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Jain D, Graci V, Beam ME, Master CL, Prosser LA, McDonald CC, Arbogast KB. Impaired Neuromotor Control During Gait in Concussed Adolescents-A Frequency Analysis. J Appl Biomech 2024; 40:138-146. [PMID: 38154023 DOI: 10.1123/jab.2023-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/27/2023] [Accepted: 11/06/2023] [Indexed: 12/30/2023]
Abstract
Disruptions in gait function are common after concussion in adolescents; however, the neuromotor control deficits driving these gait disruptions are not well known. Fifteen concussed (age mean [SD]): 17.4 [0.6], 13 females, days since injury: 26.3 [9.9]) and 17 uninjured (age: 18.0 [0.7], 10 females) adolescents completed 3 trials each of single-task gait and dual-task gait (DT). During DT, participants simultaneously walked while completing a serial subtraction task. Gait metrics and variability in instantaneous mean frequency in lower extremity muscles were captured by inertial sensors and surface electromyography, respectively. A 2-way analysis of covariance was used to compare gait metrics across groups and conditions. Functional principal components analysis was used to identify regions of variability in instantaneous mean frequency curves. Functional principal component scores were compared across groups using a Welch statistic. Both groups displayed worse performance on gait metrics during DT condition compared to single-task, with no differences between groups (P < .001). Concussed adolescents displayed significantly greater instantaneous mean frequency, indicated by functional principal component 1, in the tibialis anterior, biceps femoris, and semitendinosus (P < .05) during single-task and DT compared with uninjured adolescents. Our observations suggest that concussed adolescents display inefficient motor unit recruitment lasting longer than 2 weeks following injury, regardless of the addition of a secondary task.
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Affiliation(s)
- Divya Jain
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Valentina Graci
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Megan E Beam
- Department of Physical Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christina L Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laura A Prosser
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Rehabilitation Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Catherine C McDonald
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Jain D, Graci V, Beam ME, Ayaz H, Prosser LA, Master CL, McDonald CC, Arbogast KB. Neurophysiological and gait outcomes during a dual-task gait assessment in concussed adolescents. Clin Biomech (Bristol, Avon) 2023; 109:106090. [PMID: 37696165 PMCID: PMC10758982 DOI: 10.1016/j.clinbiomech.2023.106090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Gait deficits are common after concussion in adolescents. However, the neurophysiological underpinnings of these gait deficiencies are currently unknown. Thus, the goal of this study was to compare spatiotemporal gait metrics, prefrontal cortical activation, and neural efficiency between concussed adolescents several weeks from injury and uninjured adolescents during a dual-task gait assessment. METHODS Fifteen concussed (mean age[SD]: 17.4[0.6], 13 female, days since injury: 26.3[9.9]) and 17 uninjured adolescents (18.0[0.7], 10 female) completed a gait assessment with three conditions repeated thrice: single-task walking, single-task subtraction, and dual-task, which involved walking while completing a subtraction task simultaneously. Gait metrics were measured using an inertial sensor system. Prefrontal cortical activation was captured via functional near-infrared spectroscopy. Neural efficiency was calculated by relating gait metrics to prefrontal cortical activity. Differences between groups and conditions were examined, with corrections for multiple comparisons. FINDINGS There were no significant differences in gait metrics between groups. Compared to uninjured adolescents, concussed adolescents displayed significantly greater prefrontal cortical activation during the single-task subtraction (P = 0.01) and dual-task (P = 0.01) conditions with lower neural efficiency based on cadence (P = 0.02), gait cycle duration (P = 0.03), step duration (P = 0.03), and gait speed (P = 0.04) during the dual-task condition. INTERPRETATION Our findings suggest that several weeks after injury concussed adolescents demonstrate lower neural efficiency and display a cost to gait performance when cognitive demand is high, e.g., while multitasking, suggesting that the concussed adolescent brain is less able to compensate when attention is divided between two concurrent tasks.
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Affiliation(s)
- Divya Jain
- Department of Bioengineering, University of Pennsylvania, USA; Center for Injury Research and Prevention, Children's Hospital of Philadelphia, USA.
| | - Valentina Graci
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, USA; School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Megan E Beam
- Department of Physical Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hasan Ayaz
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, USA; School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA; Department of Psychological and Brain Sciences, College of Arts and Sciences, Drexel University, Philadelphia, PA, USA; Drexel Solutions Institute, Drexel University, Philadelphia, PA, USA; School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura A Prosser
- Division of Rehabilitation Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christina L Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Catherine C McDonald
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, USA; School of Nursing, University of Pennsylvania, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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