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

Abstract

Objectives: To prospectively evaluate single/dual-task timed-up-and-go (TUG) and tandem gait performance among children and adolescents with concussion and healthy controls.

Design: Repeated measures.

Methods: Participants 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.

Results: The 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).

Conclusions: Slower 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.

Keywords: Balance; Gait; Mild traumatic brain injury; Sports medicine.