Return to Activity after Concussion Affects Dual-Task Gait Balance Control Recovery

HOWELL, DAVID R.; OSTERNIG, LOUIS R.; CHOU, LI-SHAN

Medicine & Science in Sports & Exercise: April 2015 - Volume 47 - Issue 4 - p 673–680
doi: 10.1249/MSS.0000000000000462
Clinical Sciences

Background: Recent work has identified deficits in dual-task gait balance control for up to 2 months after adolescent concussion; however, how resumption of preinjury physical activities affects recovery is unknown.

Purpose: The objective of this study is to examine how return to activity (RTA) affects recovery from concussion on measures of symptom severity, cognition, and balance control during single-task and dual-task walking.

Methods: Nineteen adolescents with concussion who returned to preinjury activity within 2 months after injury and 19 uninjured, matched controls completed symptom inventories, computerized cognitive testing, and single-task and dual-task gait analyses. Concussion participants were assessed at five time points: within 72 h, 1 wk, 2 wk, 1 month, and 2 months postinjury. Control participants were assessed at the same time points as their matched concussion counterparts. RTA day was documented as the postinjury day in which physical activity participation was allowed. The effect of returning to physical activity was assessed by examining the percent change on each dependent variable across time before and directly after the RTA. Data were analyzed by two-way mixed effects ANOVAs.

Results: After the RTA day, concussion participants significantly increased their total center-of-mass medial/lateral displacement (P = 0.009, ηp2 = .175) and peak velocity (P = 0.048, ηp2 = 0.104) during dual-task walking when compared with pre-RTA data, whereas no changes for the concussion group or between groups were detected on measures of single-task walking, forward movement, or cognition.

Conclusions: Adolescents with concussion displayed increased center-of-mass medial/lateral displacement and velocity during dual-task walking after RTA, suggesting a regression of recovery in gait balance control. This study reinforces the need for a multifaceted approach to concussion management and continued monitoring beyond the point of clinical recovery.

Department of Human Physiology, University of Oregon, Eugene, OR

Address for correspondence: Li-Shan Chou, Ph.D., Department of Human Physiology, 122 Esslinger Hall, 1240 University of Oregon, Eugene, OR 97403; E-mail: chou@uoregon.edu.

Submitted for publication January 2014.

Accepted for publication July 2014.

© 2015 American College of Sports Medicine