At the recent National Athletic Trainers’ Association’s (NATA) 69th Clinical Symposia & AT Expo, held in New Orleans between June 26 and June 28, 2018, one of the new studies presented suggests that studying dual-task gait after a concussion can shed light on future injury risk.
To study dual-task gait outcomes, David Howell, Ph.D., ATC and colleagues evaluated 41 athletes within the first 21 days of concussion and again when they were deemed clinically recovered. The study protocol included a symptom inventory and instrumented dual-task gait evaluation, where they walked and completed a cognitive task (months backward, serial 7s backward, or spelling words backwards) while wearing an instrumented sensor system.
And then approximately one year post-concussion, they were asked to report any acute sport-related injury since returning to sports.
According to the data, the group who went on to sustain an acute injury (n=15; 38%) demonstrated significant average walking speed dual-task cost worsening across time (p = 0.005). In contrast, the group who did not sustain an injury walked with similar dual-task cost values at both time points (p = 0.45). In addition, symptoms improved for all participants (p = 0.78).
There were several limitations to the study including the fact that the questionnaire used to assess the injuries by participants in the year following their concussion was not validated against an existing metric and that neither clinical balance nor neurocognitive data were available.
Howell told OTW, “There were many challenging aspects to the study, but the most important was trying to contact people one year after their injury to assess whether or not they had sustained a concussion. We were able to successfully contact 42 individuals, but this only represented 61% of our participant sample.”
He said that one of the biggest takeaways from the study was that they identified worsened dual-task gait costs across a typical clinical recovery time line among those who went on to sustain an acute time-loss injury during the year following their concussion, but not for those who did not sustain an additional injury.
He added, “Although preliminary, these findings indicate that the ability to successfully execute a gait and cognitive task simultaneously may worsen across clinical recovery among those who go on to sustain a subsequent injury during sports.”
“Tests that incorporate simultaneous task performance across different domains may aid in identifying those at risk for further injury and thus assist clinical decision making,” he added.
A contributing factor to gait issues is cervical spine subluxation that may results in leg length discrepancy, These common injuries are often the result of jaw loading forces transferred to the skull base and can co occur with concussion. The NFL’s own research on mouth guards shows that certain types of form fit appliances are better at limiting these forces. Yet, for PR reasons, they have applied a broad brush and downplayed the effectiveness of mouth guards in reducing concussion, they’re are no screening protocols in place for this common neck condition. Only 3D radiology can clearly document these subluxations, a standard needed for Physical Therapy benefits. Most athletes are sent home with no follow up care or PT. The system needs a major upgrade, screening athletes for head neck and jaw imbalances. Please go to http://www.purepowermouthguards.com we have a network of over 500 oral surgeons who have 3D Panoramic xray and can intervene with any head neck and jaw issue, something that is being overlooked in many cases.