The effect of footwear and sports-surface on dynamic neurological screening for sport-related concussion

The Sport Concussion Assessment Tool (SCAT) is a standardised global assessment for the identification of sport-related concussion (SRC). An integral component of the SCAT is the neurological screen, which contains the assessment of motor performance including gait evaluation. However, it is not known how performance of gait is affected by the surface/footwear interactions encountered in various sporting environments. The purpose of this study was to investigate the effect of footwear and sporting surface on the time to perform a standardised Tandem Gait (TG) task. One hundred and eight amateur athletes were recruited, and three common sports-surfaces (grass, hardwood court, artificial turf) were compared. All groups were tested barefoot and with sports-surface specific footwear. Mixed model ANOVA, controlling for covariates and including a post hoc Bonferroni procedure, was used to investigate the influence of footwear and sports-surface on TG time. The study demonstrated that times for a defined TG task in healthy athletes depended on footwear, sports-surface, and the specific athletic population. The study demonstrated a significant interaction (F(2,104)=3.35, p=0.039) between groups (grass, hardwood court and artificial turf), and times were faster wearing footwear compared to barefoot (F(2,138)=26.31, p=0.001). In contrast to the footwear conditions, there was no statistical difference between the barefoot conditions on any of the sport-surfaces. These findings suggest that clinicians should standardise footwear and the testing surface at baseline in order to accurately assess motor performance tests when SRC is suspected.