Full length articleLong-term effects of adolescent concussion history on gait, across age
Introduction
Interest and research in sport concussion has grown dramatically over the previous decade due to the media and political attention to the injury. The findings of these investigations have led to an evolving understanding of injury incidence and the acute and chronic effects of concussion(s). Traditional incidence rates of concussion were thought to approach 250,000 cases annually [1], though advances in understanding the biological underpinnings [2], state legislation [3], and media coverage have resulted in increased injury reporting [4]. The most recent concussion incidence estimates suggest that 1.6-3.8 million concussions sustained during sport and recreation participation annually [5].
A growing body of evidence suggests that concussions can no longer be perceived as a transient injury without long-term consequences [6], [7], [8], [9], [10]. The current literature suggests that in the retired, professional athlete population, with longer lifetime sport exposure and therefore higher lifetime concussion rate have increased rates of depression, dementia, and possibly neurodegeneration [6], [11], [12]. Conversely, the high school athlete, who is unlikely to sustain concussion after adolescence, has been overlooked in this research domain. Indeed, of the 7.7 million high school students participating in athletics each year, only a small percentage progress to the collegiate or professional level. Yet, with incidence rates around 0.25 (per 1000 athletic exposures) for male and female high school athletes and over seven million athletes participating, former high school athletes comprise the largest population of previously concussed athletes [13], [14]. A considerable gap in the literature evaluating persistent cognitive and motor alterations among former high school athletes exists.
In young adults with a concussion history, both cognitive and motor alterations have been observed well beyond clinical recovery from concussion. These altered measures include gait, balance, and neural function [7], [8], [9], [10], [15], [16]. It is widely accepted there is a certain amount of cognitive effort needed for each task and the investment of less than the allotted effort will cause a deterioration of the performance [17]. Increasing balance and gait task difficulty, by including a dual task or obstructed path, elucidates greater alterations in the previously concussed [9], [18], [19], [20]. This could be a function of decreased ability to allocate attentional resources observed in the previously concussed when compared to controls [7], [8]. However, it remains unknown if previously concussed individuals will go on to have divergent gait declines later in life when compared to individuals without a concussion history.
Based on the available data involving individuals with a concussion history, some have proposed an accelerated rate of cognitive and motor decline among the previously concussed when compared to the natural aging process [21]. This idea rises from other accepted behavioral and environmental factors that have a negative influence on neurocognitive or dual task performance [22], as well as natural, negative age-related effects on motor control [23].
The purpose of this investigation was to assess the effect adolescent concussion history on gait, across age. Given the nature of the evidence for long-term effects of concussion, we hypothesize that individuals with an adolescent concussion history will exhibit poorer performance on the dual task component and altered motor performance with age compared to individuals without a concussion history. These decreases will manifest as increased toe clearance, slower gait velocities, a greater percentage of time in double support, and worse recall on cognitive task.
Section snippets
Participants
Data were collected from 89 participants, 12 participants were excluded due to missing data, leaving 77 included in these analyses. Participants were categorized into one of six groups based the individual’s self-report of concussion history and age (18–30, 40–50, 60+ years). Demographic information (Table 1) was collected via questionnaire detailing education, health, and concussion history. Participants were excluded if they sustained a concussion after 18 years of age or if they had a
Questionnaire
There were no significant differences between the previously concussed and controls, within age groups for any descriptive variables (Table 1). There were also no between-group differences in education, health histories, falls efficacy scale, falls risk assessment, post-concussion symptoms scale, or migraine report.
Spatiotemporal
Analysis of the spatiotemporal variables (Table 2) yielded a significant interaction effect (F = 2.62, p = 0.03) for the obstructed walk condition. Levene’s test analyses only revealed a
Discussion
The purpose of this investigation was to determine if sustaining a concussion during adolescence negatively affects spatiotemporal gait parameters and toe clearance in a divergent pattern, across the lifespan. The results of this investigation suggest there are no observable differences in spatiotemporal gait parameters between those with and without a concussion history during their teen years under single and dual-task walking conditions.
Discrepancies in balance and single/dual task gait have
Conclusion
Previous investigations have reported subtle differences in gait/balance performance between those with and without a concussion history [9], [10], [15]. The findings from this investigation support and extend these findings by demonstrating no relationship between an adolescent concussion history and gait or dual task performance. In addition, there appears to be no evidence from the spatiotemporal gait parameters or fall assessment of the concussion history groups that suggest an increase of
Conflict of interest
The authors declare no conflicts of interest, financial or otherwise.
Acknowledgements
This project was funded by the National Athletic Trainers’ Association − Research and Education Foundation (NATA-REF.) The Rackham Graduate School − University of Michigan, and The University of Michigan Injury Center.
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