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Petersell TL, Quammen DL, Crofts R, Morris AJ, Fino NF, Jensen CB, Hollien A, Pelo R, Roemmich BJ, Dibble LE, Fino PC. Instrumented Static and Reactive Balance in Collegiate Athletes: Normative Values and Minimal Detectable Change. J Athl Train 2024; 59:608-616. [PMID: 38014789 PMCID: PMC11220770 DOI: 10.4085/1062-6050-0403.23] [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] [Indexed: 11/29/2023]
Abstract
CONTEXT Wearable sensors are increasingly popular in concussion research because of their objective quantification of subtle balance deficits. However, normative data and minimal detectable change (MDC) values are necessary to serve as references for diagnostic use and tracking longitudinal recovery. OBJECTIVE To identify normative and MDC values for instrumented static- and reactive-balance tests, an instrumented static mediolateral (ML) root mean square (RMS) sway standing balance assessment and the instrumented, modified push and release (I-mP&R), respectively. DESIGN Cross-sectional study. SETTING Clinical setting. PATIENTS OR OTHER PARTICIPANTS Normative static ML RMS sway and I-mP&R data were collected on 377 (n = 184 female) healthy National Collegiate Athletic Association Division I athletes at the beginning of their competitive seasons. Test-retest data were collected in 36 healthy control athletes based on standard recovery timelines after concussion. MAIN OUTCOME MEASURE(S) Descriptive statistics, intraclass correlation coefficients (ICCs), and MDC values were calculated for primary outcomes of ML RMS sway in a static double-limb stance on firm ground and a foam block, and time to stability and latency from the I-mP&R in single- and dual-task conditions. RESULTS Normative outcomes across static ML RMS sway and I-mP&R were sensitive to sex and type of footwear. Mediolateral RMS sway demonstrated moderate reliability in the firm condition (ICC = 0.73; MDC = 2.7 cm/s2) but poor reliability in the foam condition (ICC = 0.43; MDC = 11.1 cm/s2). Single- and dual-task times to stability from the I-mP&R exhibited good reliability (ICC = 0.84 and 0.80, respectively; MDC = 0.25 and 0.29 seconds, respectively). Latency from the I-mP&R had poor to moderate reliability (ICC = 0.38 and 0.55; MDC = 107 and 105 milliseconds). CONCLUSIONS Sex-matched references should be used for instrumented static- and reactive-balance assessments. Footwear may explain variability in static ML RMS sway and time to stability of the I-mP&R. Moderate-to-good reliability suggests time to stability from the I-mP&R and ML RMS static sway on firm ground can be used for longitudinal assessments.
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Affiliation(s)
| | | | | | - Amanda J. Morris
- Departments of Health & Kinesiology and
- Department of Kinesiology, California State University Sacramento
| | - Nora F. Fino
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City
| | | | | | - Ryan Pelo
- Physical Therapy and Athletic Training and
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Anderson MN, C Lynall R, O'Connor PJ, Schmidt JD. Initial investigation of kinesiophobia as a predictor of functional reaction time one year after concussion. Concussion 2024; 9:CNC115. [PMID: 39056003 PMCID: PMC11270635 DOI: 10.2217/cnc-2023-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/04/2024] [Indexed: 07/28/2024] Open
Abstract
Aim The relationship between post-concussion kinesiophobia and clinical and functional reaction time (RT) beyond clinical recovery remains to be elucidated. Methods College-aged participants with (n = 20) and without (n = 20) a concussion history completed patient-reported outcomes, and RT tasks. Kinesiophobia, symptoms and RTs were compared using t-tests. Linear regressions were performed to determine if kinesiophobia predicted RT measures and dual-task cost. Results The concussion history group reported higher scores (p < 0.01) for all patient-reported outcomes. We observed significant single-task RT differences between groups (p = 0.013) such that those without a concussion history (m = 0.51s ± 0.08) were faster (m = 0.59s ± 0.12). There were no clinical or dual-task RT differences between groups (p > 0.05). Kinesiophobia significantly predicted single-task RT (R2 = 0.22). Discussion Kinesiophobia should be considered when measuring RT.
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Affiliation(s)
- Melissa N Anderson
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, OH 45701, USA
- College of Health Sciences & Professions, Ohio University, Athens, OH 45701, USA
| | - Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA 30605, USA
| | - Patrick J O'Connor
- Exercise Psychology Laboratory, Department of Kinesiology, University of Georgia, Athens, GA 30605, USA
| | - Julianne D Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA 30605, USA
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Anderson M, Claros CC, Qian W, Brockmeier A, Buckley TA. Integrative data analysis to identify persistent post-concussion deficits and subsequent musculoskeletal injury risk: project structure and methods. BMJ Open Sport Exerc Med 2024; 10:e001859. [PMID: 38268526 PMCID: PMC10806548 DOI: 10.1136/bmjsem-2023-001859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 01/26/2024] Open
Abstract
Concussions are a serious public health problem, with significant healthcare costs and risks. One of the most serious complications of concussions is an increased risk of subsequent musculoskeletal injuries (MSKI). However, there is currently no reliable way to identify which individuals are at highest risk for post-concussion MSKIs. This study proposes a novel data analysis strategy for developing a clinically feasible risk score for post-concussion MSKIs in student-athletes. The data set consists of one-time tests (eg, mental health questionnaires), relevant information on demographics, health history (including details regarding the concussion such as day of the year and time lost) and athletic participation (current sport and contact level) that were collected at a single time point as well as multiple time points (baseline and follow-up time points after the concussion) of the clinical assessments (ie, cognitive, postural stability, reaction time and vestibular and ocular motor testing). The follow-up time point measurements were treated as individual variables and as differences from the baseline. Our approach used a weight-of-evidence (WoE) transformation to handle missing data and variable heterogeneity and machine learning methods for variable selection and model fitting. We applied a training-testing sample splitting scheme and performed variable preprocessing with the WoE transformation. Then, machine learning methods were applied to predict the MSKI indicator prediction, thereby constructing a composite risk score for the training-testing sample. This methodology demonstrates the potential of using machine learning methods to improve the accuracy and interpretability of risk scores for MSKI.
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Affiliation(s)
- Melissa Anderson
- School of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
| | - Claudio Cesar Claros
- Department of Electrical and Computer Engineering, University of Delaware, Newark, Delaware, USA
| | - Wei Qian
- Department of Applied Economics and Statistics, University of Delaware, Newark, Delaware, USA
| | - Austin Brockmeier
- Department of Electrical and Computer Engineering, University of Delaware, Newark, Delaware, USA
- Department of Computer and Information Sciences, University of Delaware, Newark, Delaware, USA
| | - Thomas A Buckley
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware, USA
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Santo AL, Joyce ME, Lynall RC. Tandem gait test-retest reliability among healthy physically active young adults. PM R 2023; 15:1098-1105. [PMID: 36191152 DOI: 10.1002/pmrj.12909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 08/20/2022] [Accepted: 08/31/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND A tandem gait assessment is recommended after concussion. There is limited research examining psychometric properties of tandem gait assessments. OBJECTIVE To determine tandem gait test intertrial and 1-week test-retest reliability. It was hypothesized that the tandem gait test would yield moderate to good reliability, times would improve across trials/sessions, and average scores would have higher reliability. DESIGN Reliability study. SETTING Research laboratory. INTERVENTIONS Sixty participants (36 females, age: 20.4 ± 1.8 years) completed 10 tandem gait test trials on two occasions. MAIN OUTCOME MEASURES Dependent variables included number of normal trials (participants stayed on the line, heel and toe touched on every step, and they avoided touching an examiner/object) and times for each trial. We analyzed intertrial reliability using a one-way analysis of covariance and intraclass correlation coefficients (ICC), and test-retest reliability using dependent samples t-tests and ICCs. RESULTS At the first testing session, there were significant differences in times across seven trials (F2.44,80.42 = 21.55, p < .001). All trials were faster than the first trial. The second, third, and fifth trial were faster than the previous trial. There was moderately high overall reliability across the first seven trials (ICC2,1 = 0.77, 95% confidence interval = 0.63, 0.87). All times were faster at the second testing session (compared to the first). Most outcomes for the 1-week test-retest reliability demonstrated at least moderate reliability, including the best times for the first three, four, and five trials; average times for the first four and five trials; and best and average times for all of the participants' normal trials during five and 10 attempted trials. CONCLUSIONS There are practice effects when administering multiple tandem gait test trials, but scores stabilize after the fifth trial. There are practice effects associated with multiple administrations of the tandem gait test, but outcomes using times for four or five trials have adequate 1-week test-retest reliability in healthy physically active young adults.
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Affiliation(s)
- Ashley L Santo
- Department of Kinesiology, Towson University, Towson, Maryland, USA
| | - Meredith E Joyce
- Department of Speech-Language Pathology and Audiology, Towson University, Towson, Maryland, USA
| | - Robert C Lynall
- Department of Kinesiology, University of Georgia, Athens, Georgia, USA
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Lowe L, Castillo F, Allen M, Israel M, Yates C. Spatiotemporal Parameters of Gait Among Adolescent Athletes with Concussion When Performing a Visuospatial Cognitive Task. Int J Sports Phys Ther 2023; 18:338-347. [PMID: 37020449 PMCID: PMC10069392 DOI: 10.26603/001c.71361] [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: 07/22/2022] [Accepted: 01/15/2023] [Indexed: 04/03/2023] Open
Abstract
Background Adolescent athletes aged 10 to 19 years are at the highest risk of experiencing sport-related concussions (SRCs). Despite the known deficits and battery of assessments following concussion, postural stability during dual-task gait remains understudied in this population. Purpose The purpose of this study was to evaluate the dual-task cost (DTC) in adolescents with an acute or chronic SRC compared to reference values from healthy athlete peers for spatiotemporal parameters of gait during walking with and without a concurrent visuospatial memory task presented on a hand-held tablet. Researchers hypothesized that adolescents during the acute phase of concussion would be likely to experience a greater DTC compared to healthy peers in at least one spatiotemporal parameter of gait when walking within the dual-task paradigm. Study Design Cross-sectional, observational cohort design. Methods Adolescents with concussion were recruited to participate. Subjects were divided into acute and chronic categories based on significant differences in the neuropsychological function after a period of 28 days. They walked at a self-selected speed along the 5.186-meter GAITRite® Walkway System with and without a concurrent visuospatial cognitive task presented on a hand-held tablet. Outcomes included normalized velocity (m/s), step length (m), and double limb (DLS) and single limb support (SLS) (defined as the percent of a gait cycle [%GC]). The data were then compared to the previously published reference values established using the same methods in the healthy athlete participants for all spatiotemporal parameters of gait. Results Data was collected on 29 adolescent athletes with SRC. Among males (15.53+/-1.12 years) with SRC, 20% of acute and 10% of chronic cases experienced a greater DTC compared to healthy athlete reference values. A similarly increased DTC was experienced by 83% of acute and 29% of chronic SRC cases for females (15.58+/-1.16 years). Conclusions Adolescent athletes with concussion may continue demonstrating deficits in gait capabilities even in the chronic phase, and compensatory gait strategies were not the same between males and females. Dual-task cost assessment using the GAITRite® may be a valuable adjunct to comprehensive analysis of gait following SRC. Level of Evidence 2.
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Affiliation(s)
- Leah Lowe
- Physical Therapy University of Central Arkansas
| | | | | | - Michael Israel
- Orthopedics, Pediatrics Arkansas Children's Hospital, University of Arkansas for Medical Sciences
| | - Charlotte Yates
- Physical Therapy University of Central Arkansas, University of Arkansas for Medical Sciences
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Oldham JR, Howell DR, Knight CA, Crenshaw JR, Buckley TA. Single-Task and Dual-Task Tandem Gait Performance Across Clinical Concussion Milestones in Collegiate Student-Athletes. Clin J Sport Med 2021; 31:e392-e397. [PMID: 32852299 PMCID: PMC7887129 DOI: 10.1097/jsm.0000000000000836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/19/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the length of time after concussion that impaired tandem gait performance is observed. DESIGN Clinical measurement, prospective longitudinal. SETTING NCAA collegiate athletic facility. PARTICIPANTS Eighty-eight concussed NCAA Division I student-athletes and 30 healthy controls. INDEPENDENT VARIABLES Group (concussion/control) and time (Baseline, Acute, Asymptomatic, and RTP). MAIN OUTCOME MEASURES Participants completed 4 single-task and dual-task tandem gait trials. The concussion group completed tests at the following time points: preseason (Baseline), within 48 hours after concussion (Acute), on the day symptoms were no longer reported (Asymptomatic), and when cleared to return to sports (RTP). Controls completed the same protocol at similar intervals. The dual-task trials involved minimental style cognitive questions answered simultaneously during tandem gait. We analyzed the best time of the 4 trials, comparing groups with a linear mixed model. RESULTS Acutely after concussion, the concussion group performed single-task tandem gait slower (worse) than controls (concussion: 11.36 ± 2.43 seconds, controls: 9.07 ± 1.78 seconds, P < 0.001). The concussion group remained significantly slower than controls (9.95 ± 2.21 vs 8.89 ± 1.65 seconds, P = 0.03) at Asymptomatic day but not RTP. There were significant group (P < 0.001) and time (P < 0.001) effects for dual-task tandem gait. The groups were not significantly different at baseline for single-task (P = 0.95) or dual-task (P = 0.22) tandem gait. CONCLUSIONS Our results indicate that tandem gait performance is significantly impaired acutely after concussion, compared with both preseason measures and controls. Postural control impairments were not present when the student-athletes were cleared for RTP. This information can assist clinicians when assessing postural control and determining recovery after a concussive injury.
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Affiliation(s)
- Jessie R. Oldham
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children’s Hospital, Boston, MA, USA
| | - David R. Howell
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christopher A. Knight
- 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
| | - Jeremy R. Crenshaw
- 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
| | - 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
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The tandem gait test: kinematics and temporal parameters for normal children and for posterior fossa tumor survivors. КЛИНИЧЕСКАЯ ПРАКТИКА 2021. [DOI: 10.17816/clinpract77018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Tandem Gait (TG) testing is known as a clinical method for studying the walking function with complicated coordination. The precise biomechanical walking parameters in this test remain poorly investigated. Moreover, TG is a modified locomotion of walking. In general, walking is a highly automated movement. TG introduces a component of voluntary control into it.
Aims: A study of functional and biomechanical symptoms in children after the treatment for the posterior fossa tumor in the long term.
Methods: The study involved 15 healthy subjects aged 12 to 35 years (20.47.2), among them 4 men and 11 women control group. The group of patients comprised 33 children who had a tumor of the posterior cranial fossa (HF) at the age of 7 to 17 years (12.33.1), of these 15 boys and 18 girls, who were admitted for rehabilitation treatment to the "Russkoe pole" Rehabilitation Center. A study on the TG kinematics was performed with the Optitrack system.
Results: The results showed asymmetry in the duration of the step cycle and an increase in its duration proportional to the severity of the functional state. The pelvic movements showed different abnormalities. The flexion-extension movements in the hip joints were characterized by an extension lag at the end of the transfer period and a slight decrease in the amplitude, which probably became more pronounced with an increase in the degree of the motor impairment. The movements in the knee joints demonstrated two main phenomena: an increase in the flexion setting of the joint and a decrease in the amplitude of the main swing flexion. In addition, there was a delay in the maximum of the swing flexion. The kinematic parameters of the TG of the examined patients, in contrast to the control group, are not stable. This is, presumably, due to the fact, that normally such a modification of walking is easily automated and does not require voluntary control. In patients with SCF, each step in the TG mode requires additional voluntary control, and under these conditions, the stability and repeatability of a movement are dramatically reduced.
Conclusions: In contrast to the routine clinical version of the test, the analysis of the movement biomechanics allows one to present an accurate qualitative and quantitative characterization of functional disorders. According to our research, motor function disorders develop at various levels of the musculoskeletal system. The degree of their severity is in a good agreement with the expert assessment of the patient's functional state.
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Sport-related concussion adopt a more conservative approach to straight path walking and turning during tandem gait. J Clin Transl Res 2021; 7:443-449. [PMID: 34667890 PMCID: PMC8520699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND It is currently unknown what specific neuronal deficits influence postural instability following SRC; however, the modulation of postural control relies heavily on the appropriate integration of sensory information from the visual, vestibular, and somatosensory system. It is possible symptom provocation of vestibular or ocular function is related to unsteady gait patterns during tandem gait. AIM The purpose of this study was to evaluate the differences in temporal and center of pressure (CoP) metrics during discrete events of instrumented tandem gait (iTG) among those with sport-related concussion (SRC) compared to healthy controls. Secondarily, this study attempted to evaluate the relationship between iTG CoP metrics and the Vestibular/Ocular Motor Screening (VOMS) Exam. MATERIALS AND METHODS 30 collegiate athletes with SRC and 30 healthy controls completed three single task (ST) iTG trials on an instrumented walkway and the VOMS. All individuals with SRC were assessed within 24-48 h post-injury while all controls were measured during pre-participation physicals. CoP metrics in the anteroposterior (AP) and mediolateral (ML) directions and time to completion were evaluated during the first, turn and second pass of iTG between groups. VOMS score was correlated to the CoP metrics across the discrete events. RESULTS Athletes with SRC took longer to complete tandem gait (P<0.001) along with the first pass, second pass but not the turn when compared to the control group. SRC had slower velocity in the AP direction during both the first (P<0.001) and second pass (P<0.001) with increased postural sway in the ML direction during the first pass (P=0.014). During the turn, athletes with SRC had postural sway in the ML direction (P=0.008). Finally, VOMS score was weakly negatively related to CoP velocity in the AP direction during first (r=-0.39) and second (r=-0.36) pass while being weakly positively related to postural sway during the turn (r=-0.30). CONCLUSIONS Athletes with SRC adopted a more conservative walking pattern and the presence of vestibular and/or ocular symptoms influence the ability to perform heel-to-toe walking. RELEVANCE FOR PATIENTS Individuals with SRC will walk slower during heel-to-toe walking and move more in the ML direction with great movement in the ML direction while en pointe turning. This may increase given the total amount of vestibular or vision symptoms following the SRC.
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Gait Assessment in College Athletes: Do Concussion History, Symptoms, Gender, and Type of Sport Matter? J Sport Rehabil 2021; 30:988-999. [PMID: 33418540 DOI: 10.1123/jsr.2019-0331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/20/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Though previous research has focused on examining the effects of concussion history using a dual-task paradigm, the influence of factors like symptoms (unrelated to concussion), gender, and type of sport on gait in college athletes is unknown. OBJECTIVE To examine the effect of concussion history, symptoms, gender, and type of sport (noncontact/limited contact/contact) individually on gait among college athletes. DESIGN Exploratory cross-sectional study. SETTING Laboratory. PARTICIPANTS In total, 98 varsity athletes (age, 18.3 [1.0] y; height, 1.79 [0.11] m; mass, 77.5 [19.2] kg; 27 with concussion history, 58 reported at least one symptom, 44 females; 8 played noncontact sports and 71 played contact sports) walked under single- and dual-task (walking while counting backward by 7) conditions. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Dual-task cost (DTC; % difference between single task and dual task) of gait speed, cadence, step length and width, percentage of swing and double-support phases, symptom score, and total symptom severity score. Independent samples t tests and 1-way analysis of variance were conducted (α value = .05). RESULTS Self-reported concussion history resulted in no significant differences (P > .05). Those who reported symptoms at testing time showed significantly greater DTC of step length (mean difference [MD], 2.7%; 95% confidence interval [CI], 0.3% to 5.1%; P = .012), % of swing phase (MD, 1.0%; 95% CI, -0.2 to 2.1%; P = .042), and % of double-support phase (MD, 3.9%; 95% CI, 0.2% to 7.8%; P = .019). Females demonstrated significantly higher DTC of gait speed (MD, 5.3%; 95% CI, 1.3% to 9.3%; P = .005), cadence (MD, 4.0%; 95% CI, 1.4% to 6.5%; P = .002), % of swing phase (MD, 1.2%; 95% CI, 0.1% to 2.3%; P = .019), and % of double-support phase (MD, 4.1%; 95% CI, 0.4% to 7.9%; P = .018). Noncontact sports athletes had significantly greater step width DTC than contact sports athletes (MD, 14.2%; 95% CI, 0.9% to 27.6%; P = .032). CONCLUSIONS Reporting symptoms at testing time may influence gait under dual-task conditions. Additionally, female athletes showed more gait changes during a dual task. Sports medicine professionals should be aware that these variables, while unrelated to injury, may affect an athlete's gait upon analysis.
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Walker GA, Wilson JC, Potter MN, Provance AJ, Kirkwood M, Howell DR. Age is associated with postural control performance following youth concussion. J Pediatr Rehabil Med 2021; 14:443-450. [PMID: 34219677 DOI: 10.3233/prm-190665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To examine the effect of age on postural control outcomes among patients being seen during their initial post-concussion clinical visit. METHODS Youth patients were seen≤14 days post-concussion, and completed a series of postural control evaluations: tandem gait, Romberg, and Balance Error Scoring System (BESS) tests. RESULTS We included 109 children 8-12 years of age (24% female, evaluated median = 7 [interquartile range = 4-10] days post-injury) and 353 adolescents aged 13-18 years (36% female, evaluated median = 7 [4-10] days post-injury). There was a higher proportion of children who demonstrated abnormal tandem gait relative to adolescents (26% vs. 11%; p < 0.001). They also made more BESS errors in single (median = 5 [2-10] vs. 4 [2-6] errors) and tandem (median = 3 [1-6] vs. 2 [0-4]) firm stances. After covariate adjustment, children demonstrated worse tandem gait (adjusted odds ratio = 3.05, 95% CI = 1.68-5.53) and more firm surface BESS errors (double stance β=0.51, 95% CI = 0.22-0.80; single stance β= 1.18, 95% CI = 0.42-1.95; tandem stance β= 0.98, 95% CI = 0.28-1.68) than adolescents. CONCLUSIONS Tandem gait and BESS performance following concussion differ in children compared to adolescents who present within 2 weeks of injury. Clinicians assessing and managing concussion should recognize age differences in postural control performance when assessing those with concussion.
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Affiliation(s)
- Gregory A Walker
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Julie C Wilson
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Morgan N Potter
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Aaron J Provance
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael Kirkwood
- Department of Physical Medicine and Rehabilitation, Children's Hospital of Colorado, Aurora, CO, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
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Oldham JR, Howell DR, Bryk KN, Lanois CJ, Koerte IK, Meehan WP, Buckley TA. No differences in tandem gait performance between male and female athletes acutely post-concussion. J Sci Med Sport 2020; 23:814-819. [PMID: 32336568 DOI: 10.1016/j.jsams.2020.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/27/2020] [Accepted: 04/03/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To test whether 1) concussed athletes demonstrate slower tandem gait times compared to controls and 2) concussed female athletes display greater post-injury deficits than males. DESIGN Prospective longitudinal METHOD: Fifty concussed collegiate student-athletes (32% female, age=20.18±1.27 years) completed tandem gait tests during pre-season (Time 1) and acutely (<72hours) post-concussion (Time 2), and twenty-five controls (52% female, age=21.08±2.22 years) completed tandem gait at two time points, 1.96±0.46 days apart. Participants completed four single-task (ST) and dual-task (DT) trials. During DT trials, they simultaneously completed a cognitive assessment. The best ST and DT times were recorded, along with cognitive accuracy, and the change score between the two assessments was calculated. A positive change in tandem gait time was indicative of worsening performance. A 2×2 (group*sex) ANOVA was used to examine change between pre-injury and post-injury tests for ST/DT tandem gait time and DT cognitive accuracy. RESULTS The change in tandem gait time from Time 1 to Time 2 was significantly higher for the concussion group relative to controls during both ST (Concussion: 1.36±2.6 seconds, Controls: -1.16±0.8 seconds, p<0.001) and DT (Concussion: 1.70±3.8 seconds, Controls: -0.94±1.7 seconds, p=0.002) tandem gait. There were no interactions or main effects of sex for tandem gait time or cognitive accuracy. CONCLUSIONS There were no sex-specific differences in the change in tandem gait performance among concussed collegiate athletes or controls. However, all concussed participants, regardless of sex, performed significantly worse on tandem gait than male and female controls, who both improved between testing time points.
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Affiliation(s)
- Jessie R Oldham
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA.
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kelsey N Bryk
- 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
| | - Corey J Lanois
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
| | - Inga K Koerte
- Department of Child and Adolescent Psychiatry, Psychomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA, 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
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12
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Caccese JB, Best C, Lamond LC, Difabio M, Kaminski TW, Watson D, Getchell N, Buckley TA. Effects of Repetitive Head Impacts on a Concussion Assessment Battery. Med Sci Sports Exerc 2020; 51:1355-1361. [PMID: 30649104 DOI: 10.1249/mss.0000000000001905] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to determine the relationship between repetitive head impacts (RHI) and clinical concussion assessments across a season among collegiate football (FB) and women's soccer (WSOC) players. METHODS Fifteen male FB and 23 WSOC players participated in this study. Participants were included if they were medically cleared for unrestricted athletic participation. Participants were tested in a university athletic training room on two occasions: preseason (PRE) and postseason (POST). The outcome measures consisted of tandem gait (TG), Standardized Assessment of Concussion, Balance Error Scoring System, King-Devick (KD), clinical reaction time, and Immediate Post-Concussion Assessment and Cognitive Testing. Repetitive head impact during the season was quantified using the Head Impact Telemetry System (Simbex, NH) for FB and the Smart Impact Monitor (SIM; Triax Technologies, Norwalk, CT) for WSOC. Independent variables included total number of impacts, average magnitude of peak linear acceleration, cumulative linear exposure, and number of impacts ≥98g. RESULTS Results from direct-entry multiple regression analyses suggest significant associations between RHI and both visual memory (R = 0.670, F = 6.487, P = 0.002) and TG (R = 0.636, F = 3.841, P = 0.029) for WSOC and between RHI and KD (R = 0.756, F = 5.579, P = 0.013) for FB, whereby those with greater exposure performed worse. No other regression analyses within or across groups were significant. CONCLUSIONS These data suggest that RHI do not represent clinically meaningful changes on a multifaceted and multimodal concussion assessment battery. However, there may be subtle visual/vestibular impairments as observed by the associations between RHI and visual memory/TG among WSOC, RHI, and KD among FB.
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Affiliation(s)
- Jaclyn B Caccese
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | | | - Lindsey C Lamond
- Department of Family Medicine, Wake Forest Baptist Health, Winston-Salem, NC
| | - Melissa Difabio
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | - Dan Watson
- University of Delaware Athletics, Newark, DE
| | - Nancy Getchell
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
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Howell DR, Brilliant AN, Meehan WP. Tandem Gait Test-Retest Reliability Among Healthy Child and Adolescent Athletes. J Athl Train 2019; 54:1254-1259. [PMID: 31657636 DOI: 10.4085/1062-6050-525-18] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT The tandem gait test is a method for assessing dynamic postural control and part of the Sport Concussion Assessment Tool, versions 3 and 5. However, its reliability among child and adolescent athletes has yet to be established. OBJECTIVE To examine the test-retest reliability of the single-task and dual-task tandem gait test among healthy child and adolescent athletes. DESIGN Descriptive laboratory study. SETTING Sports injury-prevention center. PATIENTS OR OTHER PARTICIPANTS Uninjured and healthy athletes between the ages of 9 and 18 years. INTERVENTION(S) Tandem gait measures repeated 3 times across the period of approximately 1 month. MAIN OUTCOME MEASURE(S) Participants completed the tandem gait test under single-task and dual-task (ie, while simultaneously executing a cognitive task) conditions. Our primary outcome measure was completion time during the single-task and dual-task conditions. We also assessed cognitive accuracy and response rate while participants completed the dual-task tandem gait test. RESULTS Thirty-two child and adolescent athletes completed the study (mean age = 14.3 ± 2.4 years; females = 16). Single-task tandem gait times were similar across the 3 testing sessions (14.4 ± 4.8, 13.5 ± 4.2, and 13.8 ± 4.8 seconds; P = .45). Dual-task tandem gait times steadily improved across the test timeline (18.6 ± 6.9, 16.6 ± 4.5, and 15.8 ± 4.7 seconds; P = .02). Bivariate correlations indicated moderately high to high agreement from test 1 to test 2 (single-task r = .627; dual-task r = 0.655) and from test 2 to test 3 (single-task r = 0.852; dual-task r = 0.775). Both the single-task (intraclass correlation coefficient; ICC [3,1] = 0.86; 95% confidence interval [CI] = 0.73, 0.93) and dual-task (ICC [3,1] = 0.84; 95% CI = 0.69, 0.92) conditions demonstrated high reliability across testing sessions. CONCLUSIONS Tandem gait outcome measures demonstrated high test-retest reliability in both the single- and dual-task conditions. The overall reliability was within the acceptable range for clinical practice, but improvements across tests suggested a moderate practice effect. Tandem gait represents a reliable, dynamic, postural-control test that requires minimal space, cost, and time.
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Affiliation(s)
- David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora.,Department of Orthopedics, University of Colorado School of Medicine, Aurora.,The Micheli Center for Sports Injury Prevention, Waltham, MA
| | - Anna N Brilliant
- The Micheli Center for Sports Injury Prevention, Waltham, MA.,Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, MA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA.,Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, MA.,Departments of Pediatrics and Orthopaedics, Harvard Medical School, Boston, MA
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14
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Galea OA, Bristow HD, Chisholm SM, Mersch ME, Nullmeyer J, Reid CR, Treleaven JM. Single and dual tandem gait assessment post concussion: What performance time is clinically relevant across adult ages and what can influence results? Musculoskelet Sci Pract 2019; 42:166-172. [PMID: 31031162 DOI: 10.1016/j.msksp.2019.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/01/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Abstract
AIM The three-metre tandem gait test (TG) is used to assess postural control during locomotion following sports concussion. However, values used to determine a pass/fail result are currently based on young athletic populations. Times for test completion may be influenced by several intrinsic or extrinsic factors. The aim of this study was to collate healthy individual single, dual task as well as dual task cost - motor TG times for a non-elite athlete population, across several age groups, and to investigate several potential influencing factors. METHODS Healthy individuals aged 18-55+, who had never experienced a concussion completed single and dual task TG following the SCAT5 protocol. A separate group (n = 20, age, foot length and body mass index matched) performed the tests with alternate instructions. RESULTS Mean best TG time for all participants were: single task 21.03 (±5.26s), dual task 29.59 (±9.84s) and DTC-motor 8.57 (±7.5s:41.7%). Age and foot length but not specificity of verbal instructions were related to TG times. Significantly slower single and dual task times were identified for the 55 + age group when compared to the three youngest groups (p < 0.01). No difference was seen for DTC-motor time or % between age groups (p > 0.05). CONCLUSION Healthy individual data collected exceeded previously reported average times. Faster times were evident in younger participants and those with longer foot length. Results from this study can be used as a reliable guideline to inform clinical decisions around the pass/fail result of TGT across age ranges in non-elite athlete populations post-concussion.
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Affiliation(s)
- Olivia A Galea
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, Australia.
| | - Hayden D Bristow
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, Australia
| | - Scott M Chisholm
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, Australia
| | - Michaela E Mersch
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, Australia
| | - Jocelyn Nullmeyer
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, Australia
| | - Chantelle R Reid
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, Australia
| | - Julia M Treleaven
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, Australia
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15
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Kaminski TW, Thompson A, Wahlquist VE, Glutting J. Self-reported head injury symptoms exacerbated in those with previous concussions following an acute bout of purposeful soccer heading. Res Sports Med 2019; 28:217-230. [PMID: 31257930 DOI: 10.1080/15438627.2019.1635130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Rates of concussion in soccer are high, especially in female players. The primary aim of this study was to examine differences in self-reported concussion-related symptoms (CRS), balance (BESS), and neurocognitive performance (ImPACT) following an acute bout of soccer heading in a group of female collegiate players with and without a history of concussion. Eighty-seven players with 0 to 3+ previous concussions participated. The measurement variables were assessed before and after heading sessions; including one linear and one rotational bout. Players with concussion histories reported more CRS than their non-concussed teammates both before and after the heading sessions. Balance and neurocognitive scores were generally unaffected. This finding should heighten our awareness to carefully monitor soccer players who have experienced concussions and be aware that they may develop concussion-like symptoms, especially after acute bouts of heading either during practice or in matches. The long-term implications of this finding remain unknown.
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Affiliation(s)
- Thomas W Kaminski
- Department of Kinesiology & Applied Physiology, Athletic Training Research Laboratory, University of Delaware, Newark, DE, USA
| | - Adam Thompson
- Family Medicine, Crozer Chester Medical Center, Springfield, PA, USA
| | - Victoria E Wahlquist
- Department of Kinesiology & Applied Physiology, Athletic Training Research Laboratory, University of Delaware, Newark, DE, USA
| | - Joseph Glutting
- School of Education, University of Delaware, Newark, DE, USA
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16
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Abstract
OBJECTIVES To (1) examine the association between a commonly used concussion test, tandem gait, in single/dual-task conditions with single-task and dual-task average walking speed, (2) characterize the prevalence of tandem gait false positives, and (3) develop a normative reference range of dual-task tandem gait times. DESIGN Cross-sectional study. SETTING Two NCAA collegiate athletic facilities. INDEPENDENT VARIABLES Athletes completed the tandem gait test and a gait evaluation in single/dual-task conditions during a preseason examination. MAIN OUTCOME MEASURES Associations between tandem gait times and average walking speeds were evaluated using multiple linear regression models. Various tandem gait test time pass/fail cutoffs were calculated to examine false-positive rates. RESULTS Among the 171 participants (103 men, 19.8 ± 1.2 years of age), dual-task tandem gait completion times were independently associated with dual-task average walking speed [β = -4.018; 95% confidence interval (CI), -7.153 to -0.883], but single-task associations were not found. Male gender was associated with faster tandem gait times in both single-task (β = -0.880, 95% CI, -1.731 to -0.029) and dual-task conditions (β = -2.225, 95% CI, -3.691 to -0.759). A pass/fail cutoff threshold of 14 seconds resulted in a 2% false-positive rate for single-task tandem gait, while it resulted in a 29% false-positive rate during dual-task tandem gait. CONCLUSIONS Average walking speed and dual-task tandem gait represent objective measures that are useful in concussion management. While a single-task tandem gait cutoff of 14 seconds seems appropriate for males, adjustments may be necessary based on sex and alternate pass/fail criteria may be appropriate for dual-task tandem gait.
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Oldham JR, Difabio MS, Kaminski TW, Dewolf RM, Howell DR, Buckley TA. Efficacy of Tandem Gait to Identify Impaired Postural Control after Concussion. Med Sci Sports Exerc 2019; 50:1162-1168. [PMID: 29315170 DOI: 10.1249/mss.0000000000001540] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose was to evaluate tandem gait (TG), Balance Error Scoring System (BESS), and modified Balance Error Scoring System (mBESS) performance acutely after concussion in collegiate student-athletes. In addition, we sought to evaluate the psychometric properties of TG, including minimal detectable change (MDC), sensitivity, and specificity. METHODS Seventy-six National Collegiate Athletic Association student-athletes performed TG and BESS tests: 38 acutely after concussion and 38 controls. Participants were tested at baseline (time 1) and again acutely after concussion, or the following year for controls (time 2). Ten controls, tested simultaneously by two researchers, established a TG interrater minimal detectable change. A 2 × 2 mixed-design ANOVA compared each outcome variable. An receiver operating characteristic curve analysis was used to evaluate sensitivity, specificity, and area under the curve (AUC). RESULT There was a significant interaction (F = 8.757, P = 0.004) for TG whereby the concussion group was slower after concussion (10.59 ± 1.53 vs 11.80 ± 2.67 s), whereas there was no difference for controls (10.13 ± 1.72 vs 9.93 ± 1.85 s). There was no significant interaction for BESS (F = 0.235, P = 0.630) or mBESS (F = 0.007, P = 0.935). TG had a sensitivity of 0.632, a specificity of 0.605, and an AUC of 0.704. BESS had a sensitivity of 0.447, a specificity of 0.500, and an AUC of 0.508. mBESS had a sensitivity of 0.474, a specificity of 0.632, and an AUC of 0.535. CONCLUSIONS Participants completed TG significantly slower after concussion, whereas no change across time was detected for controls. In contrast, BESS and mBESS performances were similar at both testing times in both groups. Our AUC analysis was acceptable for TG, but a failure for both BESS and mBESS; thus, TG may be a useful alternative for clinicians conducting postconcussion postural control assessments.
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Affiliation(s)
- Jessie R Oldham
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Melissa S Difabio
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE.,Biomechanics and Movement Science, University of Delaware, Newark, DE
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Ryan M Dewolf
- Sports Concussion Clinic, MassGeneral Hospital for Children, Boston, MA
| | - David R Howell
- Sports Medicine Center, Colorado Children's Hospital, Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE.,Biomechanics and Movement Science, University of Delaware, Newark, DE
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18
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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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Howell DR, Berkstresser B, Wang F, Buckley TA, Mannix R, Stillman A, Meehan WP. Self-reported sleep duration affects tandem gait, but not steady-state gait outcomes among healthy collegiate athletes. Gait Posture 2018; 62:291-296. [PMID: 29605797 DOI: 10.1016/j.gaitpost.2018.03.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/13/2018] [Accepted: 03/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sleep deficits are associated with motor and cognitive function deficits, even in the absence of a recent concussion. RESEARCH QUESTION Does the amount of self-reported sleep prior to pre-season concussion testing affect single-task and dual-task instrumented steady-state gait and timed tandem gait test performance? METHODS One hundred and fourteen healthy collegiate athletes (mean age 18.8 ± 0.7 years; 60% female) reported the amount of sleep they received during the prior night and completed a timed tandem gait test and an instrumented assessment of steady-state gait in both single-task and dual-task conditions. Outcome variables included spatio-temporal gait parameters during steady-state gait, best and mean tandem gait times, and cognitive test accuracy. RESULTS Participants who reported sleeping <7 h of sleep during the night prior to testing (n = 62) had significantly longer tandem gait times in single-task and dual-task conditions (11.1 ± 2.2 vs. 10.1 ± 2.0 s and 14.5 ± 4.3 vs. 12.3 ± 2.6 s, respectively; p = .009) compared to those who reported sleeping ≥7 h (n = 52). No significant differences between groups were observed for spatio-temporal steady-state gait variables or for cognitive test accuracy. SIGNIFICANCE Self-reported sleep duration may be associated with baseline testing tandem gait performance. Thus, as sleep can play a role in motor abilities, clinicians may consider interpreting tandem gait performance in light of sleep duration during the night prior to testing.
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Affiliation(s)
- David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA; The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.
| | | | - Francis Wang
- Harvard University Health Service, Cambridge, MA, 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
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Alexandra Stillman
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA, USA
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20
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Howell DR, Kirkwood MW, Provance A, Iverson GL, Meehan WP. Using concurrent gait and cognitive assessments to identify impairments after concussion: a narrative review. Concussion 2018; 3:CNC54. [PMID: 30202596 PMCID: PMC6094155 DOI: 10.2217/cnc-2017-0014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 12/21/2017] [Indexed: 02/05/2023] Open
Abstract
Understanding how a concussion affects an individual is oftentimes difficult for clinicians due to the varying symptom profiles reported by the patient and the multifaceted and heterogeneous nature of the injury. Accordingly, the interpretation of postconcussion performance can be challenging, because many different testing paradigms have been reported as potentially useful in the literature. Among the types of tests clinicians use to understand how concussion affects an individual, both gait and neurocognitive evaluations have demonstrated utility. Our purpose is to describe how combined gait and cognitive (i.e., dual task), as well as single-task gait and computerized neurocognitive examinations can assist clinical decision-making.
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Affiliation(s)
- David R Howell
- The Micheli Center for Sports Injury Prevention, Waltham, MA 02453, USA
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA 02115, USA
- Brain Injury Center, Boston Children's Hospital, Boston, MA 02115, USA
- Sports Medicine Center, Children's Hospital Colorado & University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Michael W Kirkwood
- Department of Physical Medicine & Rehabilitation, University of Colorado, Aurora, CO 80045, USA
- Rehabilitation Medicine, Children's Hospital Colorado, Aurora, CO 80045, USA
| | - Aaron Provance
- Sports Medicine Center, Children's Hospital Colorado & University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Grant L Iverson
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02129, USA
- MassGeneral Hospital for Children Sport Concussion Program, Boston, MA 02114, USA
- Home Base, A Red Sox Foundation & Massachusetts General Hospital Program, Boston, MA 02129, USA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA 02453, USA
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA 02115, USA
- Brain Injury Center, Boston Children's Hospital, Boston, MA 02115, USA
- Department of Pediatrics & Orthopaedic Surgery, Harvard Medical School, Boston, MA 02115, USA
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Lynall RC, Mauntel TC, Pohlig RT, Kerr ZY, Dompier TP, Hall EE, Buckley TA. Lower Extremity Musculoskeletal Injury Risk After Concussion Recovery in High School Athletes. J Athl Train 2017; 52:1028-1034. [PMID: 29140128 DOI: 10.4085/1062-6050-52.11.22] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Although an association between concussion and musculoskeletal injury has been described in collegiate and professional athletes, no researchers have investigated an association in younger athletes. OBJECTIVE To determine if concussion in high school athletes increased the risk for lower extremity musculoskeletal injury after return to activity. DESIGN Observational cohort study. SETTING One hundred ninety-six high schools across 26 states. PATIENTS OR OTHER PARTICIPANTS We used data from the National Athletic Treatment, Injury and Outcomes Network surveillance system. Athletic trainers provided information about sport-related concussions and musculoskeletal injuries in athletes in 27 sports, along with missed activity time due to these injuries. MAIN OUTCOME MEASURE(S) Three general estimating equations were modeled to predict the odds of sustaining (1) any lower extremity injury, (2) a time-loss lower extremity injury, or (3) a non-time-loss lower extremity injury after concussion. Predictors were the total number of previous injuries, number of previous concussions, number of previous lower extremity injuries, number of previous upper extremity injuries, and sport contact classification. RESULTS The initial dataset contained data from 18 216 athletes (females = 39%, n = 6887) and 46 217 injuries. Lower extremity injuries accounted for most injuries (56.3%), and concussions for 4.3% of total injuries. For every previous concussion, the odds of sustaining a subsequent time-loss lower extremity injury increased 34% (odds ratio [OR] = 1.34; 95% confidence interval [CI] = 1.13, 1.60). The number of previous concussions had no effect on the odds of sustaining any subsequent lower extremity injury (OR = 0.97; 95% CI = 0.89, 1.05) or a non-time-loss injury (OR = 1.01; 95% CI = 0.92, 1.10). CONCLUSIONS Among high school athletes, concussion increased the odds of sustaining subsequent time-loss lower extremity injuries but not non-time-loss injuries. By definition, time-loss injuries may be considered more severe than non-time-loss injuries. The exact mechanism underlying the increased risk of lower extremity injury after concussion remains elusive and should be further explored in future research.
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Affiliation(s)
- Robert C Lynall
- Department of Kinesiology, The University of Georgia, Athens
| | - Timothy C Mauntel
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD
| | - Ryan T Pohlig
- Biostatistics Core Facility, University of Delaware, Newark
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Thomas P Dompier
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, IN
| | - Eric E Hall
- Department of Exercise Science, Elon University, NC
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology and Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark
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22
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Margolesky J, Singer C. How tandem gait stumbled into the neurological exam: a review. Neurol Sci 2017; 39:23-29. [PMID: 28894988 DOI: 10.1007/s10072-017-3108-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/01/2017] [Indexed: 12/22/2022]
Abstract
Tandem gait testing is an integral part of the neurological exam. It is informative in a wide variety of disorders ranging from cerebellar disease to vestibular and peripheral neuropathies, parkinsonism, and other neurodegenerative conditions. We discuss the history and development of tandem gait testing as well as its technique, utility, and limitations in the assessment of neurological conditions. Tandem gait has emerged as a tool in the assessment of cerebellar disease, Huntington disease, idiopathic Parkinson's disease, atypical parkinsonism, peripheral neuropathies, and vestibulopathies. Its origin can be deduced from experimental observation and clinical experience as far back as the early nineteenth century. Despite the long history and ubiquitous performance of tandem gait testing, there is no standardized, guideline-based protocol to model for more homogenous research and clinical practices. Such a protocol should be developed using historical texts and manuscripts as well as the consensus of the medical research community. With standard protocols, further studies could define the sensitivity of abnormal tandem gait testing in cerebellar disorders, more diffuse neurodegeneration, and peripheral pathologies. Tandem gait can be a useful marker of dysfunction in neurologic conditions whose pathologies extend beyond the vermis or vestibulocerebellar module to include interconnected networks throughout the nervous system.
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Affiliation(s)
- Jason Margolesky
- University of Miami School of Medicine, Professional Arts Center, 1150 NW 14th Street, Suite 609, Miami, FL, 33136, USA.
| | - Carlos Singer
- University of Miami School of Medicine, Professional Arts Center, 1150 NW 14th Street, Suite 609, Miami, FL, 33136, USA
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Buckley TA, Oldham JR, Munkasy BA, Evans KM. Decreased Anticipatory Postural Adjustments During Gait Initiation Acutely Postconcussion. Arch Phys Med Rehabil 2017; 98:1962-1968. [PMID: 28583462 DOI: 10.1016/j.apmr.2017.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 04/27/2017] [Accepted: 05/01/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate anticipatory postural adjustments (APAs) during the transitional movement task of gait initiation (GI) in individuals acutely after a concussion. DESIGN Cohort study. SETTING University research center. PARTICIPANTS A population-based sample of participants (N=84) divided into 2 equal groups of acutely postconcussion and healthy student athletes. INTERVENTION Participants were tested on 2 occasions: a preinjury baseline test and then the concussion group was retested acutely postconcussion and the healthy student athlete group again at a similar time. All participants completed 5 trials of GI on 4 forceplates. MAIN OUTCOME MEASURES The dependent variables were the displacement and velocity of the center of pressure (COP) during the APA phase and initial step kinematics. Comparisons were made with a 2 (group) × 2 (time) repeated-measures analysis of variance. RESULTS There was a significant interaction for COP posterior displacement (P<.001) and lateral displacement (P<.001). Posteriorly, post hoc testing identified a significant reduction in the concussion group (pretest: 5.7±1.6cm; posttest: 2.6±2.1cm; P<.001), but no difference in the healthy student athlete group (pretest: 4.0±1.6cm; posttest: 4.0±2.5cm; P=.921). Laterally, post hoc testing identified a significant reduction in the concussion group (pretest: 5.8±2.1cm; posttest: 3.8±1.8cm; P<.001), but no difference in the healthy student athlete group (pretest: 5.0±2.5cm; posttest: 5.2±2.4cm; P=.485). CONCLUSIONS The results of this study suggest difficulty in the planning and execution of GI acutely postconcussion, and posterior APA displacement and velocity are highly effective measures of impaired postural control. Finally, the APA phase is linked to the supplementary motor area, which suggests a supraspinal contribution to postconcussion impaired postural control.
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Affiliation(s)
- Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE; Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE.
| | - Jessie R Oldham
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Barry A Munkasy
- School of Health and Kinesiology, Georgia Southern University, Statesboro, GA
| | - Kelsey M Evans
- The Brody School of Medicine, East Carolina University, Greenville, NC
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