A multifaceted and clinically viable paradigm to quantify postural control impairments among adolescents with concussion

Abstract

Concussion, a type of traumatic brain injury, has received increased attention over the past decade coinciding with a significant increase in the number of concussion diagnoses, particularly in the athletic population (Lincoln et al 2011, Rosenthal et al 2014. Defined as a traumatically induced alteration in mental status that may or may not involve loss of consciousness, concussions can result in dysfunction such as motor control deficits, cognitive alterations, or oculomotor impairments (Broglio et al 2014). Adolescents appear to be a particularly vulnerable population to the deleterious effects of concussion, as they are more likely to develop persistent concussion symptoms and to experience cognitive or physiological deficits after concussion compared to their younger school-aged and older young adult counterparts (

Clinical Feasibility and Utility of a Dual-Task Tandem Gait Protocol for Pediatric Concussion Management

“…Downloaded from http://meridian.allenpress.com/jat/article-pdf/doi/10.4085/323-20/2632258/10.4085_323-20.pdf by guest on 24 November 2020 p. 5 Tandem gait assessment was first presented within the SCAT-3, in which performance was quantified as the best (fastest) time among 4 total trials. Despite emerging research demonstrating the utility of a timed tandem gait in the assessment of concussion, 5,6,8,9 the most recent SCAT-5 transitioned to a pass/fail evaluation, 1,11 defining a failing score as separation between the heel and toe, stepping off the line, or using the administrator to regain balance.…”

“…Regardless of this transition to a pass/fail system, recent studies have quantified single and dualtask tandem gait performance among concussed patients as either the average or the best time-tocompletion for three trials under each condition. 5,8,9 Furthermore, the SCAT-5 offers no direction or standardization of cognitive function for use in dual-task conditions. 1,11 As such, incorporating a question & answer cognitive task during tandem gait trials represents a feasible option to increase task complexity, create a more challenging and sport-like test environment, and better detect identifiable concussion-related motor performance impairments.…”

“…1,11 As such, incorporating a question & answer cognitive task during tandem gait trials represents a feasible option to increase task complexity, create a more challenging and sport-like test environment, and better detect identifiable concussion-related motor performance impairments. 6,8,9,12 However, the feasibility of the clinical assessment of tandem gait may be limited by a variety of factors. Primarily, clinician time availability is limited, given the numerous other recommended assessments performed during a clinical examination of concussion.…”

“…5,6,7 Single-task tandem gait time, the total number of seconds from commencement to completion, has demonstrated the capacity to distinguish concussed individuals from healthy controls when testing occurs within one week of injury. 6,8,9 Furthermore, dual-task tandem gait time can differentiate concussed patients from healthy controls even after symptom resolution, demonstrating its ability to provide useful information within concussion management beyond that of typically used measures, such as symptom severity. 6,8,9 When compared to pre-injury scores, collegiate athletes who sustained a concussion performed significantly slower on tandem gait testing within 48 hours of injury, as opposed to their non-concussed peers who showed no difference relative to baseline scores, indicating that baseline testing may be useful when assessing and interpreting post-injury tandem gait.…”

Focus collection on Modern Approaches for Sports Medicine and Performance

“…For example, Howell et al (2019) used a smartphone to capture gait measures to differentiate adolescents with concussion from healthy controls, and Toshiyo (2019) reviewed the use of wearables for monitoring oxygen uptake and energy consumption. These devices could allow for comprehensive objective monitoring of physiological and behavioral data within amateur and elite sport, in the near future.…”