The effect of prior concussion history on dual-task gait following a concussion

Objective To examine gait characteristics among patients following their first lifetime concussion, second or greater lifetime concussion, and individuals with no concussion history. Design Prospective observational study. Setting Regional sport-concussion clinic. Participants Fourteen patients presented following their first lifetime concussion (57% female; 15.6 [95% CI:=13.0, 17.2] years of age; 11.1 [8.3, 13.9] days post-concussion), 21 following their second or greater lifetime concussion (52% female; 16.9 [15.5, 18.4] years of age; 8.6 [6.2, 11.1] days post-concussion), and thirty-one controls without a concussion history (65% female; 15.0 [14.2, 15.8] years of age). Exclusion criteria included a current lower extremity injury or diagnosed learning disability. Interventions/independent variables Participants completed gait evaluations and medical history questionnaires. MANCOVAs evaluated between-group gait differences; correlations were calculated between the number of lifetime concussions and gait. Outcome measures Participants recorded their number of prior concussions. Three inertial sensors quantified single and dual-task gait; variables included average gait speed, cadence, and stride length. Main results During dual-task gait, patients reporting for their ≥ second lifetime concussion walked significantly slower (0.81 [0.75, 0.89] m/s vs. 0.92 [0.86, 0.97] m/s; p=0.009) and with smaller stride lengths (0.98 [0.92, 1.04] m vs. 1.08 [1.04, 1.13] m; p=0.02) compared to controls. A moderate correlation was detected between dual-task gait speed and the number of prior concussions (ρ= 0.44, p= 0.04). Conclusions Patients with a prior concussion history demonstrated altered dual-task gait strategies relative to controls. Dual-task gait velocity and number of prior concussions were moderately correlated, suggesting a worsening effect from multiple concussions across the lifetime. Competing interests None. Dr. Meehan receives royalties from ABC-Clio publishing for the sale of his book, Kids, Sports, and Concussion: A guide for coaches and parents, and royalties from Wolters Kluwer for working as an author for UpToDate. He is under contract with ABC-Clio publishing for a future book entitled, Concussions, and with Springer International publishing for a future book entitled, Head and Neck Injuries in Young Athletes. His research is funded, in part, by a grant from the National Football League Players Association and by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament. Drs. Howell, Beasley, and Vopat have no conflicts of interest to report.