David R Howell1,2,3, Jessie R Oldham4, William P Meehan1,2,3,5, Melissa S DiFabio6,4, Thomas A Buckley6,4. 1. The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts. 2. Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts. 3. Brain Injury Center, Boston Children's Hospital, Boston, Massachusetts. 4. Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware. 5. Departments of Pediatrics and Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts. 6. Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware.
Abstract
OBJECTIVES: To (1) examine the association between a commonly used concussion test, tandem gait, in single/dual-task conditions with single-task and dual-task average walking speed, (2) characterize the prevalence of tandem gait false positives, and (3) develop a normative reference range of dual-task tandem gait times. DESIGN: Cross-sectional study. SETTING: Two NCAA collegiate athletic facilities. INDEPENDENT VARIABLES: Athletes completed the tandem gait test and a gait evaluation in single/dual-task conditions during a preseason examination. MAIN OUTCOME MEASURES: Associations between tandem gait times and average walking speeds were evaluated using multiple linear regression models. Various tandem gait test time pass/fail cutoffs were calculated to examine false-positive rates. RESULTS: Among the 171 participants (103 men, 19.8 ± 1.2 years of age), dual-task tandem gait completion times were independently associated with dual-task average walking speed [β = -4.018; 95% confidence interval (CI), -7.153 to -0.883], but single-task associations were not found. Male gender was associated with faster tandem gait times in both single-task (β = -0.880, 95% CI, -1.731 to -0.029) and dual-task conditions (β = -2.225, 95% CI, -3.691 to -0.759). A pass/fail cutoff threshold of 14 seconds resulted in a 2% false-positive rate for single-task tandem gait, while it resulted in a 29% false-positive rate during dual-task tandem gait. CONCLUSIONS: Average walking speed and dual-task tandem gait represent objective measures that are useful in concussion management. While a single-task tandem gait cutoff of 14 seconds seems appropriate for males, adjustments may be necessary based on sex and alternate pass/fail criteria may be appropriate for dual-task tandem gait.
OBJECTIVES: To (1) examine the association between a commonly used concussion test, tandem gait, in single/dual-task conditions with single-task and dual-task average walking speed, (2) characterize the prevalence of tandem gait false positives, and (3) develop a normative reference range of dual-task tandem gait times. DESIGN: Cross-sectional study. SETTING: Two NCAA collegiate athletic facilities. INDEPENDENT VARIABLES: Athletes completed the tandem gait test and a gait evaluation in single/dual-task conditions during a preseason examination. MAIN OUTCOME MEASURES: Associations between tandem gait times and average walking speeds were evaluated using multiple linear regression models. Various tandem gait test time pass/fail cutoffs were calculated to examine false-positive rates. RESULTS: Among the 171 participants (103 men, 19.8 ± 1.2 years of age), dual-task tandem gait completion times were independently associated with dual-task average walking speed [β = -4.018; 95% confidence interval (CI), -7.153 to -0.883], but single-task associations were not found. Male gender was associated with faster tandem gait times in both single-task (β = -0.880, 95% CI, -1.731 to -0.029) and dual-task conditions (β = -2.225, 95% CI, -3.691 to -0.759). A pass/fail cutoff threshold of 14 seconds resulted in a 2% false-positive rate for single-task tandem gait, while it resulted in a 29% false-positive rate during dual-task tandem gait. CONCLUSIONS: Average walking speed and dual-task tandem gait represent objective measures that are useful in concussion management. While a single-task tandem gait cutoff of 14 seconds seems appropriate for males, adjustments may be necessary based on sex and alternate pass/fail criteria may be appropriate for dual-task tandem gait.
Authors: Nicholas G Murray; Brian Szekely; Arthur Islas; Barry Munkasy; Russell Gore; Marian Berryhill; Rebecca J Reed-Jones Journal: J Neurotrauma Date: 2019-10-11 Impact factor: 5.269
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