Altered gait termination strategies following a concussion

Abstract

The purpose was to determine if planned gait termination can identify acute and lingering motor control strategy alterations in post-concussion individuals. Controls completed 2 standard gait and 5 planned gait termination trials once while concussed individuals were tested on Day-1 and Day-10 post-concussion. Dependent variables included gait velocity and normalized, relative to standard gait, peak propulsive and braking forces. Control and only Day-1 post-concussion gait velocity differed. Normalized peak propulsive and braking forces were altered on both Day-1 and Day-10. Altered propulsive and braking forces persisted despite all concussion participants achieving their baseline values on standard concussion clinical tests. Thus gait termination can detect both acute and lingering motor control strategy alterations following concussion.

Altered dynamic postural control during gait termination following concussion

“…[23] The alterations identified herein may reflect changes in anticipatory postural adjustments (APAs) during planned GT. During a planned action, such as planned GT, the APAs are likely responsible for feedforward neurological control to maintain postural control during the transition from rhythmic gait through movement termination.…”

“…[28] Indeed, in a preliminary study, Buckley et al identified an altered propulsive and braking force motor strategy following concussion during planned GT. [23] Specifically, this strategy presented independent of gait velocity and persisted beyond clinical recovery (e.g., self-reported symptoms, computerized neurocognitive testing, and clinical cognitive/balance exams), suggesting a persistent deficit at least 10 days post-concussion; however that study was cross-sectional as baseline data was not presented. [23] Conversely, herein these findings identify alterations both within participants, as compared to healthy baseline performance, as well as to a healthy athletic population.…”

“…[23] Specifically, this strategy presented independent of gait velocity and persisted beyond clinical recovery (e.g., self-reported symptoms, computerized neurocognitive testing, and clinical cognitive/balance exams), suggesting a persistent deficit at least 10 days post-concussion; however that study was cross-sectional as baseline data was not presented. [23] Conversely, herein these findings identify alterations both within participants, as compared to healthy baseline performance, as well as to a healthy athletic population. Importantly, while there was differences in the timeline between group testing sessions, the healthy participant should high levels of consistency in the task.…”

“…[22] Thus, it is not surprising that GT has already identified both acute and lingering alterations in post-concussion propulsive and braking forces only; however, the COP trajectories have not been elucidated. [23] Further, individuals with compromised neurological systems (e.g., Parkinson’s disease, Cerebellar disease, moderate to severe traumatic brain injury) have noted planned GT deficits, including diminished COP displacements.…”

Comparison of psychological response between concussion and musculoskeletal injury in collegiate athletes.

“…Neurobiological supporting evidence potentially linking psychological outcomes with chronic post-concussion alterations include both altered frontal-alpha symmetry on EEG assessment and dorsolateral prefrontal cortex connectivity, which have been associated with the neural substrates underlying psycho-affective health (Chen et al, 2008; Moore, Sauve, & Ellemberg, 2016; van der Horn et al, 2016). Interestingly, postural control testing of gait termination, a functional task with dorsolateral prefrontal cortex supraspinal control, has identified deficits post-concussion which provides further potential evidence linking the systems (Buckley, Munkasy, Tapia-Lovler, & Wikstrom, 2013; Oldham, Munkasy, Evans, Wikstrom, & Buckley, 2016). An emerging area of concussion research suggests an elevated risk of post-concussion subsequent MSK injury in collegiate student-athletes (Brooks et al, 2016; Gilbert, Burdette, Joyner, Llewellyn, & Buckley, 2016; Lynall, Mauntel, Padua, & Mihalik, 2015) and both impaired postural control and residual psychological disturbances have been speculated as potential confounders or mechanisms.…”