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

Abstract

Objective: To identify clinically significant postural control measures capable of distinguishing the performance of adolescents with concussion from uninjured controls. Approach: Fifteen adolescents with concussion (67% female; median age = 16.3 years; tested 8 ± 4 d post-injury) and 31 controls (45% female; median age = 15.2 years) completed a single/dual-task gait evaluation with a smartphone affixed to their lumbar spine, modified balance error scoring system (mBESS), and single/dual-task tandem gait test. Outcome measures were obtained via smartphone (single/dual-task gait speed, cadence, step length), mBESS (double/single/tandem errors), and tandem gait (single/dual-task time). We calculated area under the curve (AUC) values for each measure that demonstrated a significant difference between groups independently, and calculated a comprehensive AUC value for all measures combined. Main results: The concussion group walked significantly slower (mean = 0.89 ± 0.15 versus 1.05 ± 0.15 m s−1; p = 0.002) and with significantly fewer steps per minute (median = 103 [interquartile range = 94–108] versus 116 [104–118] steps/minute; p = 0.002) than the control group under single-task conditions. They also completed single-task (median = 22.0 [16.6–24.2] versus 14.5 [12.4–15.5] s; p < 0.001) and dual-task (median = 30.0 [24.0–35.2] versus 18.6 [16.1–21.7] s; p < 0.001) tandem gait tests significantly slower than controls. The AUC value for single-task gait velocity, single-task cadence, single-task tandem gait time, and dual-task tandem gait time indicated an excellent ability to distinguish between concussion and control groups (AUC = 0.91, 95% CI = 0.80–0.99). Significance: Smartphone-obtained gait measures and tandem gait times allowed for an excellent differentiation between adolescents with concussion versus control participants. This reinforces the need for multimodal approaches to postural control impairment recognition among adolescents with concussion.