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. 2022 Jul 1;32(4):361-367.
doi: 10.1097/JSM.0000000000000923. Epub 2021 Mar 9.

Dizziness, Psychosocial Function, and Postural Stability Following Sport-Related Concussion

Danielle L Hunt  1   2 , Jessie Oldham  1   2 , Stacey E Aaron  3   4 , Can Ozan Tan  3   4 , William P Meehan 3rd  1   2   5 , David R Howell  6   7
Affiliations

Dizziness, Psychosocial Function, and Postural Stability Following Sport-Related Concussion

Danielle L Hunt et al. Clin J Sport Med. .

Abstract

Objective: To examine if self-reported dizziness is associated with concussion symptoms, depression and/or anxiety symptoms, or gait performance within 2 weeks of postconcussion.

Design: Cross-sectional study.

Setting: Research laboratory.

Participants: Participants were diagnosed with a concussion within 14 days of initial testing (N = 40). Participants were divided into 2 groups based on their Dizziness Handicap Inventory (DHI) score: 36 to 100 = moderate/severe dizziness and 0 to 35 = mild/no dizziness.

Interventions: Participants were tested on a single occasion and completed the DHI, hospital anxiety and depression scale (HADS), Patient Health Questionnaire-9 (PHQ-9), and Post-Concussion Symptom Inventory (PCSI). Three different postural control tests were use: modified Balance Error Scoring System, single-/dual-task tandem gait, and a single-/dual-task instrumented steady-state gait analysis.

Main outcome measures: Comparison of patient-reported outcomes and postural control outcomes between moderate/severe (DHI ≥ 36) and mild/no (DHI < 36) dizziness groups.

Results: Participants with moderate/severe dizziness (n = 19; age = 17.1 ± 2.4 years; 63% female) reported significantly higher symptom burden (PSCI: 43.0 ± 20.6 vs 22.8 ± 15.7; P = 0.001) and had higher median HADS anxiety (6 vs 2; P < 0.001) and depression (6 vs 1; P = 0.001) symptom severity than those with no/minimal dizziness (n = 21; age = 16.5 ± 1.9; 38% female). During steady-state gait, moderate/severe dizziness group walked with significantly slower single-task cadence (mean difference = 4.8 steps/minute; 95% confidence interval = 0.8, 8.8; P = 0.02) and dual-task cadence (mean difference = 7.4 steps/minute; 95% confidence interval = 0.7, 14.0; P = 0.04) than no/mild dizziness group.

Conclusion: Participants who reported moderate/severe dizziness reported higher concussion symptom burden, higher anxiety scores, and higher depression scores than those with no/mild dizziness. Cadence during gait was also associated with the level of dizziness reported.

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Conflict of interest statement

Conflicts of interest

Unrelated to this study, Dr. Howell has received research support from the National Institute of Neurological Disorders And Stroke (R01NS100952 and R43NS108823) and MINDSOURCE Brain Injury Network. Dr. Meehan receives royalties from 1) ABC-Clio publishing for the sale of his books, Kids, Sports, and Concussion: A guide for coaches and parents, and Concussions; 2) Springer International for the book Head and Neck Injuries in the Young Athlete and 3) Wolters Kluwer for working as an author for UpToDate. His research is funded, in part, by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament and a grant from the National Football League. Dr. Tan serves as a data science consultant to Lokavant Inc. and received consultancy fees.

Figures

Figure 1.
Figure 1.
Single-task (A,B,C) and dual-task (D,E,F) steady-state gait performance comparisons between the moderate/severe and no/mild dizziness groups. * Single-task cadence (mean difference = 4.8, 95% confidence interval = 0.8, 8.8) and dual-task cadence (mean difference = 7.4, 95% confidence interval = 0.7, 14.0) were significantly different between groups.
See this image and copyright information in PMC

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