Persistent Gait Stability Deficits Associated With History Of Concussion

Abstract

Postural instability during gait is a common symptom following a concussion and is often used as a diagnostic criterion. Specialized equipment has been able to detect impairments in gait patterns and center of pressure (COP) displacement weeks following a concussion. However, difficulty maintaining balance during gait is often not considered when determining whether a concussed individual has made a full recovery unless the impairments are grossly detrimental in nature. PURPOSE: To determine if deficits in gait stability seen in concussed individuals persist long after the reception of medical clearance from the initial injury. METHODS: Gait parameters were collected using a 20 ft. instrumented pressure-sensitive walkway. Healthy participants reporting a prior history of concussion (n=25) and those reporting no concussion history serving as controls (n=21) were recruited to participate. Individuals with previous history of concussion averaged 7.27 ± 5.73 years since their most recent injury. Participants were instructed to walk in their normal, preferred gait pattern while looking straight ahead. Participants then walked using a tandem gait pattern, walking heel-to-toe in line with each step while looking straight ahead. RESULTS: Individuals with prior history of concussion demonstrated significantly greater stride width compared to controls during normal, preferred gait (7.83 cm vs. 10.29 cm, p = 0.09) and tandem gait (0.17 cm vs. 1.63 cm, p = 0.01). Additionally, previously concussed individuals displayed significantly greater single-support COP path length during normal, preferred gait (12.08 cm vs. 12.97 cm, p = 0.06) and significantly greater double-support COP path length during tandem gait (22.71 cm vs. 24.69 cm, p = 0.01). CONCLUSION: Individuals that have a sustained one or more concussions demonstrate greater instability in their gait patterns as demonstrated by a wider base of support and greater instability in stance phase during gait years following the initial injury as well as reception of medical clearance. These findings suggest that concussion is associated with long-term impairment in an individual’s ability to maintain postural stability during gait, and that individuals with a prior history of concussion will adopt more conservative gait patterns in order to compensate.