Dual-Task Gait Performance Following Head Impact Exposure in Male and Female Collegiate Rugby Players

Abstract

Background Gait impairments have been well-studied in concussed athletes. However, the sex-specific effect of cumulative head impacts on gait is not well understood. When a cognitive task is added to a walking task, dual-task gait assessments can help amplify deficits in gait and are representative of tasks in everyday life. Dual-task cost is the difference in performance from walking (single-task) to walking with a cognitive load (dual-task). Purpose The objectives of this study were to explore the differences between sexes in 1) dual-task gait metrics, 2) gait metric changes from pre-season to post-concussion and post-season, and 3) the dual-task costs associated with gait metrics. Study Design Cross-sectional study Methods Over two seasons, 77 female athlete-seasons and 64 male athlete-seasons from collegiate club rugby teams participated in this study. Subjects wore inertial sensors and completed walking trials with and without a cognitive test at pre-season, post-season, and post-concussion (if applicable). Results Females athletes showed improvement in cadence (mean = 2.7 step/min increase), double support time (mean = -0.8% gait cycle time decrease), gait speed (mean = 0.1 m/s increase), and stride length (mean = 0.2 m increase) in both task conditions over the course of the season (p < 0.030). Male athletes showed no differences in gait metrics over the course of the season, except for faster gait speeds and longer stride lengths in the dual-task condition (p < 0.034). In all four gait characteristics, at baseline and post-season, females had higher dual-task costs (mean difference = 4.4, p < 0.003) than the males. Conclusions This results of this study showed little evidence suggesting a relationship between repetitive head impact exposure and gait deficits. However, there are sex-specific differences that should be considered during the diagnosis and management of sports-related concussion. Level of Evidence Level 2b

Spatiotemporal Parameters of Gait Among Adolescent Athletes with Concussion When Performing a Visuospatial Cognitive Task

“…13,14,16,18 The current study also found that the increased DTC was not experienced for the same spatiotemporal parameters of gait or to the same degree by males and females with acute SRC, suggesting that different compensatory patterns to perform dual-task gait may be evident based on sex in similar samples. Recently, Kieffer et al 30 found that even in collegiate athletes, who are presumed to function with more developed neuromuscular abilities, DTCs for several parameters of gait varied irrespective of sex but were overall higher for females. When assessing adolescent athletes within 14 days of concussion, Howell et al 16 found that females typically experienced a significantly greater DTC for cadence (not measured in the current study), whereas a separate study reported inconsistent variability in several cognitive, neuromotor, and oculomotor functions according to sex.…”

“…When assessing adolescent athletes within 14 days of concussion, Howell et al 16 found that females typically experienced a significantly greater DTC for cadence (not measured in the current study), whereas a separate study reported inconsistent variability in several cognitive, neuromotor, and oculomotor functions according to sex. 30 With respect to varying gait strategies, Table 4 provides valuable data for individual assessments by each participant during initial testing who experienced a DTC greater than one SD compared to healthy references in at least one parameter of gait. Male participant A and female participant B, both with acute SRC, experienced the DTC on at least three parameters, representing athletes with the most negative side effects Spatiotemporal Parameters of Gait Among Adolescent Athletes with Concussion When Performing a Visuospatial Cognitive Task Asterisk (*) denotes the percentage of the male and female acute (20% and 83%, respectively) and chronic (10%, and 29%, respectively) cases that experienced a DTC greater than one SD compared to healthy athlete reference values for at least one spatiotemporal parameter of gait.…”

Laboratory assessment of a head impact sensor for youth soccer ball heading impacts using an anthropomorphic test device

“…rugby). 39 Therefore, other sensor systems, such as headband-mounted sensors and skin patch sensors, have utility in providing estimates of head impact exposure for athletes who do not typically wear mouthguards, such as soccer players. In a field study using the SIM-G sensor, Patton et al 13 identified that less than 10% of sensor events recorded in high school soccer games were false positives suggesting the SIM-G can provide an accurate estimate of head impact exposure on field.…”

Heads Up! A Biomechanical Pilot Investigation of Soccer Heading Using Instrumented Mouthguards (iMGs)

“…A recording threshold of 5 g linear acceleration at the head center of gravity was selected, given that the previous threshold of 10g lacked sensitivity in capturing mild headers [1,32]. Previous studies have established the validity of the Prevent Biometric custom-fit iMG [25,33]. Liu et al [33] found the Prevent Biometric custom-fit iMG to perform best in laboratory dummy headform test-ing with lower mean relative errors of 4.9%, 4.6%, and 2.5% for peak angular acceleration, angular velocity, and linear acceleration, respectively.…”

“…Patch devices with these sensors may provide erroneous measurements due to poor skull coupling (soft tissue artifacts), which can result in overestimations of HAE magnitude [24]. Alternatively, instrumented mouthguards (iMGs) have been shown to be more accurate by directly coupling to the upper dentition and thus skull, reducing soft tissue artifacts and making them the preferred choice for measuring HAEs in real-time [24,25]. From this, researchers have identified the penalty box to be a high-risk area for concussive injury, with ball speeds frequently exceeding 120 km/h [26] and peak acceleration exposures to the head 150% greater than those noted in hockey or American football [27].…”