Concussed athletes walk slower than non-concussed athletes during cognitive-motor dual-task assessments but not during single-task assessments 2 months after sports concussion: a systematic review and meta-analysis using individual participant data

Abstract

ObjectivesTo determine whether individuals who sustained a sports concussion would exhibit persistent impairments in gait and quiet standing compared to non-injured controls during a dual-task assessment .DesignSystematic review and meta-analysis using individual participant data (IPD).Data sourcesThe search strategy was applied across seven electronic bibliographic and grey literature databases: MEDLINE, EMBASE, CINAHL, SportDISCUS, PsycINFO, PsycARTICLES and Web of Science, from database inception until June 2017.Eligibility criteria for study selectionStudies were included if; individuals with a sports concussion and non-injured controls were included as participants; a steady-state walking or static postural balance task was used as the primary motor task; dual-task performance was assessed with the addition of a secondary cognitive task; spatiotemporal, kinematic or kinetic outcome variables were reported, and; included studies comprised an observational study design with case–control matching.Data extraction and synthesisOur review is reported in line with the Preferred Reporting Items for Systematic review and Meta-Analyses-IPD Statement. We implemented the Risk of Bias Assessment tool for Non-randomised Studies to undertake an outcome-level risk of bias assessment using a domain-based tool. Study-level data were synthesised in one of three tiers depending on the availability and quality of data: (1) homogeneous IPD; (2) heterogeneous IPD and (3) aggregate data for inclusion in a descriptive synthesis. IPD were aggregated using a ‘one-stage’, random-effects model.Results26 studies were included. IPD were available for 20 included studies. Consistently high and unclear risk of bias was identified for selection, detection, attrition, and reporting biases across studies. Individuals with a recent sports concussion walked with slower average walking speed (χ2=51.7; df=4; p<0.001; mean difference=0.06 m/s; 95% CI: 0.004 to 0.11) and greater frontal plane centre of mass displacement (χ2=10.3; df=4; p=0.036; mean difference −0.0039 m; 95% CI: −0.0075 to −0.0004) than controls when evaluated using a dual-task assessment up to 2 months following concussion.Summary/conclusionsOur IPD evidence synthesis identifies that, when evaluated using a dual-task assessment, individuals who had incurred a sports concussion exhibited impairments in gait that persisted beyond reported standard clinical recovery timelines of 7–10 days. Dual-task assessment (with motion capture) may be a useful clinical assessment to evaluate recovery after sports concussion.Protocol pre-registrationThis systematic review was prospectively registered in PROSPERO CRD42017064861.

Characterization of Cognitive-Motor Function in Women Who Have Experienced Intimate Partner Violence-Related Brain Injury

“…12 Previous research has demonstrated that BIs and repetitive subconcussive head impacts in other populations (e.g., contact sport athletes, military personnel, people experiencing homelessness) are often associated with alterations in cognitive-motor performance. [12][13][14][15][16] Given the chronic and repetitive nature of IPV, it is likely that alterations in cognitive-motor function may also be present in survivors of IPV-related BI. Thus, the purpose of this study was to characterize cognitive-motor function in women who have experienced IPV and examine the extent to which it was related to clinical measures of executive function.…”

Athletes with a concussion history in the last two years have impairments in dynamic balance performance

“…Importantly, these impairments were not highlighted by traditional clinical assessments, but were captured using inertial sensor technology. These findings are part of a growing body of evidence demonstrating that deficits in sensorimotor function may exist beyond clinical recovery post-concussion, 6,7,39 contributing to an increased risk of future injury. 4 As such, clinicians and rehabilitation specialists should introduce targeted balance training interventions into the return to play process to accelerate sensorimotor control recovery and mitigate the risk of future injury.…”

“…5 These concerns are beginning to be substantiated, with research demonstrating that sensorimotor control deficits post-clinical recovery from concussion may be more pronounced during dynamic balance 6 and dual-task situations. 7 Furthermore, research has demonstrated that laboratory-based kinetic and kinematic evaluation during gait and balance tasks can detect deficits in those with a history of concussion, when compared to healthy controls. 8,9 As such, the objective and quantifiable evaluation of movement control during dynamic tasks may provide a means to sufficiently challenge the sensorimotor system in individuals who have sustained a concussion, uncovering persistent sub-clinical performance deficits which may increase an individual's risk of injury.…”

Gait measurement in chronic mild traumatic brain injury: A model approach

“…However, gait speed only reflect global gait performance and provides limited understanding of impairments seen in different pathologies [13], which is where a more comprehensive approach may add value. Similarly, gait characteristics, other than gait speed, may be useful for non-invasive discrimination between pathologies [40][41][42], with potential for gait to become a diagnostic tool for mTBI. Appropriate gait characteristics selection for mTBI studies would benefit from a more systematic and informed approach, which is where our developed gait model could add value to future studies.…”