The Diagnostic And Prognostic Utility Of Dual-task Tandem Gait For Pediatric Concussion

Abstract

BACKGROUND: Tandem gait performance is part of the Sports Concussion Assessment Tool (SCAT), but its diagnostic and prognostic value has not been fully assessed in pediatric concussion. PURPOSE: To determine the diagnostic and prognostic value of single-task and dual-task tandem gait by comparing performance of subjects with concussion relative to controls, as well as subjects who developed Persistent Post Concussion Symptoms (PPCS) and those who did not (No PPCS). METHODS: Subjects seen within 21 days of concussion and uninjured controls completed a single/dual-task tandem gait test battery and modified Balance Error Scoring System (mBESS) test. During the tandem gait test, subjects walked in a heel-toe manner along a 3m strip of fabric down and back as fast as possible. During dual-task trials, they completed a concurrent cognitive task. Outcomes included tandem gait time to completion, cognitive accuracy, and mBESS errors. Subjects with concussion were followed until symptom resolution and sub-grouped into those who developed PPCS (>28 d time to symptom resolution) vs. No PPCS. RESULTS: We evaluated 29 subjects with concussion who developed PPCS (mean age=15±2 years; 62% female; tested 12±6 days post-injury), 58 subjects with concussion who did not develop PPCS (mean age=14±3 years; 36% female; tested 8±5 days post-injury), and 58 controls (mean age= 16±1 years; 42% female). Subjects with concussion performed significantly worse than healthy controls on single-task tandem gait (24.4±12.6 vs. 14.9±3.6 s; p<0.001; area under curve [AUC]=0.85), dual-task tandem gait (33.3±14.9 vs. 20.6±7.1 s; p<0.001; AUC=0.84), dual-task cognitive accuracy (82.1±12.5 vs. 89.1±18.9 %; p=0.01; AUC=0.61), and mBESS (6.5±4.9 vs. 3.8±3.4 errors; p=0.001; AUC=0.68). The PPCS sub-group performed dual-task tandem gait significantly slower than the No PPCS group (38.8±17.7 vs. 30.6±12.7 s; p=0.016; odds ratio=1.04), but PPCS and No PPCS groups were not significantly different on other measures. CONCLUSIONS: Pediatric patients with concussion have impaired performance on balance and gait measures compared to healthy controls. Dual-task tandem gait test specifically showed diagnostic value for pediatric concussion and prognostic value in differentiating subjects who developed PPCS compared to those who did not.