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Deficits in dynamic balance during tandem gait after concussion may be exacerbated by dual-tasks
  1. RC Lynall1,
  2. JT Blackburn2,
  3. KM Guskiewicz2,
  4. SW Marshall3,
  5. P Plummer4,
  6. JP Mihalik2
  1. 1Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, USA
  2. 2Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, USA
  3. 3Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, USA
  4. 4Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, USA


Objective Expert consensus recommends tandem gait (heel-to-toe walking) to assess concussion. Failure rate when only assessing time-to-task completion is unacceptably high among healthy participants. Our purpose was to assess tandem gait centre of pressure and dual-task cost with and without cognitive distraction in recently concussed individuals.

Design Cross-sectional.

Setting University.

Subjects Thirty college-aged recreational athletes in two 15-person groups: 1) recent concussion (median time post-concussion=126 days, range 28-432d), and 2) healthy sex-, age- (±1 yr), mass- (±10%), and height- (±5%) matched controls.

Intervention Participants completed 3 trials each of 4 tandem gait conditions: 1) tandem gait (eyes open, no cognitive distraction), 2) tandem gait (eyes closed, no cognitive distraction), 3) tandem gait (eyes open, Brooks Visuospatial Task cognitive distraction), and 4) tandem gait (eyes closed, Brooks Visuospatial Task cognitive distraction).

Outcome measures Centre of pressure velocity, speed, path length, and dual-task cost.

Results The recent concussion group (25.15 cm/s) demonstrated slower tandem gait velocity compared to the control group (29.20 cm/s; p=0.049; 95% CI:0.02-8.06 cm/s). After controlling for group velocity differences, the recent concussion group (23.5%) had higher centre of pressure speed dual-task cost during the eyes closed dual-task condition than did the control group (16.3%; p=0.032; 95% CI:2.70-11.48%).

Conclusions We observed subtle centre of pressure group differences more than one month after post-concussion return to activity. It remains unclear if these differences impact clinical outcomes post-concussion. Longitudinal investigations should study acute post-concussion movement deficits, and discern the recovery of these deficits in comparison to recovery using traditional concussion assessment tools.

Competing interests None.

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