Return to Activity Timing is Associated with Dual-Task Gait Stability Two Months After Concussion

Abstract

Although new insights regarding recovery from sport-related concussion have been identified, relatively little is known about long-term outcomes resulting from a concussion. A premature return to physical activities (RTA) has been identified to potentially negatively affect how an individual recovers from a concussion. PURPOSE: The purpose of this study was to examine the relationships between the timing of resuming pre-injury levels of physical activity with single/dual-task gait stability and symptom severity measurements two months post-concussion. METHODS: Individuals with concussion and healthy control subjects were tested two months post-injury/initial exam, respectively. The RTA day was documented for each concussion participant, defined as the first day physical activities were allowed by attending physicians following concussion. Whole-body center-of-mass (COM) motion in single/dual-task walking conditions and symptom severity were assessed two months following the injury. The main outcome measures were Pearson correlation coefficients between the RTA day and single/dual-task gait stability and symptom severity measurements at two months post-injury relative to controls. RESULTS: 22 participants with concussion had been cleared by a physician to return physical activity at two months post-injury (mean age = 15.4±1.3, 4F). 24 healthy control participants (mean age = 15.5±1.1, 4F) also completed the study. Concussion participant dual-task medial-lateral COM displacement at two months post-injury was strongly and negatively correlated with the day of RTA clearance (r = -.53). The relationships were weak-to-moderate for RTA timing and COM medial-lateral velocity (r = - .32), peak forward velocity (r = .28), single-task gait stability measures (r < .14), and clinical symptoms (r = - .24). CONCLUSION: The time of RTA, within a two-month post-injury period, is strongly correlated with dual-task gait stability measured at the end of that period. Early returners to activity tended to exhibit less gait stability while simultaneously performing a secondary task than later returners. This suggests that dual-task gait stability two months post-injury may be improved with a greater duration of physical rest acutely post-injury.