Prognosis for Persistent Post Concussion Symptoms using a Multifaceted Objective Gait and Balance Assessment Approach

被引:17
作者
Howell, David R. [1 ,2 ,3 ]
Mayer, Andrew R. [4 ,5 ,6 ,7 ]
Master, Christina L. [8 ,9 ,10 ]
Leddy, John [11 ]
Zemek, Roger [12 ,13 ]
Meier, Timothy B. [14 ]
Yeates, Keith Owen [15 ,16 ,17 ]
Arbogast, Kristy B. [8 ,10 ]
Mannix, Rebekah [18 ,19 ,20 ]
Meehan, William P., III [3 ,21 ]
机构
[1] Childrens Hosp Colorado, Sports Med Ctr, Aurora, CO USA
[2] Univ Colorado, Dept Orthoped, Sch Med, Aurora, CO 80045 USA
[3] Micheli Ctr Sports Injury Prevent, Waltham, MA USA
[4] Mind Res Network, Lovelace Biomed & Environm Res Inst, Albuquerque, NM USA
[5] Univ New Mexico, Sch Med, Dept Neurol, Albuquerque, NM 87131 USA
[6] Univ New Mexico, Sch Med, Dept Psychiat, Albuquerque, NM 87131 USA
[7] Univ New Mexico, Dept Psychol, Albuquerque, NM 87131 USA
[8] Childrens Hosp Philadelphia, Ctr Injury Res & Prevent, Philadelphia, PA 19104 USA
[9] Childrens Hosp Philadelphia, Sports Med & Performance Ctr, Philadelphia, PA 19104 USA
[10] Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA
[11] SUNY Buffalo, UBMD Orthopaed & Sports Med, Buffalo, NY USA
[12] Univ Ottawa, Dept Pediat & Emergency Med, Ottawa, ON, Canada
[13] Childrens Hosp Eastern Ontario, Res Inst, Ottawa, ON, Canada
[14] Med Coll Wisconsin, Dept Neurosurg, Milwaukee, WI 53226 USA
[15] Univ Calgary, Dept Psychol, Calgary, AB, Canada
[16] Univ Calgary, Alberta Childrens Hosp Res Inst, Calgary, AB, Canada
[17] Univ Calgary, Hotchkiss Brain Inst, Calgary, AB, Canada
[18] Harvard Med Sch, Dept Emergency Med, Boston, MA 02115 USA
[19] Harvard Med Sch, Dept Pediat, Boston, MA 02115 USA
[20] Boston Childrens Hosp, Div Emergency Med, Boston, MA USA
[21] Boston Childrens Hosp, Div Sports Med, Boston, MA USA
关键词
DUAL-TASK GAIT; SINGLE-TASK; SPORT; STATEMENT; RECOVERY; INJURY; RISK;
D O I
10.1016/j.gaitpost.2020.04.013
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
Background: Concussion prognosis is a challenging clinical task. Identification of measures useful for persistent symptom risk can help optimize treatment pathways and allow clinicians to offer appropriate anticipatory guidance. Research Question: Can a multifaceted single/dual-task postural control assessment within one week of a diagnosed concussion identify the odds of developing persistent post-concussion symptoms (PPCS; symptoms that persist for more than 28 days post-concussion)? Methods: We conducted a prospective cohort study of youth and young adult athletes who were evaluated within 7 days of injury, and followed until they no longer reported concussion symptoms. Participants were grouped into those who developed PPCS and those who did not. During the initial evaluation, participants completed a postural control evaluation in single/dual-task conditions. We calculated six gait performance variables (in single/dual-task conditions), nine quiet stance performance variables, and three cognitive task performance (standing and walking) variables. We conducted between-group comparisons to identify candidate PPCS prognostic variables, and multivariable models to adjust for covariates (age, post-injury evaluation time, history of concussion, and BMI). Results: Sixty-six participants completed the study: 24% reported PPCS (mean age = 16.9 ± 3.5 years; 50% female; evaluated 4.2 ± 1.9 days post-injury) and 74% (mean age = 18.3 ± 3.0 years; 52% female; evaluated 3.5 ± 1.6 days post-injury) did not. Between-group comparisons indicated greater dual-task transverse plane center-of-mass (COM) range of motion (ROM) (13.1 ± 4.3 vs. 9.9 ± 2.5 degrees; p = 0.013) and lateral step variability (5.1 ± 1.4 vs. 4.0 ± 1.2 cm; p = 0.003) for the PPCS group relative to the no PPCS group. After multivariable modeling, dual-task transverse plane COM ROM (adjusted odds ratio = 1.34, 95% CI = 1.07, 1.68) and lateral step variability (adjusted odds ratio = 1.85, 95% CI = 1.13, 3.05) were significantly associated with PPCS. Significance: Dual-task transverse plane movement and lateral step variability demonstrate viable prognostic ability for PPCS among youth and young adult athletes and, along with other established factors, may add incremental value to PPCS prognosis models. © 2020 Elsevier B.V.
引用
收藏
页码:53 / 59
页数:7
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