Single-task Tandem Gait Research Articles

Early physical activity after concussion is associated with sleep quality but not dizziness among adolescent athletes.

To assess the association between early physical activity and post-concussion sleep quality, dizziness, and postural stability among adolescents with concussion compared to uninjured controls. Cross-sectional. Adolescents ages 13-18 years assessed within 14 days post-concussion and uninjured controls. Those with concussion reported if they participated in physical activity between the concussion and assessment. Participants completed the Dizziness Handicap Inventory, Pittsburgh Sleep Quality Index, and single/dual-task tandem gait. We enrolled 34 participants with concussion (early physical activity: n = 10, age = 15.8 ± 1.6 years, 70% female; no physical activity: n = 24, age = 16.0 ± 1.3 years, 50% female) and 21 uninjured controls (age = 16.0 ± 1.8 years, 48% female). Compared to controls, the no physical activity group reported worse sleep quality (Pittsburgh Sleep Quality Index: 3.8 ± 2.7 vs 8.0 ± 4.9 points, p = 0.002) and single-task tandem gait time (13.7 ± 3.4 vs 21.2 ± 8.1 s, p = 0.0006), while the early physical activity group did not (Pittsburgh Sleep Quality Index: 3.8 ± 2.7 vs 5.8 ± 3.2 points, p = 0.38; single-task tandem gait: 13.7 ± 3.4 vs 19.0 ± 5.7 s, p = 0.08). Compared to controls, early/no physical activity groups reported worse dizziness (Dizziness Handicap Inventory: 2.0 ± 3.4 vs 22.9 ± 23.8 vs 27.4 ± 19.2 points, p < 0.0001). There were no significant between-group differences for dual-task tandem gait (24.1 ± 8.0 vs 24.8 ± 6.2 vs 26.6 ± 7.3 s, p = 0.57). The no physical activity group reported worse sleep quality and slower single-task tandem gait than controls, while both groups reported similar sleep quality and tandem gait. Early physical activity may promote sleep quality and postural stability, or early physical activity may be a function of improved sleep and postural stability after concussion.

Effect Of Ice Hockey Repetitive Head Impacts On Dual Task Tandem Gait Performance

Repetitive head impacts (RHI) may adversely affect neurophysiological health, but their effect of functional tasks remain to be further elucidated. PURPOSE: To determine the effect of RHI on single task (ST) and dual task (DT) tandem gait performance in collegiate ice hockey players. METHODS: 36 male collegiate ice hockey players (age: 19.7 + 1.2 y.o., ht: 1.80 + 0.06 m, wt: 80.9 + 6.8 kg, concussion history: 48.6% (17/36), 0.8 + 0.9 concussions) were assessed over the course of a club collegiate ice hockey season between 2016 and 2019. Head impact monitoring occurred during each practice and home game using the Smart Impact Monitor (SIM-G) through visual and/or video review. Participants performed five trials each of ST and DT Tandem Gait (TG) at pre-season, mid-season, and post-season. The DT challenges were working memory tasks which included subtraction, spelling, and reciting the months of the year backwards as the participant walked heel-to-toe down a 3-meter line, turned around, and returned. To assess changes over the course of the season, a repeated measures mixed model ANOVA was performed for ST and DT tandem gait total time with pairwise post-hoc on significant findings. RESULTS: There was a significant main effect for time for both ST tandem gait (p = 0.001, partial eta = 0.217) and DT tandem gait (p < 0.001, partial eta = 0.305). There was a significant improvement in ST tandem gait from Pre-season to Post-season (pre; 10.3 + 1.8 sec, post; 9.2 + 1.8 sec, p < 0.001, d = 0.61), but not Mid-Season (mid; 9.7 + 1.8 sec, p = 0.067). There was a significant main effect for time in DT tandem gait from pre-season to both mid-season (pre; 13.8 + 4.7 sec, mid; 12.2 + 3.3 sec, p = 0.001, d = 0.39) and Post-Season (post; 11.9 + 3.9 sec, p < 0.001, d = 0.43). CONCLUSION: Contrary to our hypothesis that repetitive head impacts experienced over the course of an ice hockey season would result in reduced/worsened tandem gait performance, the participants herein showed significant improvements over time with medium to large effects sizes. While prior studies have shown modest improvements in tandem gait performance with repeat administration, these results suggest that participation in collegiate club ice hockey season are not associated with postural control impairments as measured by either ST or DT tandem gait.

Post-Concussion Dizziness, Sleep Quality, and Postural Instability: A Cross-Sectional Investigation.

Dizziness, postural instability, and poor sleep quality are all commonly reported post-concussion and individually relate to poor outcomes. To examine sleep quality and postural stability among adolescents who did and did not report dizziness within two weeks of concussion. Cross-sectional study. Research laboratory. Participants ages 12-18 years within 14 days of concussion (n=58, 15.2±1.8 years; 50% female; 7.1±3.1 days post-injury) and uninjured controls (n=73; 15.8±1.3 years; 42% female). Participants completed pre-injury and current dizziness ratings on the Post-Concussion Symptom Inventory (PCSI) and current sleep quality on the Pittsburgh Sleep Quality Index (PSQI). Participants also completed postural stability assessments (single/dual-task tandem gait and modified Balance Error Scoring System [mBESS]). We grouped concussion patients into dizzy (n=21) or not dizzy (n=37) groups based on PCSI dizziness ratings: difference between current and pre-injury dizziness rating >3=dizzy; difference <3=not dizzy. The dizzy and not dizzy groups both reported significantly worse sleep quality than the control group (PSQI score: mean=9.6±3.7 vs 7.2±3.5 vs 4.3±2.6; p<0.001) upon univariable comparison. Similarly, the dizzy group performed slowest on single and dual-task tandem gait, followed by the not dizzy group, then the control group (single-task TG: mean= 27.2±11.7 sec vs 21.2±6.3 vs 14.7±3.6; p<0.001); (dual-task TG: mean=38.4±16.2 sec vs 29.9±7.2 vs 21.6±7.5; p<0.001). Both concussion groups demonstrated significantly more errors than the control group on the mBESS (mean=9.8±5.1 vs 6.9±5.8 vs 3.8±3.5; p<0.001). After controlling for total symptom severity in the multivariable model, tandem gait, but not mBESS or sleep quality, was associated with dizziness. Individuals with post-concussion dizziness also demonstrated impaired tandem gait performance, while poor sleep quality was associated with total symptom severity. Identifying and treating the underlying dysfunction contributing to dizziness and postural instability may guide individualized rehabilitation strategies and facilitate recovery.

Handball concussion case series in a Brazilian Team

To analyze the history of self-reported head impacts, prevalence of post-concussion symptoms and performance in motor coordination tests in amateur handball athletes. Handball is a contact sport where athletes can suffer collisions through different mechanisms and there are few published data about brain concussion in handball, mainly in Brazilian athletes. Amateur male athletes aged between 18 and 35 years, with 4-6 hours of training per week and an average of 12.5 games in the last 6 months were evaluated regarding to the head impact history during handball games and practices. The athletes were also evaluated regarding of the most common kind of impact mechanism, loss of consciousness (LOC), reported cervical injury (pain and decreased range of motion), symptoms prevalence and their severity using the Post Concussion Symptom Scale (PCSS), time to execution of single-task tandem gait (TG) and performance in the Finger-to-Nose test (>4 seconds to perform five successive finger to nose repetitions was considered abnormal). Six athletes reported direct impacts on the head while playing handball. Falls, elbow to the head, trunk to the head and hit by the ball were the most reported mechanisms of head impact in handball athletes. Two athletes reported LOC and all of them denied cervical injury after trauma. Regarding the PCSS score, three athletes had a score between 6-21 and five athletes had a 22-84 score. The most reported symptoms were sleeping more than usual, drowsiness, fatigue, changes in behavior (nervousness, feeling more emotional and irritability), trouble falling asleep and dizziness. However, athletes shown a normal performance in the single task TG (14.6-17.2 seconds) compared to normative data and three athletes shown altered performance on the Finger-to-Nose test. Amateur handball athletes had significant scores of PCSS mainly related to sleep, emotional and possibly to the vestibular function.

Single-Task and Dual-Task Tandem Gait Performance Across Clinical Concussion Milestones in Collegiate Student-Athletes.

To determine the length of time after concussion that impaired tandem gait performance is observed. Clinical measurement, prospective longitudinal. NCAA collegiate athletic facility. Eighty-eight concussed NCAA Division I student-athletes and 30 healthy controls. Group (concussion/control) and time (Baseline, Acute, Asymptomatic, and RTP). Participants completed 4 single-task and dual-task tandem gait trials. The concussion group completed tests at the following time points: preseason (Baseline), within 48 hours after concussion (Acute), on the day symptoms were no longer reported (Asymptomatic), and when cleared to return to sports (RTP). Controls completed the same protocol at similar intervals. The dual-task trials involved minimental style cognitive questions answered simultaneously during tandem gait. We analyzed the best time of the 4 trials, comparing groups with a linear mixed model. Acutely after concussion, the concussion group performed single-task tandem gait slower (worse) than controls (concussion: 11.36 ± 2.43 seconds, controls: 9.07 ± 1.78 seconds, P < 0.001). The concussion group remained significantly slower than controls (9.95 ± 2.21 vs 8.89 ± 1.65 seconds, P = 0.03) at Asymptomatic day but not RTP. There were significant group (P < 0.001) and time (P < 0.001) effects for dual-task tandem gait. The groups were not significantly different at baseline for single-task (P = 0.95) or dual-task (P = 0.22) tandem gait. Our results indicate that tandem gait performance is significantly impaired acutely after concussion, compared with both preseason measures and controls. Postural control impairments were not present when the student-athletes were cleared for RTP. This information can assist clinicians when assessing postural control and determining recovery after a concussive injury.

Fear Of Re-injury Correlates With Concussion Symptoms And Reaction Time Among Adolescents With Concussion

BACKGROUND: Athletes appear to be at an increased risk of musculoskeletal injury following return to play after concussion. Underlying causes are likely multi-factorial but not well established. Fear of re-injury has been widely studied in musculoskeletal injuries, but its effect on concussion recovery is unknown. PURPOSE: To examine the association of fear of re-injury with physical and self-reported measures after concussion. We hypothesized that greater fear of re-injury would be correlated with a higher symptom severity, worse sleep quality, and worse physical test performance. METHODS: Athletes (n=19; 15.0±1.8 years of age; 42% female; 7.4±3.3 days post-injury) were tested within 14 days of concussion, and underwent assessments of self-reported and physical examination measures. Self-reported measures included the Tampa Scale of Kinesiophobia (TSK)- assessing fear of re-injury, Post-Concussion Symptom Inventory (PCSI), and Pittsburgh Sleep Quality Index (PSQI). Physical examination measures included clinical reaction time, near point of convergence, single and dual-task tandem gait, and Balance Error Scoring System (BESS). We examined correlations between TSK scores and each outcome measure using Pearson correlation coefficients, adjusting for age, sex, and time from injury using linear regression models. RESULTS: Higher TSK scores were significantly correlated with higher symptom severity (PSCI) scores (r= 0.69; p=0.001) and slower reaction times (r= 0.53; p=0.02). TSK scores were not significantly correlated with single-task tandem gait (r= 0.23; p=0.34), dual-task tandem gait (r= 0.29; p=0.23), PSQI (r= 0.43; p=0.08), NPC (r= 0.03; p=0.91), or BESS (r= 0.23; p=0.35) scores. After adjusting for the effect of age, sex, and time from injury to examination, higher TSK scores were significantly associated with slower clinical reaction time performance (β= 2.8; 95% CI= 0.94, 4.62; p=0.006), greater symptom severity (β= 3.64; 95% CI=2.07, 5.21; p < 0.001), and worse sleep quality (β= 0.37; 95% CI= 0.05, 0.68; p=0.03). CONCLUSIONS: In accordance with our hypothesis, higher TSK scores were correlated with higher symptom severity and slower reaction times. This suggests that assessing an athlete’s fear of re-injury may be useful following concussion and throughout recovery.

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

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.

A multifaceted and clinically viable paradigm to quantify postural control impairments among adolescents with concussion

Objective: To identify clinically significant postural control measures capable of distinguishing the performance of adolescents with concussion from uninjured controls. Approach: Fifteen adolescents with concussion (67% female; median age = 16.3 years; tested 8 ± 4 d post-injury) and 31 controls (45% female; median age = 15.2 years) completed a single/dual-task gait evaluation with a smartphone affixed to their lumbar spine, modified balance error scoring system (mBESS), and single/dual-task tandem gait test. Outcome measures were obtained via smartphone (single/dual-task gait speed, cadence, step length), mBESS (double/single/tandem errors), and tandem gait (single/dual-task time). We calculated area under the curve (AUC) values for each measure that demonstrated a significant difference between groups independently, and calculated a comprehensive AUC value for all measures combined. Main results: The concussion group walked significantly slower (mean = 0.89 ± 0.15 versus 1.05 ± 0.15 m s−1; p = 0.002) and with significantly fewer steps per minute (median = 103 [interquartile range = 94–108] versus 116 [104–118] steps/minute; p = 0.002) than the control group under single-task conditions. They also completed single-task (median = 22.0 [16.6–24.2] versus 14.5 [12.4–15.5] s; p < 0.001) and dual-task (median = 30.0 [24.0–35.2] versus 18.6 [16.1–21.7] s; p < 0.001) tandem gait tests significantly slower than controls. The AUC value for single-task gait velocity, single-task cadence, single-task tandem gait time, and dual-task tandem gait time indicated an excellent ability to distinguish between concussion and control groups (AUC = 0.91, 95% CI = 0.80–0.99). Significance: Smartphone-obtained gait measures and tandem gait times allowed for an excellent differentiation between adolescents with concussion versus control participants. This reinforces the need for multimodal approaches to postural control impairment recognition among adolescents with concussion.

Objective clinical tests of dual-task dynamic postural control in youth athletes with concussion

ObjectivesTo prospectively evaluate single/dual-task timed-up-and-go (TUG) and tandem gait performance among children and adolescents with concussion and healthy controls. DesignRepeated measures. MethodsParticipants with concussion (n=23; age=14.1±2.5years; 52% female) completed single/dual-task TUG, tandem gait, and symptom assessments 6.7±2.6 and 23.3±6.1days post injury. The control group (n=27; age=14.1±2.3years; 48% female) completed the same protocol initially and 10.7±16.1days later. All participants completed single-task (undivided attention) and dual-task (divided attention) tests. The primary outcome variable was test completion time. ResultsThe concussion group completed single-task (concussion group mean=11.1±1.9 vs. control group mean 9.9±1.4s, p=0.027) and dual-task (concussion group mean=14.4±3.3 vs. control group mean 12.7±1.9s, p=0.047) TUG tests slower than the control group across both time points. The concussion group completed dual-task tandem gait tests slower than the control group at both time points (21.3±6.3 vs. 16.8±5.5s, p=0.006), and were slower in the single-task condition at the first test (19.8±5.4 vs. 13.8±4.4s, p=0.003). Symptoms were significantly worse for the concussion group compared to the control group at the first (34.1±21.4 vs. 3.9±9.1, p<0.001), but not the second test (9.1±12.0 vs. 2.2±6.8; p=0.08). ConclusionsSlower dual-task TUG and tandem gait times were detected across both time points for the concussion group relative to the control group. In contrast, single-task tandem gait deficits appeared to improve in a similar fashion as symptoms, suggesting increased complexity from the addition of a cognitive task allows for the detection of persistent post-concussion deficits that might take longer to resolve.

Dual-Task Tandem Gait and Average Walking Speed in Healthy Collegiate Athletes.

To (1) examine the association between a commonly used concussion test, tandem gait, in single/dual-task conditions with single-task and dual-task average walking speed, (2) characterize the prevalence of tandem gait false positives, and (3) develop a normative reference range of dual-task tandem gait times. Cross-sectional study. Two NCAA collegiate athletic facilities. Athletes completed the tandem gait test and a gait evaluation in single/dual-task conditions during a preseason examination. Associations between tandem gait times and average walking speeds were evaluated using multiple linear regression models. Various tandem gait test time pass/fail cutoffs were calculated to examine false-positive rates. Among the 171 participants (103 men, 19.8 ± 1.2 years of age), dual-task tandem gait completion times were independently associated with dual-task average walking speed [β = -4.018; 95% confidence interval (CI), -7.153 to -0.883], but single-task associations were not found. Male gender was associated with faster tandem gait times in both single-task (β = -0.880, 95% CI, -1.731 to -0.029) and dual-task conditions (β = -2.225, 95% CI, -3.691 to -0.759). A pass/fail cutoff threshold of 14 seconds resulted in a 2% false-positive rate for single-task tandem gait, while it resulted in a 29% false-positive rate during dual-task tandem gait. Average walking speed and dual-task tandem gait represent objective measures that are useful in concussion management. While a single-task tandem gait cutoff of 14 seconds seems appropriate for males, adjustments may be necessary based on sex and alternate pass/fail criteria may be appropriate for dual-task tandem gait.