Youth With Concussion Have Less Adaptable Gait Patterns Than Their Uninjured Peers: Implications for Concussion Management

Abstract

To compare cross-recurrence quantification analysis measurements obtained during gait between adolescents who sustained a diagnosed concussion within 14 days of assessment and healthy adolescents. U DESIGN: Cross-sectional study. U METHODS: Youth athletes with concussion (n = 43; mean ± SD age, 14.4 ± 2.3 years; 56% female; tested median, 7 days post concussion) and healthy controls (n = 38; age, 14.9 ± 2.0 years; 55% female) completed a single-task and dualtask gait protocol while wearing a set of inertial sensors. We used cross-recurrence quantification analysis techniques to quantify the similarity between accelerations obtained from the sensor on the dorsum of each foot. Four outcome variables were compared between groups: percent determinism, average diagonal-line length, laminarity, and trapping time. U RESULTS: Athletes with concussion had significantly higher percent determinism, laminarity, and trapping time than the control group in single-task and dual-task conditions (P<.05). Gait patterns, when simultaneously completing a secondary cognitive task (dual task), were no different from gait patterns under a single-task condition. U CONCLUSION: Higher percent determinism, laminarity, and trapping time among athletes with concussion suggest that concussion may be associated with a more stuck and predictable gait pattern. These altered movement patterns may be one reason for underlying slower gait speeds that have been observed following concussion.

Dizziness, Psychosocial Function, and Postural Stability Following Sport-Related Concussion

“…19 All question responses were assigned point values: 0 (no response), 2 (sometimes response), and 4 (yes response) on 25 questions, and a total score was computed from these scores, ranging from 0 to 100. Scores were then categorized into no (,16), mild (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35), moderate (36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51), or severe (.51) dizziness. 19 Validity of the scale was established as higher scores demonstrated an increased level of functional impairment.…”

Peripheral Display in Virtual Reality Environments involves Higher Cognitive Demands Compared to Centered Display during Dual-Tasking

“…The most important result in our study was variability in step width between the control and peripheral cognitive load. Therefore, when the results are coupled with the results of other studies that show that variability in step width and fall risk are positively correlated in young healthy individuals, it can be inferred that healthy young individuals can be at risk of falling in specific scenarios such as texting and walking (Howell et al, 2020;Nordin et al, 2010). The potential fall risk in young, healthy individuals produced through cognitive loading provides the opportunity to test and compare fall risk in different age populations before injuries or at the onset of neurological disorders.…”

“…Implementation of DTP could potentially provide a new way to specifically analyze gait correlating to post-concussion injuries and aid in diagnosing concussions in young adults due to step width allowing clinicians to associate the component to balance control (Decker et al, 2016). Therefore, dual tasking requires concurrent execution of cognitive and motor tasks, allowing clinicians to measure patients' abilities during a similar sports-like demand than to single tasks (Howell et al, 2020). Earlier concussion research has utilized measures that quantify gait variability dysfunction, such as stride width (Howell et al, 2020).…”

“…Therefore, dual tasking requires concurrent execution of cognitive and motor tasks, allowing clinicians to measure patients' abilities during a similar sports-like demand than to single tasks (Howell et al, 2020). Earlier concussion research has utilized measures that quantify gait variability dysfunction, such as stride width (Howell et al, 2020). DTP could create ideal cognitive and motor task conditions to test for balance and fall-risk postconcussion.…”

“…We found that DTP challenges cognitive and motor function significantly among healthy individuals by adapting step width, which lends to using DTP as a tool for recognizing fall risk in measuring gait variability. Detection of subtle gait deviations can help the objective identification of post-concussion deficits under dual-task conditions (Howell et al, 2020). This may be attributed to dual-task walking correlating neural mechanisms subserving attentional cognition and gait (Smeeton et al, 2021).…”