Gait Deficits Under Dual – Task Conditions in the Concussed Adolescent and Young Athlete Population: A Systematic Review

Abstract

Background: There are no current sport concussion assessments that capture the effects of dual-task conditions on gait. Multiple studies have evaluated changes, but none have comprehensively examined literature related to the adolescent and young adult population. Purpose: The purpose of this systematic review is to synthesize documented changes in gait under dual-task conditions in adolescents and young adults after sustaining a concussion. Study Design: Systematic Review Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was consulted to guide this systematic review. Six databases were searched: Cinahl, ProQuest, PubMed, Scopus, SPORTdiscus, and Web of Science. Concussion, gait, and dual-task, along with their synonymous terms were the search terms used. Inclusion criteria consisted of adolescent and young adult age groups, acute concussion, dual-tasking, and matched controls. Quality assessment was performed using The Joanna Briggs Institute Critical Appraisal Checklist for Case Control Studies. Results: Ten full-text articles were selected for inclusion. Concussed individuals demonstrated longer stride times with shorter stride lengths, increased mediolateral displacement with corresponding increases in sagittal and frontal plane peak velocity, and decreased sagittal plane Center of Mass (COM) and Center of Pressure (COP) displacement. The majority of included studies demonstrated moderate to large effect sizes in these gait characteristics. Conclusion: Concussed individuals demonstrated decreased gait stability while ambulating with a dual-task condition. Though statistically significant differences between concussed individuals and matched controls lasted only 72 hours, concussed individuals demonstrated continued improvements in gait for up to two months post-injury, which has the potential to affect an athlete's ability to perform. Further research is needed to determine if a gait examination with a dual-task condition is a realistic, reliable, and valid measure to be included in return to sport testing.

Concussed athletes walk slower than non-concussed athletes during cognitive-motor dual-task assessments but not during single-task assessments 2 months after sports concussion: a systematic review and meta-analysis using individual participant data

“…The concussion group also exhibited less and slower anteroposterior CoM movement compared with the control group up to 1 week and 1 month, respectively, during dual-task walking following sports concussion. These findings contrast to individual aggregate data studies, wherein main effects of group, time, or task predominate, reflected by previously-published aggregate data evidence syntheses 9 10 13…”

“…We pre-registered our review protocol, whereas related reviews did not publish a review protocol 13 15. Since the pre-registration of this meta-analysis, four systematic reviews were published that explore the use of dual-task assessments to identify impairments following sports concussion 9 10 13 15. These reviews do not directly address the same research question but demonstrate considerable conceptual overlap 94.…”

“…Our use of IPD enabled us to identify and remove duplicate samples, and to statistically analyse original data rather than summary data. Our IPD meta-analysis could quantitatively synthesise the results of included studies, whereas aggregate data systematic reviews could only apply methods of vote counting10 13 and narrative synthesis 9 15. Larger sample sizes of IPD facilitated greater statistical power, increasing the ability to identify true persistent effects over time 76…”

“…Cognitive-motor dual-task evaluations can detect latent gait impairments following sports concussion that extend beyond the reported recovery timelines for clinical symptoms, cognitive impairments, and static postural balance impairments 67 8–10 Everyday movement tasks such as walking and quiet standing are completed regularly with little-to-no conscious effort, and participant performance does not tend to improve on these tasks with practice 11. Therefore, walking and quiet standing are ideal tasks with which to simultaneously present a cognitive task to assess dual-task performance.…”

“…These systematic reviews concluded that wide variability existed in the reliability of dual-task assessment measures, that studies were of poor quality, but also that athletes walked with slower walking speed and greater frontal plane centre of mass (CoM) sway following sports concussion. Due to low study quality and large between-study differences,8–10 15 these systematic reviews can make only tentative conclusions about the persistence of impairments under dual-task assessment in athletes following sports concussion. Given the inherent limitations of descriptive and quantitative aggregate data evidence syntheses, a meta-analysis using individual participant data (IPD)—in which the original data for each participant in relevant studies are centrally collected, validated, harmonised and re-analysed—is the gold-standard approach to evidence synthesis 16 17.…”