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Inertial Sensors Reveal Subtle Motor Deficits When Walking With Horizontal Head Turns After Concussion

Fino, Peter C., PhD; Wilhelm, Jennifer, DPT, PT; Parrington, Lucy, PhD; Stuart, Samuel, PhD; Chesnutt, James C., MD; King, Laurie A., PhD, PT

The Journal of Head Trauma Rehabilitation: March/April 2019 - Volume 34 - Issue 2 - p E74–E81
doi: 10.1097/HTR.0000000000000418
Focus on Clinical Research and Practice

Objective: To examine whether horizontal head turns while seated or while walking, when instrumented with inertial sensors, were sensitive to the acute effects of concussion and whether horizontal head turns had utility for concussion management.

Setting: Applied field setting, athletic training room.

Participants: Twenty-four collegiate athletes with sports-related concussion and 25 healthy control athletes.

Design: Case-control; longitudinal.

Main Measures: Peak head angular velocity and peak head angle (range of motion) when performing head turns toward an auditory cue while seated or walking. Gait speed when walking with and without head turns.

Results: Athletes with acute sports-related concussion turned their head slower than healthy control subjects initially (group β = −49.47; SE = 16.33; P = .003) and gradually recovered to healthy control levels within 10 days postconcussion (group × time β = 4.80; SE = 1.41; P < .001). Peak head velocity had fair diagnostic accuracy in differentiating subjects with acute concussion compared with controls (areas under the receiver operating characteristic curve [AUC] = 0.71-0.73). Peak head angle (P = .17) and gait speed (P = .64) were not different between groups and showed poor diagnostic utility (AUC = 0.57-0.62).

Conclusion: Inertial sensors can improve traditional clinical assessments by quantifying subtle, nonobservable deficits in people following sports-related concussion.

Department of Neurology, Oregon Health & Science University, Portland (All Authors); Veterans Affairs Portland Health Care System, Portland (Drs Fino, Wilhelm, Parrington, Stuart, and King); Department of Physical Therapy and Rehabilitation, Oregon Health & Science University, Portland (Dr. Wilhelm); and Departments of Family Medicine, Orthopedics, and Rehabilitation, Oregon Health & Science University, Portland (Dr. Chesnutt).

Corresponding Author: Peter C. Fino, PhD, Department of Neurology, Oregon Health & Science University, 3181 S.W. Sam Jackson Park, Mail Code OP-32, Portland, OR 97239 (

The authors would like to thank the athletic departments of participating universities (Portland State University, Lewis & Clark College, Pacific University, Linfield College, George Fox University and Concordia University), the athletic trainers who contributed to the recruitment of participants, and the athletes for their participation. The authors would especially like to thank Clayton Swanson for his assistance in data collection.

This project was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the NIH (Award Number R21HD080398) and by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health/Complex Traumatic Brain Injury Rehabilitation Research Program under Award No. W81XWH-17-1-0424. Opinions, interpretations, conclusions and recommendations are those of the authors and are not necessarily endorsed by the NIH or the Department of Defense.

The authors declare no conflicts of interest.

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