Increased Auditory Dual Task Cost During Gait Initiation in Adult Patients With Persistent Concussion Symptoms

Kelsey N Bryk; Scott Passalugo; Li- Shan Chou; Darcy S Reisman; Jocelyn F Hafer; Jennifer A Semrau; Thomas A Buckley

doi:10.1016/j.apmr.2024.08.007

Increased Auditory Dual Task Cost During Gait Initiation in Adult Patients With Persistent Concussion Symptoms

Arch Phys Med Rehabil. 2024 Dec;105(12):2262-2268. doi: 10.1016/j.apmr.2024.08.007. Epub 2024 Aug 24.

Authors

Kelsey N Bryk¹, Scott Passalugo¹, Li- Shan Chou², Darcy S Reisman³, Jocelyn F Hafer¹, Jennifer A Semrau⁴, Thomas A Buckley⁵

Affiliations

¹ Department of Kinesiology and Applied Physiology, University of Delaware, DE; Biomechanics & Movement Sciences, University of Delaware, Newark, DE.
² Iowa State University, Department of Human Sciences, Ames, IA.
³ Biomechanics & Movement Sciences, University of Delaware, Newark, DE; Department of Physical Therapy, University of Delaware, Newark, DE; Interdisciplinary Neuroscience Graduate Program, University of Delaware, Newark, DE.
⁴ Department of Kinesiology and Applied Physiology, University of Delaware, DE; Biomechanics & Movement Sciences, University of Delaware, Newark, DE; Interdisciplinary Neuroscience Graduate Program, University of Delaware, Newark, DE.
⁵ Department of Kinesiology and Applied Physiology, University of Delaware, DE; Biomechanics & Movement Sciences, University of Delaware, Newark, DE; Interdisciplinary Neuroscience Graduate Program, University of Delaware, Newark, DE. Electronic address: [email protected].

PMID: 39187006
PMCID: PMC11620944 (available on 2025-12-01)
DOI: 10.1016/j.apmr.2024.08.007

Abstract

Objective: To compare dual task cost (DTC) during gait initiation (GI) between a population of patients with persistent concussion symptoms (PCS) and age-matched healthy participants.

Design: Cohort study.

Setting: University research center.

Participants: A cohort sample including 15 participants with PCS (43.9±11.7y, 73.3% female) and 23 age-matched healthy participants (42.1±10.3y, 65.2% female) as controls.

Interventions: Participants were tested on a single occasion where they performed 5 trials of single task and 5 trials of dual task GI with 12-camera motion capture and 3 force plates.

Main outcome measures: The dependent variables of interest were the DTC for the center of pressure (COP) displacement and velocity during the anticipatory postural adjustment (APA) phase, the COP-center of mass (COP-COM) separation, and the response accuracy during the auditory cognitive tasks.

Results: There were significant group differences with worse DTC for the PCS participants in anterior (A)/posterior (P) displacement (PCS, -37.5±22.1%; Control, -9.7±39.2%; P=.016, d=0.874), APA medial (M)/lateral (L) velocity (PCS, -34.8±28.8%; Control, -17.0±40.21%; P=.041, d=0.866), and the peak COP-COM separation (PCS, -7.3±6.7%; Control, 0.6±6.5%; P=.023, d=1.200). There were no significant group differences in the APA A/P velocity (PCS, -38.8±33.1%; Control, -19.8±43.9%; P=.094), APA M/L displacement (PCS, -34.8±21.8%; Control, -10.6±25.3%; P=.313), or cognitive task performance (PCS, -2.7±10.8%; Control, -0.2±4.3%; P=.321).

Conclusions: PCS participants had greater (worse) DTC during both the planning and execution of the task, with large effect sizes (d>0.80). PCS participants also used a posture-second strategy whereby attentional resources were inappropriately allocated to the cognitive task. These deficits may challenge a patient's ability to complete activities of daily living and limit their functional independence.

Keywords: Balance; Mild traumatic brain injury; Postural control; Rehabilitation.

MeSH terms

Adult
Brain Concussion* / physiopathology
Case-Control Studies
Cohort Studies
Female
Gait* / physiology
Humans
Male
Middle Aged
Postural Balance* / physiology
Task Performance and Analysis

Grants and funding

R03 NS104371/NS/NINDS NIH HHS/United States