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Gait Deviations Associated With Concussion

A Systematic Review

Manaseer, Thaer S. PT, MSc*; Gross, Douglas P. PT, PhD*; Dennett, Liz MLIS; Schneider, Kathryn PT, PhD; Whittaker, Jackie L. PT, PhD*,§

doi: 10.1097/JSM.0000000000000537
Critical Review: PDF Only

Background: Gait deviations resulting from concussion are important to consider in the diagnosis, treatment progression, and return to activity after a concussion.

Objective: To identify quantifiable gait deviations associated with concussion across populations and time since injury.

Methods and Materials: Six electronic databases were systematically searched from January 1974 to September 2016. Studies selected included original data, had an analytic design, and reported a quantifiable gait parameter in individuals who had sustained a concussion as defined by the American Congress of Rehabilitation Medicine or related definitions. Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines were followed. Two independent authors assessed study quality [Downs and Black (DB) criteria] and level of evidence (Oxford Center of Evidence-Based Medicine Model).

Results: Of 2650 potentially relevant articles, 21 level 4 studies were included. The median DB score was 12/33 (range 10-16). Heterogeneity in gait parameters and timing of postconcussion testing precluded meta-analysis. There is consistent level 4 evidence of increased medial-lateral center-of-mass displacement, and inconsistent level 4 evidence of decreased gait velocity after concussion. Further, there is preliminary level 4 evidence that gait deficits may exist beyond the typical 10-day recovery period and return to activity.

Conclusion: These findings suggest that individuals who have suffered a concussion may sway more in the frontal plane, and walk slower compared to healthy controls. Consensus about the most important gait parameters for concussion diagnosis and clinical management are lacking. Further, high-quality prospective cohort studies evaluating changes in gait from time of concussion to return to activity, sport, recreation and/or work are needed.

*Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada;

John Walter Scott Library, University of Alberta, Edmonton, AB, Canada;

Sport Injury Prevention Research Centre, Faculty of Kinesiology, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; and

§Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, AB, Canada.

Corresponding Author: Jackie L. Whittaker, PT, PhD, University of Alberta, Edmonton, AB, Canada T6G 2G4 (

T. S. Manaseer is funded by the Hashemite University. This sponsor had no involvement with respect to design, collection or data analyses, interpretation, writing or submission. The remaining authors report no conflicts of interest.

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