Objective clinical tests of dual-task dynamic postural control in youth athletes with concussion

Howell, David R.; Wilson, Julie C.; Brilliant, Anna N.; Gardner, Andrew J.; Iverson, Grant L.; Meehan, William P.

doi:10.1016/j.jsams.2018.11.014

Cited by 30 publications

(27 citation statements)

References 30 publications

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“…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.…”

Section: O N L I N E F I R S Tmentioning

confidence: 99%

“…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.…”

Section: O N L I N E F I R S Tmentioning

confidence: 99%

“…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.…”

Section: O N L I N E F I R S Tmentioning

confidence: 99%

“…1 A single tandem gait trial can last approximately 20 to 30 seconds following concussion. 8,9 With intermittent preparation, instruction, and transition, a full assessment that contains multiple trials and conditions may take up to 10 minutes to conduct. Furthermore, previous studies have demonstrated a significant difference between post-injury tandem gait times and baseline scores obtained prior to injury.…”

Section: O N L I N E F I R S Tmentioning

confidence: 99%

“…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.…”

Section: O N L I N E F I R S T Introductionmentioning

confidence: 99%

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

Wingerson

Seehusen

Walker

et al. 2020

Journal of Athletic Training

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Context: Clinical management of sport-related concussion requires the assessment of various factors, including motor performance. The tandem gait test, a measure of post-injury motor performance, has demonstrated clinical utility, but is limited by time availability and test uniformity. Objective: To assess intrasession reliability between tandem gait test trials and determine the number trials necessary for optimal utility and feasibility in clinical decision-making following concussion. Design: Cross-Sectional Study Setting: Pediatric Sport Medicine Clinic Participants: Adolescent athletes who recently sustained a concussion (n=44; age=15.4±1.8 years; 39% female) and were seen for care within 14 days (7.3±3.2 days) of their injury, as well as uninjured control participants (n=73; age=15.8±1.3 years; 41% female). All participants completed three single-task and three dual-task tandem gait trials. Outcome Measures: We collected test completion time and cognitive performance for each trial and calculated Pearson correlation coefficients between trials and Intraclass Correlation Coefficients to determine intrasession reliability. We also compared performance between groups, and calculated area under the curve (AUC) values to identify the ability of each trial to distinguish between groups. Results: Both the concussion and control group demonstrated high intrasession reliability between tandem gait trials under single (R ≥ 0.82; ICC≥ 0.93) and dual-task conditions (R ≥ 0.79; ICC≥ 0.92). The greatest group classification values were obtained from the second single-task trial (AUC = 0.89) and first dual-task trial (AUC = 0.83). Test completion time provided excellent between-group discrimination in single-task and dual-task conditions. However, cognitive performance during dual-task trials demonstrated only marginally significant clinical utility (AUC ≤ 0.67). Conclusion: Tandem gait assessments may only require two trials under single-task and one trial under dual-task conditions to effectively discriminate between concussion and control groups. This approach may improve the feasibility (time requirement) of the test, while maintaining excellent discriminatory ability.

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