Abstract
Background: Vestibular deficit is common following concussion and may affect gait. The purpose of this study was to investigate differences in head and pelvic center of mass (COM) movement during gait in military tactical athletes with and without concussion-related central vestibular impairment.Material and Methods: 24 patients with post-concussion vestibular impairment (20 males, 4 females; age: 31.7 ± 7.9 years; BMI: 27.3 ± 3.3) and 24 matched controls (20 males, 4 females; age: 31.8 ± 6.4 years; BMI: 27.2 ± 2.6) were included in the analyses. Three-dimensional head and pelvic displacement and velocities were collected at a 1.0 m/s standardized treadmill walking speed and assessed using Statistical Parametric Mapping t-tests. Maximum differences (dmax) between groups were reported for all significant kinematic findings.Results: The Vestibular group demonstrated significantly diminished anteroposterior head excursions (dmax = 2.3 cm, p = 0.02) and slower anteroposterior (dmax = 0.37 m/s, p = 0.01), mediolateral (dmax = 0.47 m/s, p = 0.02) and vertical (dmax = 0.26 m/s, p < 0.001) velocities during terminal stance into pre-swing phases compared to the Control group. Vertical pelvic excursion was significantly increased in midstance (dmax = 2.4 cm, p = 0.03) and mediolaterally during pre- to initial-swing phases (dmax = 7.5 cm, p < 0.001) in the Vestibular group. In addition, pelvic velocities of the Vestibular group were higher mediolaterally during midstance (dmax = 0.19 m/s, p = 0.02) and vertically during post-initial contact (dmax = 0.14 m/s, p < 0.001) and pre-swing (dmax = 0.16 m/s, p < 0.001) compared to the Control group.Significance: The Vestibular group demonstrated a more constrained head movement strategy during gait compared with Controls, a finding that is likely attributed to a neurological impairment of visual-vestibular-somatosensory integration.
Highlights
Concussion, known as mild traumatic brain injury, is a common clinical entity experienced by more than 15thousand military tactical athletes serving in the United States Armed Forces annually (DoD worldwide numbers for TBI, 2016) and is responsible for more than 2.8 million civilian emergency room visits per year (Taylor, 2017)
Several significant group differences were observed in head and pelvic center of mass (COM) movement during gait (Figure 3)
The primary findings of this study were that patients with postconcussion vestibular deficit demonstrated a more constrained head but increased mediolateral and vertical pelvic movement strategy during gait compared with the Control group, a finding that is likely attributed to a deficit of the vestibulo-ocular reflex (VOR), vestibulospinal reflex, and dynamic balance integration
Summary
Concussion, known as mild traumatic brain injury (mTBI), is a common clinical entity experienced by more than 15thousand military tactical athletes serving in the United States Armed Forces annually (DoD worldwide numbers for TBI, 2016) and is responsible for more than 2.8 million civilian emergency room visits per year (Taylor, 2017). Many individuals who sustain a concussion experience signs and symptoms that include dizziness, imbalance, dyskinesis, and cognitive deficit (Sosnoff et al, 2008). These manifestations are a result of neurophysiological impairment in higher-order brain function, pyramidal and extrapyramidal motor pathways, and vestibular function (Kolev and Sergeeva, 2016). These alterations in visualvestibular-somatosensory integration may persist well-beyond the initial injury. The purpose of this study was to investigate differences in head and pelvic center of mass (COM) movement during gait in military tactical athletes with and without concussion-related central vestibular impairment
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