Balance and Gait Alterations Observed More Than 2 Weeks After Concussion (original) (raw)

Different gait tasks distinguish immediate vs. long-term effects of concussion on balance control

Journal of NeuroEngineering and Rehabilitation, 2009

The purpose of this study was to longitudinally compare the sensitivity of previously documented paradigms for measuring balance control during gait following a concussion. We hypothesized that gait with a concurrent cognitive task would be most sensitive to the effects of concussion on dynamic balance control. Individuals with concussion (n = 30) and matched controls (n = 30) performed a single task of level walking, attention divided walking, and an obstacle-crossing task at two heights. Testing occurred four times post-injury. Balance control during gait was assessed with whole-body center of mass and center of pressure motion. The single-task level walking task did not result in any significant differences in balance control between individuals with concussion and control subjects. Within 48 hours post-injury, individuals with concussion walked slower and allowed less motion of their center of mass in the sagittal plane when attention was divided during walking, but there were no group differences by day 6 for this task. Group differences in balance control during obstacle crossing was unremarkable during the first two testing sessions, but by day 14 individuals with concussion displayed less mediolateral motion of their center of mass. Attention divided gait is able to better distinguish gait adaptations immediately following a concussion, but obstacle crossing can be used further along in the recovery process to detect new gait adaptations.

Balance control during gait in athletes and non-athletes following concussion

Medical Engineering & Physics, 2008

Current literature provides only limited information regarding performance on dynamic motor tasks following concussion. However, recent investigations have suggested that participation in contact sports may have a negative effect on cognitive function without the existence of a medically diagnosed concussion. The purpose of this study was to examine balance control during gait in concussed and uninjured athletes and non-athletes. Twenty-eight Grade 2 concussed individuals (14 athletes and 14 non-athletes) and 28 uninjured matched controls (14 athletes and 14 non-athletes) were assessed for their gait performance within 48 h, 5, 14, and 28 days post-injury under conditions of divided and undivided attention. Athletes, whether concussed or not, walked slower and swayed more and faster than non-athletes. Athletes consistently demonstrated gait imbalance even in the absence of concussion. The findings of this study support the supposition that participation in high-impact sports has a measurable and possibly detrimental effect on balance control in the absence of a medically diagnosed concussion.

Gait stability following concussion

Journal of Biomechanics, 2006

The need to identify functional impairment following a brain injury is critical to prevent reinjury during the period of recovery. However, little is known about the effect of concussion on dynamic motor function. The purpose of this study was to examine the effect of concussion on a dynamic motor task under conditions of divided and undivided attention over the course of 28 d. Fifteen subjects with concussions (CONC) and 15 uninjured controls (NORM) were observed while walking with undivided attention and while concurrently completing simple mental tasks. The CONC were assessed within 48 h of injury and again at 5, 14, and 28 d postinjury. The NORM were evaluated at the same time intervals. Whole-body motion data were collected to examine displacement and velocity of the center of mass (COM) and the maximum separation between the COM and center of pressure (COP). Three-way repeated-measures mixed-design ANOVA and Tukey post hoc tests were completed to determine differences between group, task, and testing day (P<0.05). Several aspects of gait stability were compromised in the CONC group for up to 4 wk after injury. CONC were found to walk significantly slower during dual tasks on all testing days when compared with the uninjured controls. The injured subjects were also found to have greater sway and sway velocity than controls when attention was divided for up to 28 d postinjury. The findings of this study suggest that concussion may have long-term observable and measurable effects on the control of gait stability.

Altered balance control following concussion is better detected with an attention test during gait

Gait & Posture, 2007

The purpose of this study was to examine the effects of concussion on gait stability when either a cognitive or motor perturbation is imposed. Fourteen individuals suffering from a grade II concussion and 14 matched controls performed a single task of level walking, a continuous sequential question and answer task while walking, and an obstacle-crossing task. Common gait spatial/temporal measurements, whole-body center of mass motion, and center of pressure trajectory were assessed. Concussed individuals adopted a more conservative strategy to maintain gait stability. Some measurements indicating conservative gait were seen during obstacle crossing, but this was most evident during the Q&A task. Concussed individuals also displayed signs of possible instability during the Q&A task. The question and answer task was most sensitive to distinguishing concussed individuals from healthy individuals, supporting the use of a similar dual-task modality in future testing after concussion to determine a proper time for return to activity.

Reliability and Validity Evidence of Multiple Balance Assessments in Athletes With a Concussion

Journal of Athletic Training, 2014

Context: An estimated 300 000 sport-related concussion injuries occur in the United States annually. Approximately 30% of individuals with concussions experience balance disturbances. Common methods of balance assessment include the Clinical Test of Sensory Organization and Balance (CTSIB), the Sensory Organization Test (SOT), the Balance Error Scoring System (BESS), and the Romberg test; however, the National Collegiate Athletic Association recommended the Wii Fit as an alternative measure of balance in athletes with a concussion. A central concern regarding the implementation of the Wii Fit is whether it is reliable and valid for measuring balance disturbance in athletes with concussion. Objective: To examine the reliability and validity evidence for the CTSIB, SOT, BESS, Romberg test, and Wii Fit for detecting balance disturbance in athletes with a concussion. Data Sources: Literature considered for review included publications with reliability and validity data for the assessmen...

The effect of divided attention on gait stability following concussion

Clinical Biomechanics, 2005

Background. The need to identify functional impairment following a brain injury is critical to prevent re-injury during the period of recovery. While many neuropsychological tests have been developed to assess cognitive performance, relatively little information on gait and dynamic stability is available on motor task performance for young adults following concussion. This study was performed to investigate the effect of divided attention following concussion on various gait variables. It was hypothesized that, when compared to uninjured controls, concussed subjects would demonstrate deficits in maintenance of dynamic stability.

Evidence of a conservative gait strategy in athletes with a history of concussions

Journal of Sport and Health Science, 2016

Background: A history of 3 or more concussions is frequently associated with numerous short-and long-term neuropathologies. Impairments in postural control are a known acute consequence of concussion; however, limited evidence exists on the effects of multiple concussions on gait. The purpose of this study was to assess gait stepping characteristics in collegiate aged student-athletes based on concussion history. Methods: There were 63 participants divided into 3 even groups based on concussion history: ≥3 concussions, 1-2 concussions, and 0 concussion. All participants completed 10 trials of gait on a 4.9 m instrumented walkway. The dependent variables of interest included both gait stepping characteristics (step velocity, length, and width, double support time, and the percentage of the gait cycle in stance) and coefficient of variability (CoV) measures (step length, time, and width). The gait stepping characteristics were compared first with a MANOVA with follow-up 1-way ANOVAs and Tukey post hoc tests as appropriate. The CoV measures were compared with 1-way ANOVAs and Tukey post hoc tests. Results: There were main effects for group for step velocity, length, width, and double support time. Overall, the 0 concussion group displayed typical healthy young gait parameters and performed significantly better than either concussion group. The 0 concussion group had a significantly greater step length CoV, but there were no differences in the step time or width CoV. Conclusion: This finding provides evidence of subtle impairments in postural control during gait among individuals with prior history of concussion which could be an early indicator of future neurological deficiencies. The limited difference in the variability measures is consistent with prior static stance studies and could suggest the individuals constrain their motor systems to reduce variability. Taken together, these findings suggest a conservative gait strategy which is adopted by individuals with a history of concussions.