Smartphone Measured Single- and Dual-Task Gait Evaluation in Adolescents Post-Concussion: A Longitudinal Comparison to Healthy Controls

• Published in: Orthopaedic journal of sports medicine 2022-05, Vol.10 (5_suppl2)
• Main Authors: Wingerson, Mathew J., Seehusen, Corrine N., Wilson, Julie C., Smulligan, Katherine L., Lynall, Robert C., Lugade, Vipul, Howell, David R.
• Format: Article
• Language: English
• Subjects: Accuracy; Concussion; Gait; Orthopedics; Posture; Response time; Smartphones; Sports medicine; Teenagers; Velocity
• ISSN: 2325-9671; 2325-9671
• DOI: 10.1177/2325967121S00454

Background: Impairments in postural stability are common following concussion. However, subjectively-scored assessments of postural control, such as the Balance Error Scoring System, may not accurately reflect postural instability. Objective measures, such as gait performance, can more accurately identify ongoing impairments in postural control throughout concussion recovery. Recent technological advances make gait evaluations more feasible across different clinical settings. Purpose: To compare performance on smartphone measured single- and dual-task gait evaluations among adolescent concussion participants and healthy controls across two timepoints. Methods: We evaluated concussed participants at initial (n=13; 14.6±1.3 years; 54% female; 5.5±1.6 days post-concussion) and follow-up visits (33.2±3.3 days post-concussion), and healthy control participants (n=21; 15.5±1.6 years; 48% female) at two timepoints 27.3±0.7 days apart on single- and dual-task gait performance. Single-task gait trials consisted of walking at a self-selected pace for 20 meters. Single-task cognitive trials involved responding to a cognitive task while standing in place. For dual-task trials, participants completed gait and cognitive tasks simultaneously. During each trial a smartphone affixed to the lumbar spine measured gait velocity and cognitive response accuracy and response time. We conducted a 2x2 mixed effects ANOVA to examine changes between groups across the testing timeline. Results: Concussion participants reported significantly greater symptom severity than control participants at the initial timepoint (23.1±13.5 vs 7.4±8.5; p=0.001); however, this difference did not persist to the second timepoint (p=0.99). The concussion group demonstrated significant improvements in single-task gait velocity between timepoints; although, between-group differences in gait velocity were not observed at either timepoint (Figure 1). No differences in cognitive accuracy between groups were identified. However, concussed participants performed worse than healthy controls on cognitive response time at both time points in single- and dual-task testing (Figure 2). Further, response time improved between testing periods for single-task, but not dual-task, conditions. Conclusion: Smartphone gait evaluations indicate improvement in single-task gait velocity during concussion recovery. However, no significant differences in gait velocity were found between concussed and control participants at eit