Increased Auditory Dual Task Cost During Gait Initiation in Adult Patients With Persistent Concussion Symptoms

Abstract

ObjectiveTo compare dual task cost (DTC) during gait initiation (GI) between a population of patients with persistent concussion symptoms (PCS) and age-matched healthy participants. DesignCohort study. SettingUniversity research center. ParticipantsA cohort sample including 15 participants with PCS (43.9±11.7y, 73.3% female) and 23 age-matched healthy participants (42.1±10.3y, 65.2% female) as controls. InterventionsParticipants were tested on a single occasion where they performed 5 trials of single task and 5 trials of dual task GI with 12-camera motion capture and 3 force plates. Main Outcome MeasuresThe dependent variables of interest were the DTC for the center of pressure (COP) displacement and velocity during the anticipatory postural adjustment (APA) phase, the COP-center of mass (COP-COM) separation, and the response accuracy during the auditory cognitive tasks. ResultsThere were significant group differences with worse DTC for the PCS participants in anterior (A)/posterior (P) displacement (PCS, −37.5±22.1%; Control, −9.7±39.2%; P=.016, d=0.874), APA medial (M)/lateral (L) velocity (PCS, −34.8±28.8%; Control, −17.0±40.21%; P=.041, d=0.866), and the peak COP-COM separation (PCS, −7.3±6.7%; Control, 0.6±6.5%; P=.023, d=1.200). There were no significant group differences in the APA A/P velocity (PCS, −38.8±33.1%; Control, −19.8±43.9%; P=.094), APA M/L displacement (PCS, −34.8±21.8%; Control, −10.6±25.3%; P=.313), or cognitive task performance (PCS, −2.7±10.8%; Control, −0.2±4.3%; P=.321). ConclusionsPCS participants had greater (worse) DTC during both the planning and execution of the task, with large effect sizes (d>0.80). PCS participants also used a posture-second strategy whereby attentional resources were inappropriately allocated to the cognitive task. These deficits may challenge a patient's ability to complete activities of daily living and limit their functional independence.