Abstract
Persistent gait alterations can occur after concussion and may underlie future musculoskeletal injury risk. We compared dual-task gait stability measures among adolescents who did/did not sustain a subsequent injury post-concussion, and uninjured controls. Forty-seven athletes completed a dual-task gait evaluation. One year later, they reported sport-related injuries and sport participation volumes. There were three groups: concussion participants who sustained a sport-related injury (n = 8; age =15.4 ± 3.5 years; 63% female), concussion participants who did not sustain a sport-related injury (n = 24; 14.0 ± 2.6 years; 46% female), and controls (n = 15; 14.2 ± 1.9 years; 53% female). Using cross-recurrence quantification, we quantified dual-task gait stability using diagonal line length, trapping time, percent determinism, and laminarity. The three groups reported similar levels of sports participation (11.8 ± 5.8 vs. 8.6 ± 4.4 vs. 10.9 ± 4.3 hours/week; p = 0.37). The concussion/subsequent injury group walked slower (0.76 ± 0.14 vs. 0.65 ± 0.13 m/s; p = 0.008) and demonstrated higher diagonal line length (0.67 ± 0.08 vs. 0.58 ± 0.05; p = 0.02) and trapping time (5.3 ± 1.5 vs. 3.8 ± 0.6; p = 0.006) than uninjured controls. Dual-task diagonal line length (hazard ratio =1.95, 95% CI = 1.05–3.60), trapping time (hazard ratio = 1.66, 95% CI = 1.09–2.52), and walking speed (hazard ratio = 0.01, 95% CI = 0.00–0.51) were associated with subsequent injury. Dual-task gait stability measures can identify altered movement that persists despite clinical concussion recovery and is associated with future injury risk.
Highlights
Advancements with return-to-play guidelines have led to improved patient care for individuals who sustain a concussion [1]
The current results, observed in a small sample of participants, extend prior observations suggesting that the dual-task gait metrics may be a useful addition for clinicians who care for athletes with concussion to identify risk of subsequent injury upon clinical recovery [11,12]
Rather than measures that index the fine scale aspects of gait dynamics, these studies used a gross measure of gait— the average speed of gait—as the outcome measure
Summary
Advancements with return-to-play guidelines have led to improved patient care for individuals who sustain a concussion [1]. One study observed common clinical concussion assessments do not provide predictive information regarding subsequent musculoskeletal injury risk [10], while poor dual-task gait (i.e., completing a cognitive task during gait) is associated with injuries sustained during the year after a concussion [11,12]. While both studies suggest that dual-task approaches can be one approach to identifying post-concussion injury risk, they did not include a non-concussed control group to serve as a reference for typical performance of similar athletes. Given that both attention [13] and motor control [14] deficits are associated with higher injury risk independent of a concussion history, dual-task gait performance may provide increased sensitivity to quantify post-concussion deficits associated with future injury risk
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