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Near Point of Convergence and Gait Deficits in Adolescents After Sport-Related Concussion

Howell, David R. PhD*,†,‡; O'Brien, Michael J. MD*,†,‡,§; Raghuram, Aparna OD, PhD‡,¶,‖; Shah, Ankoor S. MD, PhD‡,¶,‖; Meehan, William P. III MD*,†,‡,§,**

Clinical Journal of Sport Medicine: May 2018 - Volume 28 - Issue 3 - p 262–267
doi: 10.1097/JSM.0000000000000439
Original Research

Objective: To prospectively examine gait characteristics of participants acutely after concussion with and without receded near point of convergence (NPC), compared with healthy controls.

Design: Cross-sectional study.

Setting: Sports-medicine clinic.

Participants: Patients examined after concussion (n = 33; mean ± SD = 7.2 ± 3.1 days) and a group of uninjured athletes (n = 31) completed a Postconcussion Symptom Scale, underwent NPC testing, and single/dual-task gait assessments.

Independent Variables: Near point of convergence was defined as the patient-reported diplopia distance when a fixation target moved toward the nose. Receded NPC was defined as a distance >5 cm from the tip of the nose.

Main Outcome Measures: Spatiotemporal gait characteristics in single-task and dual-task conditions were evaluated with analysis of variance; correlations were calculated between NPC and gait measures.

Results: Eighteen of 33 (55%) patients with concussion presented with receded NPC. Those with receded NPC exhibited slower gait speed (single-task = 1.06 ± 0.14 m/s vs 1.19 ± 0.15 m/s; dual-task = 0.80 ± 0.13 m/s vs 0.94 ± 0.13 m/s; P = 0.003) and shorter stride lengths (single-task = 1.11 ± 0.10 m vs 1.24 ± 0.11 m; dual-task = 0.97 ± 0.11 m vs 1.09 ± 0.11 m; P = 0.001) than healthy controls. Near point of convergence was moderately correlated with dual-task average walking speed for the normal NPC group (ρ = −0.56; P = 0.05). Postconcussion Symptom Scale scores did not significantly differ between groups (27 ± 18 vs 28 ± 16).

Conclusions: After concussion, adolescents with receded NPC exhibited significant gait-related deficits compared with healthy controls, whereas those with normal NPC did not. Vergence and gross motor system dysfunction may be associated after concussion. Gait and vergence measures may contribute useful information to postconcussion evaluations.

*The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts;

Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts;

Brain Injury Center, Boston Children's Hospital, Boston, Massachusetts;

§Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts;

Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; and

Departments of Ophthalmology; and

**Pediatrics, Harvard Medical School, Boston, Massachusetts.

Corresponding Author: David R. Howell, PhD, Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, 9 Hope Ave, Waltham, MA 02453 (

W. P. Meehan receives royalties from (1) ABC-Clio publishing for the sale of his books, Kids, Sports, and Concussion: A guide for coaches and parents, and Concussions; (2) Springer International for the book Head and Neck Injuries in Young Athlete; and (3) Wolters Kluwer for working as an author for UpToDate. His research is funded, in part, by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament and by a grant from the Football Players Health Study at Harvard University, which is funded by the NFL Players Association. M. J. O'Brien receives royalties from Wolters Kluwer for working as an author for UpToDate and from Springer International publishing for the book, Head and Neck Injuries in Young Athletes. The remaining authors report no conflicts of interest.

Received October 13, 2016

Accepted March 23, 2017

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.