May 2017

Gait metrics highlight gender differences after concussion

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Girls show more postinjury changes

By Hank Black

A recent study’s findings related to dual-task gait analysis in adolescents add to the body of evidence suggesting that concussion effects differ between male and female patients.

The findings, epublished April 1 by Gait & Posture, also suggest dual-task costs—the percentage change from a focused-attention single-task condition to a divided-attention dual-task condition—are useful for comparing characteristics such as gender among a group of individuals postconcussion, but traditional gait metrics may distinguish better between concussion and control groups.

Previous studies, including a recent meta-analysis, have found female patients have greater visual memory impairments and report more severe symptoms after concussion than male patients. But it previously was unknown whether dual-task gait differences existed between genders postconcussion.

The current study noted, “Our results indicate that during tasks with dynamic equilibrium and control challenges such as gait, paired with a cognitive task, differences exist between genders.”

Lead author David R. Howell, PhD, ATC, a clinical researcher at The Micheli Center and Boston Children’s Hospital, said those differences, which are independent of gender differences in body size, may be useful in determining individualized evaluation and management of functional recovery following sports concussion. He noted most prior studies of postconcussion gender differences have used subjective symptom inventories.

Identifying specific deficits among patient subgroups could enhance clinicians’ postconcussion counsel.

“We were interested in whether the objective evaluation of postconcussion deficits, such as instrumented dual-task gait assessment, would provide additional insights,” he said.

The researchers recruited 35 participants (49% girls; mean age 15 ± 2.1 years) who were postinjury (7.5 ± 3 days) and compared them with 51 uninjured controls (51% girls; mean age 14.4 ± 2.1 years). Both groups completed a symptom inventory and single- and dual-task gait assessments.

They also evaluated average speed, cadence, stride length, and double support time. To suss out the individual differences, the researchers chose the dual-task cost as the primary outcome variable.

Investigators found no significant differences between genders in postconcussion measures of symptom severity. Dual-task gait metrics, however, showed girls with concussion walked with lower cadences than female controls and boys with concussion. Stride length differed between concussion and control groups and between genders in both groups; all concussion participants walked with shorter stride lengths than controls.

A wide variation in dual-task costs was found in the concussion cohort, but a significant difference was found only in gait cadence: Girls with concussion walked with significantly greater dual-task costs than boys with concussion (there was no significant difference between genders in the control group).

The researchers hope identifying specific deficits among patient subgroups will allow clinicians to provide better counsel after injury and direct patients to appropriate clinical pathways, Howell said, noting they expect their findings to be used as part of an in-clinic evaluation rather than field-side assessment.

“Since we conducted all testing in a hallway nearby the exam room, our hope is that clinicians may be able to adapt dual-task paradigms into their everyday practice to understand if an athlete has recovered the ability to walk and think simultaneously,” he said.  “We are hoping to use this study as a basis to also gather data that answer some of the physiologic underpinnings of our findings. By addressing this, we hope to help improve how clinicians tailor management plans to different individuals based on their innate characteristics, as well as their postinjury function.”

Daniel Herman, MD, PhD, of the University of Florida, Gainesville, said the varied effects of concussion on neuro­­-muscular control are relevant to both the clinical use of dual-attention tasks, as well as to postrecovery complications, such as risk for musculoskeletal injury.

“In general, the paradigm of dual tasking can help us identify differences between groups [whether gender or based on concussion status],” said Herman, assistant professor in the division of Physical Medicine and Rehabilitation, Sports Medicine, and Research in the Department of Orthopedics and Rehabilitation.

He believes the sports medicine community should be using dual-task analysis more extensively in concussion evaluation, injury risk assessment, and injury rehabilitation.

“This is another strong manuscript by David Howell, who really has become a leader in sports concussion, but particularly in the area of the effects of concussion on gait,” he said.

Hank Black is a freelance writer in Birmingham, AL. 

Sources:

Howell DR, Stracciolini A, Geminiani E, Meehan WP 3rd. Dual-task gait differences in female and male adolescents following sports concussion. Gait Posture 2017;54:284-289.

Howell DR, Osternig LR, Chou L-S. Dual-task effect on gait balance control in adolescents with concussion. Arch Phys Med Rehabil 2013;94(8):1513-1520.

Brown DA, Elsass JA, Miller AJ, et al. Differences in symptom reporting between males and females at baseline and after a sports-related concussion: a systematic review and meta-analysis. Sports Med 2015;45(7):1027-1040.

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