Clinical Feasibility and Utility of a Dual-Task Tandem Gait Protocol for Pediatric Concussion Management

Abstract

Context: Clinical management of sport-related concussion requires the assessment of various factors, including motor performance. The tandem gait test, a measure of post-injury motor performance, has demonstrated clinical utility, but is limited by time availability and test uniformity. Objective: To assess intrasession reliability between tandem gait test trials and determine the number trials necessary for optimal utility and feasibility in clinical decision-making following concussion. Design: Cross-Sectional Study Setting: Pediatric Sport Medicine Clinic Participants: Adolescent athletes who recently sustained a concussion (n=44; age=15.4±1.8 years; 39% female) and were seen for care within 14 days (7.3±3.2 days) of their injury, as well as uninjured control participants (n=73; age=15.8±1.3 years; 41% female). All participants completed three single-task and three dual-task tandem gait trials. Outcome Measures: We collected test completion time and cognitive performance for each trial and calculated Pearson correlation coefficients between trials and Intraclass Correlation Coefficients to determine intrasession reliability. We also compared performance between groups, and calculated area under the curve (AUC) values to identify the ability of each trial to distinguish between groups. Results: Both the concussion and control group demonstrated high intrasession reliability between tandem gait trials under single (R ≥ 0.82; ICC≥ 0.93) and dual-task conditions (R ≥ 0.79; ICC≥ 0.92). The greatest group classification values were obtained from the second single-task trial (AUC = 0.89) and first dual-task trial (AUC = 0.83). Test completion time provided excellent between-group discrimination in single-task and dual-task conditions. However, cognitive performance during dual-task trials demonstrated only marginally significant clinical utility (AUC ≤ 0.67). Conclusion: Tandem gait assessments may only require two trials under single-task and one trial under dual-task conditions to effectively discriminate between concussion and control groups. This approach may improve the feasibility (time requirement) of the test, while maintaining excellent discriminatory ability.

Postconcussion Dizziness Severity Predicts Daily Step Count during Recovery among Adolescent Athletes

“…Our measure of dynamic postural stability was timed tandem gait under single-and dual-task conditions. For singletask tandem gait, we instructed participants to walk as quickly as possible in a heel-toe pattern along a 3-m line, turn 180°, and return to the starting position in the same heel-toe pattern (27,28). Dual-task tandem gait trials consisted of the same tandem gait task with the addition of a cognitive task performed simultaneously.…”

Postconcussion Exercise Volume Associations With Depression, Anxiety, and Dizziness Symptoms, and Postural Stability: Preliminary Findings

“…The tandem gait test is a reliable assessment within a session and across time and can distinguish between patients with concussion and control patients. 21,22 During the test, participants walked without shoes using an alternate heel-to-toe gait pattern along a 3-m strip of tape while a test administrator timed how long it took them to complete. Participants were instructed to approximate their heel and toe, walk beyond the end of the 3-m line, make a 180°turn and return to the original starting point while walking in the same heel-to-toe fashion, completing 3 trials in singletask and dual-task conditions.…”

“…The cognitive test forms included spelling a 5letter word backwards, serial subtraction by 6s or 7s from a randomly presented 2-digit number, or reciting the months in reverse order starting from a randomly selected month, as described previously. 21,22 During the mBESS, participants stood on a solid surface for 20 seconds with their eyes closed. They completed 1 trial in 3 conditions: double-leg stance, single-leg stance, and tandem stance.…”

More Physical Activity after Concussion Is Associated with Faster Return to Play among Adolescents

“…Participants responded to 21 items by rating each symptom (e.g., headache, nausea, balance problems) on a 7-point scale indicating severity from 0 (Not a Problem) to 6 (Severe Problem). We calculated total PCSI score as the sum of all responses where the higher the value, the more symptomatic the participant [18,19].…”