How Long to Read Clinical Implications of Dynamic Postural Control Impairments Following Concussion

How Long Does it Take to Read Clinical Implications of Dynamic Postural Control Impairments Following Concussion?

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BACKGROUND: Concussions have been classified as a significant health problem and are a potential risk to an individual across the entire lifespan. Impaired postural control is a cardinal symptom following concussion, but current clinical post-concussion assessments (e.g., BESS) have poor sensitivity and specificity for identifying appropriate impairments in dynamic postural control. Conversely, gait related challenges have successfully identified both acute and lingering postural control impairments following concussion. These impairments have traditionally been elucidated through the use of sophisticated motion capture instrumentation that is not feasible for most clinical settings; thus, there is a need for postural control assessments that are more clinically feasible. Furthermore, impaired postural control has been hypothesized as a potential factor in the elevated risk of subsequent musculoskeletal injury following concussion; however, the true underlying mechanism is still unknown. PURPOSE: Therefore, the purpose of this study was threefold: 1) utilize an instrumented dynamic battery to identify postural control impairments across the typical concussion clinical recovery timeline, 2) determine the efficacy of tandem gait as a more clinically feasible alternative to instrumented gait, 3) investigate the association between concussion and subsequent lower extremity musculoskeletal injury risk and examine the role of dynamic postural control impairments as possible determinants. METHODS: This study utilized the APDM Opal IMUs to evaluate changes in gait from baseline to return to play in concussed collegiate student-athletes and matched healthy controls. Linear mixed models were used to examine the gait and tandem gait variables. A Cox proportional hazard model and binary logistic regression were used to evaluate injury risk and subsequent predictors. RESULTS: There were no significant differences between the concussion and control groups across the recovery timeline in single task gait; however, more challenging tasks (i.e. dual-task, step initiation, turning) were able to identify group differences. Tandem gait demonstrated better overall efficacy than the BESS, which is the most commonly used post-concussion postural control assessment. The AUC for the tandem gait variables ranged from 0.717-0.723, whereas the AUC for the BESS was only 0.427 acutely post-concussion. Further, tandem gait performance was significantly worse acutely post-concussion while BESS performance remained the same. Finally, there was a 1.82x increased risk of subsequent lower extremity injury in the year following concussion, compared to those who did not sustain a concussion. In the concussion group, 91% of athletes sustained an injury in the following year, compared to only 66% of controls. There were significant differences between the injured and non-injured groups for multiple gait parameters; however, none of the gait variables demonstrated to be significant predictors for injury risk. DISCUSSION: These results suggest that an instrumented dynamic battery can identify postural control impairments; however, more challenging tasks may be required. Further, tandem gait appears to be a more robust assessment than the BESS in identifying post-concussion impairments; therefore, clinicians may adopt the tandem gait test, particularly during the acute window. This investigation did identify an elevated risk of subsequent lower extremity musculoskeletal injury in the year following concussion, and there were significant group differences between those who did and did not sustain and injury across multiple gait variables. Future research should continue to work toward identifying possible predictors of subsequent injury. CONCLUSION: Dynamic postural control impairments were observed through both instrumented and clinical gait assessments following concussion, and the athletes who displayed a conservative gait strategy were more likely to be in the group sustaining a subsequent lower extremity injury in the following year.

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