Associations Between Tandem Gait And Self-selected Gait In Adolescents Following Concussion: A Cross-sectional Analysis

PURPOSE: Tandem gait (TG) is a commonly used assessment for evaluating motor-cognitive function and dynamic postural control after concussion. Self-selected, walking gait (WG) temporal-distance metrics may provide similar information to TG outcomes. The purpose of this study was to investigate the association between TG and WG in single-task (ST) and dual-task (DT) conditions among adolescents following recent concussion. METHODS: We conducted a cross-sectional study of adolescents within 21 days of concussion. Participants completed, timed TG test on a 3-meter path and WG along a 10-meter path for one-minute. TG and WG were performed under both ST and DT conditions. WG temporal-distance metrics were collected using a novel smartphone application (IMPROVE, Control One LLC). Primary outcomes were ST and DT TG completion time and ST and DT WG speed. We calculated pairwise correlation coefficients (Pearson r) between TG and WG outcomes. We used multivariate linear regression, adjusting for symptom severity, time since concussion, age, and sex to further assess the relationship between TG and WG outcomes. Covariates were pre-specified based on existing literature. RESULTS: We enrolled and tested 82 participants (mean age = 15.6 ± 2.1 years, 49% female; mean time since concussion = 12.7 ± 4.4 days). In unadjusted analysis, there was a significant, weak, negative correlation between ST TG completion time and ST WG speed and a significant, moderate, negative correlation between DT TG completion time and DT WG speed (Figure). After covariate adjustment, significant associations remained between TG completion time and WG speed in both ST and DT conditions. CONCLUSIONS: TG completion time and WG speed were significantly correlated in both ST and DT conditions among adolescents with recent concussion. These results suggest that WG could serve as a useful proxy for TG, but that it may also provide unique information in concussion assessment. Supported by: Eunice Kennedy Shriver National Institute of Child Health & Human Development (R01HD108133); U.S Army Medical Department