jennifer B Dai
- Neurosurgery, The Icahn School of Medicine at Mount Sinai, New York, USA
| | - Adam Y Li
- Neurosurgery, The Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Syed Haider
- Neurosurgery, The Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alex Gometz
- Physical Medicine and Rehabilitation, Concussion Management of New York, New York, USA
| | - Alexander F Post
- Neurosurgery, The Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tanvir F Choudhri
- Neurosurgery, The Icahn School of Medicine at Mount Sinai, New York, USA
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Fino PC, Parrington L, Pitt W, Martini DN, Chesnutt JC, Chou LS, King LA. Detecting gait abnormalities after concussion or mild traumatic brain injury: A systematic review of single-task, dual-task, and complex gait. Gait Posture 2018; 62:157-166. [PMID: 29550695 DOI: 10.1016/j.gaitpost.2018.03.021] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 03/01/2018] [Accepted: 03/07/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND While a growing number of studies have investigated the effects of concussion or mild traumatic brain injury (mTBI) on gait, many studies use different experimental paradigms and outcome measures. The path for translating experimental studies for objective clinical assessments of gait is unclear. RESEARCH QUESTION This review asked 2 questions: 1) is gait abnormal after concussion/mTBI, and 2) what gait paradigms (single-task, dual-task, complex gait) detect abnormalities after concussion. METHODS Data sources included MEDLINE/PubMed, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) accessed on March 14, 2017. Original research articles reporting gait outcomes in people with concussion or mTBI were included. Studies of moderate, severe, or unspecified TBI, and studies without a comparator were excluded. RESULTS After screening 233 articles, 38 studies were included and assigned to one or more sections based on the protocol and reported outcomes. Twenty-six articles reported single-task simple gait outcomes, 24 reported dual-task simple gait outcomes, 21 reported single-task complex gait outcomes, and 10 reported dual-task complex gait outcomes. SIGNIFICANCE Overall, this review provides evidence for two conclusions: 1) gait is abnormal acutely after concussion/mTBI but generally resolves over time; and 2) the inconsistency of findings, small sample sizes, and small number of studies examining homogenous measures at the same time-period post-concussion highlight the need for replication across independent populations and investigators. Future research should concentrate on dual-task and complex gait tasks, as they showed promise for detecting abnormal locomotor function outside of the acute timeframe. Additionally, studies should provide detailed demographic and clinical characteristics to enable more refined comparisons across studies.
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Affiliation(s)
- Peter C Fino
- Department of Neurology, Oregon Health & Science University, United States; Veterans Affairs Portland Health Care System, United States.
| | - Lucy Parrington
- Department of Neurology, Oregon Health & Science University, United States
| | - Will Pitt
- Department of Human Physiology, University of Oregon, United States
| | - Douglas N Martini
- Department of Neurology, Oregon Health & Science University, United States; Veterans Affairs Portland Health Care System, United States
| | - James C Chesnutt
- Department of Orthopedics & Rehabilitation and Family Medicine, Oregon Health & Science University, United States
| | - Li-Shan Chou
- Department of Human Physiology, University of Oregon, United States
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, United States; National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, United States
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Abstract
Study Design Systematic review. Background When assessed in isolation, balance and neurocognitive testing may not be sufficiently responsive to capture changes that occur with concussion. Normal daily activities require simultaneous cognitive and physical demands. Therefore, a dual-task assessment paradigm should be considered to identify performance deficits. Objectives To evaluate the literature and to identify dual-task testing protocols associated with changes in gait after concussion. Methods A systematic review of articles of individuals with concussion who underwent dual-task testing with a combination of motor and cognitive tasks was conducted. The AMED, CINAHL, Embase, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science databases and gray literature were searched from inception to January 29, 2017. Title and abstract, full-text, and quality review and data abstraction were performed by 2 independent reviewers. Results Twenty-four articles met the inclusion criteria. Eleven articles reported decreased gait velocity and increased medial-lateral displacement for individuals with concussion during dual-task conditions. Overall, included articles were of poor to moderate methodological quality. Fifteen articles used the same participants and data sets, creating a threat to validity and limiting the ability to make conclusions. Conclusion A deterioration in gait performance during dual-task testing is present among people with concussion. Specific recommendations for the use of a dual-task protocol to assess individuals with suspected concussion injury in a clinical setting have yet to be determined. J Orthop Sports Phys Ther 2018;48(2):87-103. Epub 7 Nov 2017. doi:10.2519/jospt.2018.7432.
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Grants L, Powell B, Gessel C, Hiser F, Hassen A. GAIT DEFICITS UNDER DUAL - TASK CONDITIONS IN THE CONCUSSED ADOLESCENT AND YOUNG ATHLETE POPULATION: A SYSTEMATIC REVIEW. Int J Sports Phys Ther 2017; 12:1011-1022. [PMID: 29234553 PMCID: PMC5717477 DOI: 10.26603/ijspt20171011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are no current sport concussion assessments that capture the effects of dual-task conditions on gait. Multiple studies have evaluated changes, but none have comprehensively examined literature related to the adolescent and young adult population.Purpose: The purpose of this systematic review is to synthesize documented changes in gait under dual-task conditions in adolescents and young adults after sustaining a concussion.Study Design: Systematic Review. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was consulted to guide this systematic review. Six databases were searched: Cinahl, ProQuest, PubMed, Scopus, SPORTdiscus, and Web of Science. Concussion, gait, and dual-task, along with their synonymous terms were the search terms used. Inclusion criteria consisted of adolescent and young adult age groups, acute concussion, dual-tasking, and matched controls. Quality assessment was performed using The Joanna Briggs Institute Critical Appraisal Checklist for Case Control Studies. RESULTS Ten full-text articles were selected for inclusion. Concussed individuals demonstrated longer stride times with shorter stride lengths, increased mediolateral displacement with corresponding increases in sagittal and frontal plane peak velocity, and decreased sagittal plane Center of Mass (COM) and Center of Pressure (COP) displacement. The majority of included studies demonstrated moderate to large effect sizes in these gait characteristics. CONCLUSION Concussed individuals demonstrated decreased gait stability while ambulating with a dual-task condition. Though statistically significant differences between concussed individuals and matched controls lasted only 72 hours, concussed individuals demonstrated continued improvements in gait for up to two months post-injury, which has the potential to affect an athlete's ability to perform. Further research is needed to determine if a gait examination with a dual-task condition is a realistic, reliable, and valid measure to be included in return to sport testing. LEVEL OF EVIDENCE 2a.
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13
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Martini DN, Broglio SP. Long-term effects of sport concussion on cognitive and motor performance: A review. Int J Psychophysiol 2017; 132:25-30. [PMID: 29017781 DOI: 10.1016/j.ijpsycho.2017.09.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 09/14/2017] [Accepted: 09/25/2017] [Indexed: 02/05/2023]
Abstract
Motor and cognitive dysfunction is intractable sequela in the acute stage of concussion. While typical concussion recovery occurs in two weeks, empirical evidence suggests that some sequela persist beyond this period, though there is inconsistency surrounding the duration the sequela persist. In part, confusion around the issue is limited by the volume of literature evaluating those with a concussion history, permitting vast interpretations of significance. The purpose of this paper is to review the concussion history literature, summarizing the long-term effects of concussion history on motor and cognitive performance. Additionally, this review intends to provide direction and options of future investigations addressing the long-term effects of concussion on motor and cognitive performance.
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Affiliation(s)
- Douglas N Martini
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States.
| | - Steven P Broglio
- NeuroTrauma Research Laboratory, University of Michigan, School of Kinesiology, Ann Arbor, MI, United States
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Martini DN, Eckner JT, Meehan SK, Broglio SP. Long-term Effects of Adolescent Sport Concussion Across the Age Spectrum. Am J Sports Med 2017; 45:1420-1428. [PMID: 28298054 PMCID: PMC6813832 DOI: 10.1177/0363546516686785] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Research in sport concussion has increased greatly over the previous decade due to increased scientific interest as well as the media and political spotlight that has been cast on this injury. However, a dearth of literature is available regarding the long-term (>1 year after concussion) effects of adolescent concussion on cognitive and motor performance of high school athletes. PURPOSE To evaluate the potential for long-term effects of concussion sustained during high school on cognitive and motor performance across the lifespan. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Adults with (n = 30) and without (n = 53) a concussion history were recruited in 3 age groups: younger (18-30 years; n = 43), middle-aged (40-50 years; n = 18), and older (≥60 years; n = 22). Each participant completed a computerized neurocognitive assessment and continuous tracking and discrete temporal auditory tasks with the hand and foot. Root mean squared error and timing variability were derived from the tracking and temporal auditory tasks, respectively. Data were analyzed by regression analyses for each recorded variable. RESULTS The analysis revealed significant age effects on neurocognitive task, continuous tracking task, and discrete auditory timing task performance ( P values < .05). No concussion history or interaction (concussion history by age) effects were found for performance on any task ( P values > .05). CONCLUSION While longitudinal investigations are still needed, this cross-sectional study failed to identify any observable effect of adolescent concussion history on cognition or motor performance with age.
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Affiliation(s)
- Douglas N. Martini
- NeuroTrauma Research Laboratory, University of Michigan, School of Kinesiology, Ann Arbor, Michigan, USA
| | - James T. Eckner
- Michigan NeuroSport, University of Michigan, Ann Arbor, Michigan, USA.,Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Sean K. Meehan
- Human Sensorimotor Laboratory, University of Michigan, School of Kinesiology, Ann Arbor, Michigan, USA
| | - Steven P. Broglio
- NeuroTrauma Research Laboratory, University of Michigan, School of Kinesiology, Ann Arbor, Michigan, USA
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