Longitudinal Assessment of Balance and Gait After Concussion and Return to Play in Collegiate Athletes

• Published in: Journal of athletic training 2019-04, Vol.54 (4), p.429-438
• Main Authors: Parrington, Lucy, Fino, Peter C, Swanson, Clayton W, Murchison, Charles F, Chesnutt, James, King, Laurie A
• Format: Article
• Language: English
• Subjects: Adolescents; Athletes; Balance; Brain Concussion - physiopathology; Brain Concussion - rehabilitation; Brain research; Cellular telephones; Concussion; Exercise Therapy - methods; Female; Follow-Up Studies; Gait; Gait - physiology; Humans; Longitudinal studies; Male; Physiology; Postural Balance - physiology; Posture; Reading; Research Methodology; Researchers; Return to Sport; Sensors; Student athletes; Teenagers; Traumatic brain injury; Universities; Walking; Walking - physiology; Young Adult; Young adults
• ISSN: 1062-6050; 1938-162X
• DOI: 10.4085/1062-6050-46-18

In longitudinal studies tracking recovery after concussion, researchers often have not considered the timing of return to play (RTP) as a factor in their designs, which can limit the understanding of how RTP may affect the analysis and resulting conclusions. To evaluate the recovery of balance and gait in concussed athletes using a novel linear mixed-model design that allows an inflection point to account for changes in trend that may occur after RTP. Cohort study. University athletics departments, applied field setting. Twenty-three concussed (5 women, 18 men; age = 20.1 ± 1.3 years) and 25 healthy control (6 women, 19 men; age = 20.9 ± 1.4 years) participants were studied. Participants were referred by their team athletic trainers. Measures consisted of the Balance Error Scoring System (BESS) total score, sway (instrumented root mean square of mediolateral sway), single-task gait speed, gait speed while simultaneously reading a handheld article (dual-task gait speed), dual-task cost of reading on gait speed, and dual-task cost of walking on reading. We observed no significant effects or interactions for the BESS. Instrumented sway was worse in concussed participants, and a change in the recovery trend occurred after RTP. We observed group and time effects and group × time and group × RTP change interactions ( ≤ .046). No initial between-groups differences were found for single-task or dual-task gait. Both groups increased gait speed initially and then leveled off after the average RTP date. We noted time and RTP change effects and positive group × time interactions for both conditions ( ≤ .042) and a group × RTP change interaction for single-task gait speed ( .005). No significant effects or interactions were present for the dual-task cost of reading on gait speed or the dual-task cost of walking on reading. Changes in the rate of recovery were coincident with the timing of RTP. Although we cannot suggest these changes were a result of the athletes returning to play, these findings demonstrate the need for further research to evaluate the effects of RTP on concussion recovery.