Dual-task Gait Research Articles

Effects of aging on cognitive and brain inter-network integration patterns underlying usual and dual-task gait performance.

IntroductionAging affects the interplay between cognition and gait performance. Neuroimaging studies reported associations between gait performance and structural measures; however, functional connectivity (FC) analysis of imaging data can help to identify dynamic neural mechanisms underlying optimal performance. Here, we investigated the effects on divergent cognitive and inter-network FC patterns underlying gait performance during usual (UW) and dual-task (DT) walking.MethodsA total of 115 community-dwelling, healthy participants between 20 and 80 years were enrolled. All participants underwent comprehensive cognitive and gait assessments in two conditions and resting state functional MRI (fMRI) scans. Inter-network FC from motor-related to 6 primary cognitive networks were estimated. Step-wise regression models tested the relationships between gait parameters, inter-network FC, neuropsychological scores, and demographic variables. A threshold of p < 0.05 was adopted for all statistical analyses.ResultsUW was largely associated with FC levels between motor and sustained attention networks. DT performance was associated with inter-network FC between motor and divided attention, and processing speed in the overall group. In young adults, UW was associated with inter-network FC between motor and sustained attention networks. On the other hand, DT performance was associated with cognitive performance, as well as inter-network connectivity between motor and divided attention networks (VAN and SAL). In contrast, the older age group (> 65 years) showed increased integration between motor, dorsal, and ventral attention, as well as default-mode networks, which was negatively associated with UW gait performance. Inverse associations between motor and sustained attention inter-network connectivity and DT performance were observed.ConclusionWhile UW relies on inter-network FC between motor and sustained attention networks, DT performance relies on additional cognitive capacities, increased motor, and executive control network integration. FC analyses demonstrate that the decline in cognitive performance with aging leads to the reliance on additional neural resources to maintain routine walking tasks.

Gait performance and non-motor symptoms burden during dual-task condition in Parkinson's disease.

Impaired gait is observed in patients with Parkinson's disease (PD) in both single-task (ST) and dual-task (DT) conditions. Non-motor symptoms (NMSs), another vital symptom future experienced along the PD disease trajectory, contribute to gait performance in PD. However, whether DT gait performance is indicative of NMS burden (NMSB) remains unknown. This study investigated correlation between NMS and DT gait performance and whether NMSB is reflected in the DT effects (DTEs) of gait parameters in PD. Thirty-three idiopathic PD participants were enrolled in this study; the median H-Y staging was 2.5. NMSB was assessed by Non-motor Symptoms Scale (NMSS). Spatiotemporal gait parameters under ST and DT conditions were evaluated by wearable sensors. Gait parameters under ST and DT conditions and DTEs of gait parameters were compared across NMSB groups. The associations between NMS and DTEs of gait parameters were analyzed by correlation analysis and linear regression models. Compared to PD patients with mild-moderate NMSB, the severe-very severe NMSB group showed slower gait speed and shorter stride length under both ST and DT conditions (p < 0.05). DT had significantly negative effect on gait parameters in PD patients, including gait speed, stride length, and gait cycle duration (p < 0.05). PD patients with mild-moderate NMSB showed larger DTEs of cadence and bilateral gait cycle duration (p < 0.05). DTEs of bilateral gait cycle duration and swing phase on the more affected (MA) side were significantly correlated with NMSS scores (∣rSp∣ ≥ 0.3, p < 0.05). Gait cycle duration on the less affected (LA) side explained 43% of the variance in NMSS scores, when accounting for demographic and clinical confounders (β = - 1.095 95% CI - 4.061 ~ - 0.058, p = 0.044; adjusted R2 = 0.434). DT gait performance could reflect NMSB in PD patients at early stage, and gait cycle duration is a valuable gait parameter to further investigate and to provide more evidence for PD management.

Abnormal neural oscillations during gait and dual-task in Parkinson's disease.

Gait dysfunctions are debilitating motor symptoms of Parkinson’s disease (PD) and may result in frequent falling with health complications. The contribution of the motor-cognitive network to gait disturbance can be studied more thoroughly by challenging motor-cognitive dual-task gait performances. Gait is a complex motor task that requires an appropriate contribution from motor and cognitive networks, reflected in frequency modulations among several cortical and subcortical networks. Electrophysiological recordings by scalp electroencephalography and implanted deep brain stimulation (DBS) electrodes have unveiled modulations of specific oscillatory patterns in the cortical-subcortical circuits in PD. In this review, we summarize oscillatory contributions of the cortical, basal ganglia, mesencephalic locomotor, and cerebellar regions during gait and dual-task activities in PD. We detail the involvement of the cognitive network in dual-task settings and compare how abnormal oscillations in the specific frequency bands in the cortical and subcortical regions correlate with gait deficits in PD, particularly freezing of gait (FOG). We suggest that altered neural oscillations in different frequencies can cause derangements in broader brain networks, so neuromodulation and pharmacological therapies should be considered to normalize those network oscillations to improve challenged gait and dual-task motor functions in PD. Specifically, the theta and beta bands in premotor cortical areas, subthalamic nucleus, as well as alpha band activity in the brainstem prepontine nucleus, modulate under clinically effective levodopa and DBS therapies, improving gait and dual-task performance in PD with FOG, compared to PD without FOG and age-matched healthy control groups.

Evaluation of a Novel Step Training Mobile App Intervention in Cardiopulmonary Rehabilitation: A Single-Arm Prospective Cohort Study

Objective: To establish the usability, acceptability, safety, and exercise adherence of a step training mobile app. Design: A single-arm prospective cohort study. Setting: Royal Brisbane and Women's Hospital, Australia. Subjects: Twenty-six cardiopulmonary rehabilitation participants. Intervention: Twelve weeks of step training using the mobile app Clock Yourself. Participants used Clock Yourself at home and during cardiopulmonary rehabilitation sessions, prescribed for a total of 15-20 minutes three times a week. Main Measures: The primary outcomes of interest were usability and acceptability and were measured using the System Usability Scale (SUS) and Attitudes to Falls-Related Interventions Scale (AFRIS) questionnaire, respectively. Safety and adherence were measured by self-report and participant diary, respectively. Secondary outcomes measuring changes in stepping, gait, balance, and physical performance included Manual test of Choice Stepping Reaction Time (CSRT-M), Short Physical Performance Battery (SPPB), Gait speed with and without a cognitive dual task (DT) and Timed Up and Go with and without a cognitive DT (TUG and TUGcog). Results: Twenty-one participants completed the study. Clock Yourself was considered highly useable (SUS [median] = 82.5/100; interquartile range [IQR, 67.5-95], equating to an "A" rating [A-F scale]) and acceptable (AFRIS [median] = 38/42 [IQR, 31-41]). Participants practiced Clock Yourself for a median of 18.29 minutes per week and no adverse events were reported. At 12 weeks, mean change in CSRT-M, SPPB, gait speed, DT gait speed, TUG, and TUGcog were all statistically significant (P < 0.01). Conclusion: Twelve weeks of mobile app-based step training was safe and considered usable and acceptable by participants. On average, participants did not meet the prescribed practice dosage. Statistically significant changes were observed in all physical measures; however, results are confounded by participation in cardiopulmonary rehabilitation and lack of control group.

Comparison of gait parameters under single- and dual-task conditions between children with specific learning disorder and typically developing children

BackgroundChildren with specific learning disorder (SLD) have some cognitive and postural stability problems compared to typically developing (TD) children. Their single and dual-task gait performance may be affected depending on these problems. Research questionAre there any differences between the gait parameters of children with SLD and TD under single- and dual-task conditions? MethodsA comparative-descriptive study was conducted among 35 children with SLD and 33 TD children. All participants were assessed for gait parameters using a custom wireless inertial sensor under single and dual-task conditions. In the dual-task gait tests, there were the following tasks: to carry a glass of water and to tell apart the color of the paper. ResultsThe children with SLD exhibited gait deterioration in both single and dual-task gait (p < 0.05). Dual-task cost cognitive values were higher in children with SLD (p < 0.05). SignificanceThis study highlights the worse gait performance of children with SLD under single- and dual-task conditions compared with TD children. However, interventions for their gait impairments are limited. At this point, SLD specialists can focus on multitasking to improve their walking skills.

Does Concussion History Alter Cortical Activity During Single And Dual Task Gait?

Does Concussion History Alter Cortical Activity During Single And Dual Task Gait?

A Career Of Collegiate Contact Sports Does Not Impair Dual Task Gait Performance

A Career Of Collegiate Contact Sports Does Not Impair Dual Task Gait Performance

Comparative Effects of Motor and Cognitive Dual- Task Gait Training on balance and mobility in persons with Intellectual Disabilities

Background: Dual tasks fall into two main groups: motor dual tasks, which require performance of a motor task and a postural control task at the same time; and cognition dual task that require performance of a cognition task and postural control task at the same time. Aim: To focus on comparative effects of motor and cognitive dual-task gait training on balance and mobility in persons with intellectual disabilities Methodology: A randomized clinical trial was conducted on 52 subjects (n=26) in a District Headquarter Hospital, Mirpur AJK. Fifty-two patients were randomly allocated in two groups as Group A received motor dual task and Group B received cognitive dual task training. Total duration of study was three weeks and assessment done before treatment and after every week. Rancho Los Amigos Cognitive Functional Scale (RLACF), Berg Balance Scale (BBS), Walking While Talking Test (WWT) and Stair Climb Test (SCT) for the assessment of the patient’s improvement in skills, balance and mobility. Results: The results of the study concluded that Rancho Los Amigos Cognitive Function Scale, Berg Balance Scale, Walking While Talking Test and Stair Climb Test scores were improved in both groups significantly. But on comparison; Cognitive dual task training significantly produce better results in improving the balance and mobility in the person with intellectual disability as compared to Motor dual task training with p value&lt;0.005. Conclusion: The study concluded that Cognitive dual task training is statistically and clinically more significant in improving the balance and mobility in the intellectual disable persons as compared to Motor dual task training. Key words: Cognitive dual task, Intellectual disabilities, Motor and cognitive dual-task gait training.

Effects of a Cognitively Challenging Agility Boot Camp Program on Balance and Gait in People With Parkinson’s Disease: Does Freezing of Gait Status Matter?

Background and Aim: Individuals with Parkinson’s disease (PD) with and without freezing of Gait (FoG) may respond differently to exercise interventions for several reasons, including disease duration. This study aimed to determine whether both people with and without FoG benefit from the Agility Boot Camp with Cognitive Challenges (ABC-C) program. Methods: This secondary analysis of our ABC-C trial included 86 PD subjects: 44 without FoG (PD−FoG) and 42 with FoG (PD + FoG). We collected measures of standing sway balance, anticipatory postural adjustments, postural responses, and a 2-minute walk with and without a cognitive task. Two-way repeated analysis of variance, with disease duration as covariate, was used to investigate the effects of ABC-C program. Effect sizes were calculated using standardized response mean (SRM) for PD−FoG and PD + FoG, separately. Results: The ABC-C program was effective in improving gait performance in both PD−FoG and PD + FoG, even after controlling for disease duration. Specifically, dual-task gait speed (P < .0001), dual-cost stride length (P = .012), and these single-task measures: arm range of motion (P < .0001), toe-off angle (P = .005), gait cycle duration variability (P = .019), trunk coronal range of motion (P = .042), and stance time (P = .046) improved in both PD−FoG and PD + FoG. There was no interaction effect between time (before and after exercise) and group (PD−FoG/PD + FoG) in all 24 objective measures of balance and gait. Dual-task gait speed improved the most in PD + FoG (SRM = 1.01), whereas single-task arm range of motion improved the most in PD−FoG (SRM = 1.01). Conclusion: The ABC-C program was similarly effective in improving gait (and not balance) performance in both PD−FoG and PD + FoG.

A Review of the Measurement of the Neurology of Gait in Cognitive Dysfunction or Dementia, Focusing on the Application of fNIRS during Dual-Task Gait Assessment

Poor motor function or physical performance is a predictor of cognitive decline. Additionally, slow gait speed is associated with poor cognitive performance, with gait disturbances being a risk factor for dementia. Parallel declines in muscular and cognitive performance (resulting in cognitive frailty) might be driven primarily by muscle deterioration, but bidirectional pathways involving muscle–brain crosstalk through the central and peripheral nervous systems are likely to exist. Following screening, early-stage parallel declines may be manageable and modifiable through simple interventions. Gait–brain relationships in dementia and the underlying mechanisms are not fully understood; therefore, the current authors critically reviewed the literature on the gait–brain relationship and the underlying mechanisms and the feasibility/accuracy of assessment tools in order to identify research gaps. The authors suggest that dual-task gait is involved in concurrent cognitive and motor activities, reflecting how the brain allocates resources when gait is challenged by an additional task and that poor performance on dual-task gait is a predictor of dementia onset. Thus, tools or protocols that allow the identification of subtle disease- or disorder-related changes in gait are highly desirable to improve diagnosis. Functional near-infrared spectroscopy (fNIRS) is a non-invasive, cost-effective, safe, simple, portable, and non-motion-sensitive neuroimaging technique, widely used in studies of clinical populations such as people suffering from Alzheimer’s disease, depression, and other chronic neurological disorders. If fNIRS can help researchers to better understand gait disturbance, then fNIRS could form the basis of a cost-effective means of identifying people at risk of cognitive dysfunction and dementia. The major research gap identified in this review relates to the role of the central/peripheral nervous system when performing dual tasks.

Relationship and Latent Factors Between Clinical Concussion Assessments and the Functional Standardized Assessment of Reaction Time (StART).

To examine the relationships and latent factors within the Standardized Assessment of Reaction Time (StART), and between StART and current clinical assessments. Cross-sectional study. Clinical medicine facility. Eighty-nine healthy collegiate student-athletes (63% male, age: 19.5 ± 0.9 years, 28% ≥1 concussion history). Student-athletes completed StART and clinical assessments during preinjury testing. Standardized Assessment of Reaction Time consisted of 3 conditions (standing, single-leg balance, cutting) under 2 cognitive states (single task and dual task) for 3 trials each condition. Clinical assessments were the Sport Concussion Assessment Tool (SCAT) symptom checklist, Standardized Assessment of Concussion (SAC), tandem gait (single task and dual task), and Immediate PostConcussion Assessment and Cognitive Testing (ImPACT). We used Pearson- r correlation coefficients and exploratory factor analysis (EFA) to examine relationships and latent factors between StART and clinical assessments. Null to moderate correlations presented among the StART outcomes (r range: 0.06-0.70), and null to small correlations between StART and clinical assessments (r range: -0.16 to 0.34). The three-factor EFA for solely StART explained 70.6% total variance: functional movement (cutting), static dual-task (standing and single-leg balance), and static single task (standing and single-leg balance). The five-factor EFA for StART and clinical assessments explained 65.8% total variance: gait (single-task and dual-task tandem gait), functional movement (StART single-task and dual-task cutting), static dual-task (StART standing, single-leg balance), neurocognitive (ImPACT verbal memory, visual memory, visual-motor speed), and static single task (StART standing, single-leg balance). No other outcomes met the factor loading threshold. StART displayed 3 distinct categories and had minimal redundancy within its subtests. StART did not meaningfully correlate with clinical assessments, suggesting that StART provides unique information by examining more functional, reactive movement.

Temporal Variation Quantification During Cognitive Dual-Task Gait Using Two IMU Sensors.

Multiple tasks are simultaneously performed during walking in our daily life. Distracted walk by smartphone usage is recently getting a social problem. The term dual-task gait refers to the secondary task added to the walking. Attention demanding tasks may influence how a person walks. Since in-lab measurement may not accurately reflect the daily living gait, wearable sensors approach have been proposed for gait analysis in an out-of-lab setting. This study addresses the potential of using only two inertial measurement units (IMUs) attached to the shoes for the assessment of cognitive dual-task gait and how it differs from single-task gait. We found that the proposed system is sensitive to recognizing a tiny change in gait features such as on the double support time and gait indices when subject performing dual-task gait compared to the single-task gait experiment.

Comparison of Wuqinxi Qigong with Stretching on Single- and Dual-Task Gait, Motor Symptoms and Quality of Life in Parkinson's Disease: A Preliminary Randomized Control Study.

The objective of this study was to investigate the therapeutic effect of Wuqinxi Qigong vs. stretching on single- and dual-task gait, motor symptoms, and quality of life in people with mild and moderate Parkinson’s disease (PD). This single-blind, randomized control trial included 40 participants with idiopathic PD who were randomized into the Wuqinxi Qigong (WQ) group or stretching group. Participants completed 12 weeks (two sessions/week) of intervention. The primary outcomes were gait parameters when performing single-task (comfortable pace) and dual-task (obstacle crossing, serial-3 subtraction and backward digit span) walking, including gait speed, stride length, and double support percentage. The secondary outcomes were ratings from the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), results of the timed-up-and-go test (TUGT), results of the Mini-Balance Evaluation Systems Test (MiniBESTest), and responses from the 39-item Parkinson’s Disease Questionnaire (PDQ-39). All measures were assessed pre- and post-intervention. The WQ group demonstrated increased gait speed (p = 0.000) during the single task, and increased stride length (p = 0.001, p = 0.021) during the single-task and serial-3 subtraction task. Double support percentage significantly decreased (p = 0.004) in the WQ group during the obstacle crossing task, and also decreased (p = 0.045) in the stretching group during the single-task. TUGT (p = 0.005), MiniBESTest (p = 0.023) and PDQ-39 (p = 0.043) in the WQ group significantly improved, and both groups showed significant improvement in MDS-UPDRS after intervention. Wuqinxi Qigong is an effective method to improve single- and dual-task gait. While both exercises improve motor symptoms, Wuqinxi Qigong results in better mobility, balance and quality of life compared to stretching alone.

Association Between Collision Sport Career Duration and Gait Performance in Male Collegiate Student-Athletes

Background: Investigations of estimated age of first exposure to repetitive head impacts from collision and contact sports have shown no associations with neurocognitive or neurobehavioral function at the collegiate level, but the effect of career duration may be a more comprehensive factor. Understanding whether longer career duration influences gait performance would provide insights into potential neurological impairment. Purpose: To examine the relationship between career duration of collision sports and single/dual-task gait performance in collegiate student-athletes. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We recruited 168 male student-athletes from collision sports: football, lacrosse, ice hockey, and wrestling (mean ± SD age, 19.2 ± 1.3 years; height, 184.5 ± 7.2 cm; mass, 94.3 ± 15.9 kg; estimated age of first exposure, 8.6 ± 3.1 years; career duration, 10.6 ± 3.0 years). All participants completed a baseline single- and dual-task gait assessment before the start of their athletic season. Inertial measurement units were used to measure gait speed and stride length. During the dual task, participants were asked to perform working memory cognitive tasks while walking. The dependent variables were single/dual-task gait speed and stride length, cognitive accuracy, and dual-task cost. The relationship between career duration, analyzed as a continuous variable, and the dependent variables was analyzed using a linear regression. Results: There were no significant associations between career duration and single-task gait speed (1.16 ± 0.16 m/s; β = −0.004; P = .35; 95% CI = −0.012 to 0.004; η2 = 0.005) or dual-task gait speed (1.02 ± 0.17 m/s; β = −0.003; P = .57; 95% CI = −0.011 to 0.006; η2 = 0.002). There were also no significant associations between career duration and single/dual-task stride length, cognitive accuracy, or dual-task cost. Conclusion: Career duration among collegiate collision sport athletes was not associated with single- or dual-task gait performance, suggesting that a greater exposure to repetitive head impacts is not detrimental to dynamic postural control at the college level. However, the effects of diminished gait performance over the lifetime remain to be elucidated.

Treadmill training and physiotherapy similarly improve dual task gait performance: a randomized-controlled trial in Parkinson’s disease

Motor-cognitive dual tasks are used to investigate the interplay between gait and cognition. Dual task walking in patients with Parkinson’s disease (PD) results in decreased gait speed and more importantly in an increased fall risk. There is evidence that physical training may improve gait during dual task challenge. Physiotherapy and treadmill walking are known to improve single task gait. The aim of this study was to investigate the impact of individualized physiotherapy or treadmill training on gait during dual task performance. 105 PD patients were randomly assigned to an intervention group (physiotherapy or treadmill). Both groups received 10 individual interventional sessions of 25 min each and additional group therapy sessions for 14 days. Primary outcome measure was the dual task gait speed. Secondary outcomes were additional gait parameters during dual task walking, UPDRS-III, BBS and walking capacity. All gait parameters were recorded using sensor-based gait analysis. Gait speed improved significantly by 4.2% (treadmill) and 8.3% (physiotherapy). Almost all secondary gait parameters, UPDRS-III, BBS, and walking capacity improved significantly and similarly in both groups. However, interaction effects were not observed. Both interventions significantly improved gait in patients with mild to moderate PD. However, treadmill walking did not show significant benefits compared to individualized physiotherapy. Our data suggest that both interventions improve dual task walking and therefore support safe and independent walking. This result may lead to more tailored therapeutic preferences.

Dual-task gait and mild behavioral impairment: The interface between non-cognitive dementia markers.

Mild behavioral impairment (MBI) and dual-task gait cost (DTGC) are two non-cognitive markers of dementia that capture behavioral and motor symptoms. We investigated the relationship between MBI and DTGC in a sample of non-demented older adults. This was a cross-sectional observational study of 193 participants (10 cognitively normal, 48 subjective cognitive decline (SCD), 135 mild cognitive impairment (MCI); 52.8% female) from 13 Canadian sites from the Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) study. The Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to define MBI severity using a published algorithm. DTGC, the percentage difference between dual-task and preferred walking speeds, was assessed under three cognitive tasks: animal naming, counting backwards, and serial seven subtractions. Associations were tested in the entire cohort and in the MCI subgroup using multivariable linear regression adjusted for age, sex, education, and diagnosis. The role of global cognition, executive function, verbal and working memory in the association were investigated using tests of mediation and moderation. MBI symptoms were present in 46.6% of participants (mean age=72.4years). Greater overall MBI burden was associated with lower gait speed across all conditions. Furthermore, a one-point increase in global MBI symptom severity was associated with a 0.8% increase in DTGC in the animal fluency condition, a 0.9% increase in the counting backwards condition and a 1.1% increase in the serial sevens condition. These associations were strongest in the subgroup of MCI participants. Executive function but not global cognition or verbal and working memory mediated the association between MBI and DTGC in all three conditions. MBI is associated with gait speed and DTGC in this group of non-demented individuals, independent of the presence or absence of MCI. These findings provide evidence of the relationship between these non-cognitive dementia markers of behavior and gait beyond cognitive impairment.

A machine learning approach for the identification of kinematic biomarkers of chronic neck pain during single- and dual-task gait

BackgroundChanges in gait characteristics have been reported in people with chronic neck pain (CNP). Research questionCan we classify people with and without CNP by training machine learning models with Inertial Measurement Units (IMU)-based gait kinematic data? MethodsEighteen asymptomatic individuals and 21 participants with CNP were recruited for the study and performed two gait trajectories, (1) linear walking with their head straight (single-task) and (2) linear walking with continuous head-rotation (dual-task). Kinematic data were recorded from three IMU sensors attached to the forehead, upper thoracic spine (T1), and lower thoracic spine (T12). Temporal and spectral features were extracted to generate the dataset for both single- and dual-task gait. To evaluate the most significant features and simultaneously reduce the dataset size, the Neighbourhood Component Analysis (NCA) method was utilized. Three supervised models were applied, including K-Nearest Neighbour, Support Vector Machine, and Linear Discriminant Analysis to test the performance of the most important temporal and spectral features. ResultsThe performance of all classifiers increased after the implementation of NCA. The best performance was achieved by NCA-Support Vector Machine with an accuracy of 86.85%, specificity of 83.30%, and sensitivity of 92.85% during the dual-task gait using only nine features. SignificanceThe results present a data-driven approach and machine learning-based methods to identify test conditions and features from high-dimensional data obtained during gait for the classification of people with and without CNP.

Smartphone Measured Single- and Dual-Task Gait Evaluation in Adolescents Post-Concussion: A Longitudinal Comparison to Healthy Controls

Background: Impairments in postural stability are common following concussion. However, subjectively-scored assessments of postural control, such as the Balance Error Scoring System, may not accurately reflect postural instability. Objective measures, such as gait performance, can more accurately identify ongoing impairments in postural control throughout concussion recovery. Recent technological advances make gait evaluations more feasible across different clinical settings. Purpose: To compare performance on smartphone measured single- and dual-task gait evaluations among adolescent concussion participants and healthy controls across two timepoints. Methods: We evaluated concussed participants at initial (n=13; 14.6±1.3 years; 54% female; 5.5±1.6 days post-concussion) and follow-up visits (33.2±3.3 days post-concussion), and healthy control participants (n=21; 15.5±1.6 years; 48% female) at two timepoints 27.3±0.7 days apart on single- and dual-task gait performance. Single-task gait trials consisted of walking at a self-selected pace for 20 meters. Single-task cognitive trials involved responding to a cognitive task while standing in place. For dual-task trials, participants completed gait and cognitive tasks simultaneously. During each trial a smartphone affixed to the lumbar spine measured gait velocity and cognitive response accuracy and response time. We conducted a 2x2 mixed effects ANOVA to examine changes between groups across the testing timeline. Results: Concussion participants reported significantly greater symptom severity than control participants at the initial timepoint (23.1±13.5 vs 7.4±8.5; p=0.001); however, this difference did not persist to the second timepoint (p=0.99). The concussion group demonstrated significant improvements in single-task gait velocity between timepoints; although, between-group differences in gait velocity were not observed at either timepoint (Figure 1). No differences in cognitive accuracy between groups were identified. However, concussed participants performed worse than healthy controls on cognitive response time at both time points in single- and dual-task testing (Figure 2). Further, response time improved between testing periods for single-task, but not dual-task, conditions. Conclusion: Smartphone gait evaluations indicate improvement in single-task gait velocity during concussion recovery. However, no significant differences in gait velocity were found between concussed and control participants at either time point in single- or dual-task gait conditions. Interestingly, concussion patients had slower cognitive responses than healthy controls at both time points, despite no differences in cognitive accuracy or symptom severity at time 2. Our preliminary findings suggest that smartphone gait evaluations are effective in measuring changes in gait velocity and cognitive performance following adolescent concussion, as well as detecting subtle differences in gait and cognitive performance between concussed and control patients throughout recovery. [Figure: see text][Figure: see text]

Sleep Problems Following Concussion are Associated with Worse Balance and More Severe Symptoms in Youth Athletes

Background:Sleep disturbances are common following concussion and may affect symptom severity and recovery timing. Whether post-concussion sleep problems are associated with functional outcomes, such as postural stability, remains unexplored.Hypothesis/Purpose:We examined the association of self-reported sleep problems with clinical measures of postural stability, persistent post-concussion symptoms (PPCS), and symptom severity following pediatric concussion. We hypothesized that patients reporting post-concussion sleep problems would demonstrate worse postural stability, more severe symptoms at their initial clinical visit, and slower symptom recovery times than those without sleep problems.Methods:We retrospectively examined data from patients (6-18 years) evaluated by a sports medicine physician ≤21 days post-concussion. Patients performed the modified Balance Error Scoring System (mBESS) and single- and dual-task tandem gait (TG). They also reported initial concussion symptom severity they recalled within the first 24 hours post-injury and current symptoms at the first clinical visit using the Health and Behavior Inventory (HBI). Symptom duration was the number of days post-injury until the patient reported a return to baseline status. PPCS was defined as a symptom duration >28 days post-injury. We stratified patients based on those that self-reported sleep problems since injury (n=97, 14.32.9 years; 49% female; initial visit 10.25.8 days post-injury) compared to those who did not (n=110, 14.32.4 years; 46% female; initial visit 9.35.4 days post-injury) assessed with a yes/no question. Groups were compared using independent sample t-tests, Mann Whitney U tests, or Chi square analyses evaluated at a significance level of p=0.05. We examined PPCS development between groups using a logistic regression analysis adjusted for time of initial visit. Symptom severity was analyzed using a 2x2 repeated measures ANOVA with pairwise follow-up using an adjusted significance level of p=0.025.Results:Patients reporting sleep problems post-concussion had significantly more mBESS errors than those without (Table 1). We observed no between-group differences for single- or dual-task TG time or dual-task cognitive performance. Sleep problems post-concussion were associated with more severe symptoms during the first clinical visit despite similar day-of-injury symptoms (Figure 1), and a 2x greater odds of developing PPCS (adjusted odds ratio=2.02, 95% confidence interval = 1.01, 4.06; p=0.049).Conclusion:Youth athletes who reported sleep problems post-concussion demonstrated worse balance on the mBESS, increased likelihood of developing PPCS, and more severe symptoms than those who did not. Identifying sleep problems early in concussion recovery may allow clinicians to implement targeted treatment recommendations to improve sleep, and potentially reduce incidence of PPCS.Table 1.1.Postural stability outcomes assessed at the initial visit. Data are presented as mean (standard deviation).Figure 1.2.Symptom severity profiles for groups with and without sleep problems. Violin plots describe the probability density of measurements. Data are presented as the median (center dot, with corresponding number included) and interquartile range (box around the median). The retrospective rating of symptom severity at the time of concussion was not significantly different after making Bonferroni adjustment (p=0.03; where we defined statistical significance as p<0.025 due to multiple comparisons: the two time points where outcomes were compared). The sleep problem group, however, had significantly worse symptoms than the no sleep problem group at the time of initial clinical visit.

POST-CONCUSSION DIZZINESS SEVERITY PREDICTS DAILY STEP COUNT DURING RECOVERY AMONG ADOLESCENT ATHLETES

Background:Physical activity after concussion is an important aspect of appropriate management and may help to improve recovery time. However, symptom burden or functional deficits may be self-limiting and reduce activity level in the first weeks following a concussion.Purpose/Hypothesis:To examine dizziness and postural stability as potential predictors of physical activity level after concussion. We hypothesized that increased dizziness severity and more postural instability would predict lower step count acutely post-concussion.Methods:We initially evaluated athletes ages 12-18 years within 14 days of concussion using questionnaires and clinical tests to assess overall symptom burden, dizziness, and postural stability. Athletes were provided with an activity monitor that tracked daily step count for the subsequent two weeks after their initial care visit. Our primary outcome variable was daily step count (mean steps/day) during this two-week period. Potential predictor variables included participant characteristics (sex, age, time since injury, and history of: concussion, musculoskeletal injury, migraine, ADD, anxiety, depression), Post-Concussion Symptom Inventory (PCSI) total symptom burden, specific PCSI ratings of dizziness and balance impairment, and postural stability assessments [single and dual-task tandem gait (TG) and modified balance error scoring system (mBESS)]. To examine clinical predictors of activity we calculated Pearson correlation coefficients between mean steps/day and each potential predictor, and then included significantly correlated variables in a multiple linear regression model.Results:Athletes who participated in the study (n=35, mean 15.2±1.7 years of age, 49% female, mean steps/day=9195±3779) were initially evaluated a mean of 7.3±3.0 days post-concussion. PCSI dizziness rating (Pearson R=-0.49, p=0.003; Figure 1) and sex (mean difference=2449 steps/day, p=0.05) were associated with daily step count upon univariable evaluation and included in the multiple linear regression model. No other participant characteristics, symptom ratings, or objective balance or postural stability measures were significantly associated with steps/day (Table 1). In the multivariable model, PCSI dizziness rating (β=-1035; 95% CI: -191, -1880; p=0.018), but not sex, predicted average steps/day in the two weeks after initial clinical care visits.Conclusion:Self-reported dizziness severity assessed within 14 days of concussion predicted daily step count in the subsequent two weeks, while other measures of overall symptom severity and postural stability did not. Given the importance of physical activity for concussion recovery, identifying individuals with acute post-concussion dizziness may facilitate timely treatment of dizziness, potentially reducing a barrier to physical activity to improve recovery trajectories.Figure 1.Scatterplot and line of best fit of the relationship between PCSI dizziness rating and average step count per day.Table 1.Symptom ratings, postural stability measures, and balance assessments and associations with average steps/day.