Neurophysiological and gait outcomes during a dual-task gait assessment in concussed adolescents

Divya Jain; Valentina Graci; Megan E Beam; Hasan Ayaz; Laura A Prosser; Christina L Master; Catherine C McDonald; Kristy B Arbogast

doi:10.1016/j.clinbiomech.2023.106090

Neurophysiological and gait outcomes during a dual-task gait assessment in concussed adolescents

Clin Biomech (Bristol, Avon). 2023 Oct:109:106090. doi: 10.1016/j.clinbiomech.2023.106090. Epub 2023 Sep 1.

Authors

Divya Jain¹, Valentina Graci², Megan E Beam³, Hasan Ayaz⁴, Laura A Prosser⁵, Christina L Master⁶, Catherine C McDonald⁷, Kristy B Arbogast⁸

Affiliations

¹ Department of Bioengineering, University of Pennsylvania, USA; Center for Injury Research and Prevention, Children's Hospital of Philadelphia, USA. Electronic address: jaind@chop.edu.
² Center for Injury Research and Prevention, Children's Hospital of Philadelphia, USA; School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA.
³ Department of Physical Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁴ Center for Injury Research and Prevention, Children's Hospital of Philadelphia, USA; School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA; Department of Psychological and Brain Sciences, College of Arts and Sciences, Drexel University, Philadelphia, PA, USA; Drexel Solutions Institute, Drexel University, Philadelphia, PA, USA; School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
⁵ Division of Rehabilitation Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁶ Center for Injury Research and Prevention, Children's Hospital of Philadelphia, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁷ Center for Injury Research and Prevention, Children's Hospital of Philadelphia, USA; School of Nursing, University of Pennsylvania, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁸ Center for Injury Research and Prevention, Children's Hospital of Philadelphia, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

PMID: 37696165
PMCID: PMC10758982 (available on 2024-10-01)
DOI: 10.1016/j.clinbiomech.2023.106090

Abstract

Background: Gait deficits are common after concussion in adolescents. However, the neurophysiological underpinnings of these gait deficiencies are currently unknown. Thus, the goal of this study was to compare spatiotemporal gait metrics, prefrontal cortical activation, and neural efficiency between concussed adolescents several weeks from injury and uninjured adolescents during a dual-task gait assessment.

Methods: Fifteen concussed (mean age[SD]: 17.4[0.6], 13 female, days since injury: 26.3[9.9]) and 17 uninjured adolescents (18.0[0.7], 10 female) completed a gait assessment with three conditions repeated thrice: single-task walking, single-task subtraction, and dual-task, which involved walking while completing a subtraction task simultaneously. Gait metrics were measured using an inertial sensor system. Prefrontal cortical activation was captured via functional near-infrared spectroscopy. Neural efficiency was calculated by relating gait metrics to prefrontal cortical activity. Differences between groups and conditions were examined, with corrections for multiple comparisons.

Findings: There were no significant differences in gait metrics between groups. Compared to uninjured adolescents, concussed adolescents displayed significantly greater prefrontal cortical activation during the single-task subtraction (P = 0.01) and dual-task (P = 0.01) conditions with lower neural efficiency based on cadence (P = 0.02), gait cycle duration (P = 0.03), step duration (P = 0.03), and gait speed (P = 0.04) during the dual-task condition.

Interpretation: Our findings suggest that several weeks after injury concussed adolescents demonstrate lower neural efficiency and display a cost to gait performance when cognitive demand is high, e.g., while multitasking, suggesting that the concussed adolescent brain is less able to compensate when attention is divided between two concurrent tasks.

Keywords: Adolescent; Attention; Concussion; Functional near-infrared spectroscopy; Locomotion.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Brain Concussion* / complications
Female
Gait* / physiology
Humans
Infant, Newborn
Walking / physiology
Walking Speed

Abstract

Publication types

MeSH terms

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