Abstract
The purpose of this study was to longitudinally compare the sensitivity of previously documented paradigms for measuring balance control during gait following a concussion. We hypothesized that gait with a concurrent cognitive task would be most sensitive to the effects of concussion on dynamic balance control. Individuals with concussion (n = 30) and matched controls (n = 30) performed a single task of level walking, attention divided walking, and an obstacle-crossing task at two heights. Testing occurred four times post-injury. Balance control during gait was assessed with whole-body center of mass and center of pressure motion. The single-task level walking task did not result in any significant differences in balance control between individuals with concussion and control subjects. Within 48 hours post-injury, individuals with concussion walked slower and allowed less motion of their center of mass in the sagittal plane when attention was divided during walking, but there were no group differences by day 6 for this task. Group differences in balance control during obstacle crossing was unremarkable during the first two testing sessions, but by day 14 individuals with concussion displayed less mediolateral motion of their center of mass. Attention divided gait is able to better distinguish gait adaptations immediately following a concussion, but obstacle crossing can be used further along in the recovery process to detect new gait adaptations.
Highlights
Concussive incidents rarely result in any patientreported long-term symptoms [1], studies have found that symptoms may last longer than that reported by the patient; even long after a return to normal unrestricted activities [2,3,4]
The results for sagittal plane balance control clearly indicate that individuals with concussion reduce their forward motion immediately after injury when having to perform a divided attention gait task
Our findings indicated that a divided attention task performed during unobstructed gait was only able to better distinguish conservative gait adaptations immediately following a concussion
Summary
Concussive incidents rarely result in any patientreported long-term symptoms [1], studies have found that symptoms may last longer than that reported by the patient; even long after a return to normal unrestricted activities [2,3,4]. The specific causes of repeated concussions is unclear, it is our contention that one contributing factor may be related to the well documented [25] long-term deficits in dynamic motor function, such as balance control during walking. Symptoms measured with neuropsychological tests are often reported normal after 14 days post-injury. Findings of motor dysfunction, gait imbalance and attentional deficits during motor/cognitive dual-task tests have contradicted this quick (within two weeks) return to normal functioning. A group of predominately mild traumatic brain injury (mTBI) subjects were reported displaying deficits in finger tapping up to a (page number not for citation purposes)
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