Original research| Volume 99, ISSUE 7, P1318-1324, July 2018

Detection of Acute and Long-Term Effects of Concussion: Dual-Task Gait Balance Control Versus Computerized Neurocognitive Test

Published:February 17, 2018DOI:



      To examine the acute (within 72h of injury) and long-term (2mo postinjury) independent associations between objective dual-task gait balance and neurocognitive measurements among adolescents and young adults with a concussion and matched controls.


      Longitudinal case-control.


      Motion analysis laboratory.


      A total of 95 participants completed the study: 51 who sustained a concussion (mean age, 17.5±3.3y; 71% men) and 44 controls (mean age, 17.7±2.9y; 72% men). Participants who sustained a concussion underwent a dual-task gait analysis and computerized neurocognitive testing within 72 hours of injury and again 2 months later. Uninjured controls also completed the same test protocol in similar time increments.


      Not applicable.

      Main Outcome Measures

      We compared dual-task gait balance control and computerized neurocognitive test performance between groups using independent samples t tests. Multivariable binary logistic regression models were then constructed for each testing time to determine the association between group membership (concussion vs control), dual-task gait balance control, and neurocognitive function.


      Medial-lateral center-of-mass displacement during dual-task gait was independently associated with group membership at the initial test (adjusted odds ratio [aOR], 2.432; 95% confidence interval [CI], 1.269–4.661) and 2-month follow-up test (aOR, 1.817; 95% CI, 1.014–3.256) tests. Visual memory composite scores were significantly associated with group membership at the initial hour postinjury time point (aOR, .953; 95% CI, .833–.998). However, the combination of computerized neurocognitive test variables did not predict dual-task gait balance control for participants with concussion, and no single neurocognitive variable was associated with dual-task gait balance control at either testing time.


      Dual-task assessments concurrently evaluating gait and cognitive performance may allow for the detection of persistent deficits beyond those detected by computerized neurocognitive deficits alone.


      List of abbreviations:

      AUC (area under the curve), COM (center-of-mass), ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), PCSS (Post Concussion Symptom Scale)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • McCrory P.
        • Meeuwisse W.
        • Dvorak J.
        • et al.
        Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016.
        Br J Sports Med. 2017; 51: 838-847
        • Toledo E.
        • Lebel A.
        • Becerra L.
        • et al.
        The young brain and concussion: imaging as a biomarker for diagnosis and prognosis.
        Neurosci Biobehav Rev. 2012; 36: 1510-1531
        • Guskiewicz K.M.
        • Register-Mihalik J.K.
        Postconcussive impairment differences across a multifaceted concussion assessment protocol.
        PM R. 2011; 3: S445-S451
        • Baugh C.M.
        • Kroshus E.
        • Stamm J.M.
        • Daneshvar D.H.
        • Pepin M.J.
        • Meehan W.P.
        Clinical practices in collegiate concussion management.
        Am J Sports Med. 2016; 44: 1391-1399
        • Meehan W.P.
        • d’Hemecourt P.
        • Collins C.L.
        • Taylor A.M.
        • Comstock R.D.
        Computerized neurocognitive testing for the management of sport-related concussions.
        Pediatrics. 2012; 129: 38-44
        • Iverson G.L.
        • Lovell M.R.
        • Collins M.W.
        Interpreting change on ImPACT following sport concussion.
        Clin Neuropsychol. 2003; 17: 460-467
        • Iverson G.
        • Franzen M.
        • Lovell M.
        • Collins M.
        Construct validity of ImPACT in athletes with concussions.
        Arch Clin Neuropsychol. 2004; 19: 961-962
        • Iverson G.L.
        • Lovell M.R.
        • Collins M.W.
        Validity of ImPACT for measuring processing speed following sports-related concussion.
        J Clin Exp Neuropsychol. 2005; 27: 683-689
        • Moser R.S.
        • Iverson G.L.
        • Echemendia R.J.
        • et al.
        Neuropsychological evaluation in the diagnosis and management of sports-related concussion.
        Arch Clin Neuropsychol. 2007; 22: 909-916
        • Iverson G.
        Predicting slow recovery from sport-related concussion: the new simple-complex distinction.
        Clin J Sport Med. 2007; 17: 31-37
        • Nelson L.D.
        • LaRoche A.A.
        • Pfaller A.Y.
        • et al.
        Prospective, head-to-head study of three computerized neurocognitive assessment tools (CNTs): reliability and validity for the assessment of sport-related concussion.
        J Int Neuropsychol Soc. 2016; 22: 24-37
        • Buckley T.A.
        • Munkasy B.A.
        • Tapia-Lovler T.G.
        • Wikstrom E.A.
        Altered gait termination strategies following a concussion.
        Gait Posture. 2013; 38: 549-551
        • Oldham J.R.
        • Munkasy B.A.
        • Evans K.M.
        • Wikstrom E.A.
        • Buckley T.A.
        Altered dynamic postural control during gait termination following concussion.
        Gait Posture. 2016; 49: 437-442
        • Baker C.S.
        • Cinelli M.E.
        Visuomotor deficits during locomotion in previously concussed athletes 30 or more days following return to play.
        Physiol Rep. 2014; 2: e12252
        • Shumway-Cook A.
        • Woollacott M.
        Attentional demands and postural control: the effect of sensory context.
        J Gerontol A Biol Sci Med Sci. 2000; 55: M10-M16
        • Beauchet O.
        • Berrut G.
        [Gait and dual-task: definition, interest, and perspectives in the elderly].
        Psychol Neuropsychiatr Vieil. 2006; 4 ([French]): 215-225
        • Lee H.
        • Sullivan S.J.
        • Schneiders A.G.
        The use of the dual-task paradigm in detecting gait performance deficits following a sports-related concussion: a systematic review and meta-analysis.
        J Sci Med Sport. 2013; 16: 2-7
        • Sutherland D.H.
        • Olshen R.
        • Cooper L.
        • Woo S.L.
        The development of mature gait.
        J Bone Joint Surg Am. 1980; 62: 336-353
        • Howell D.R.
        • Osternig L.R.
        • Chou L.S.
        Consistency and cost of dual-task gait balance measure in healthy adolescents and young adults.
        Gait Posture. 2016; 49: 176-180
        • Howell D.R.
        • Oldham J.R.
        • DiFabio M.
        • et al.
        Single-task and dual-task gait among collegiate athletes of different sport classifications: implications for concussion management.
        J Appl Biomech. 2017; 33: 24-31
        • Howell D.R.
        • Osternig L.R.
        • Chou L.S.
        Dual-task effect on gait balance control in adolescents with concussion.
        Arch Phys Med Rehabil. 2013; 94: 1513-1520
        • Howell D.R.
        • Osternig L.R.
        • Koester M.C.
        • Chou L.S.
        The effect of cognitive task complexity on gait stability in adolescents following concussion.
        Exp Brain Res. 2014; 232: 1773-1782
        • Howell D.R.
        • Osternig L.R.
        • Chou L.S.
        Adolescents demonstrate greater gait balance control deficits after concussion than young adults.
        Am J Sports Med. 2015; 43: 625-632
        • Howell D.R.
        • Osternig L.R.
        • Chou L.S.
        Monitoring recovery of gait balance control following concussion using an accelerometer.
        J Biomech. 2015; 48: 3364-3368
        • Manaseer T.S.
        • Gross D.P.
        • Dennett L.
        • Schneider K.
        • Whittaker J.L.
        Gait deviations associated with concussion: a systematic review.
        Clin J Sport Med. 2017 Nov 21; ([Epub ahead of print])
        • Broglio S.P.
        • Macciocchi S.N.
        • Ferrara M.S.
        Neurocognitive performance of concussed athletes when symptom free.
        J Athl Train. 2007; 42: 504-508
        • Howell D.R.
        • Stillman A.
        • Buckley T.A.
        • Berkstresser B.
        • Wang F.
        • Meehan W.P.
        The utility of instrumented dual-task gait and tablet-based neurocognitive measurements after concussion.
        J Sci Med Sport. 2018; 21: 358-362
        • Pearce A.J.
        • Hoy K.
        • Rogers M.A.
        • et al.
        Acute motor, neurocognitive and neurophysiological change following concussion injury in Australian amateur football. A prospective multimodal investigation.
        J Sci Med Sport. 2015; 18: 500-506
        • McCrory P.
        • Meeuwisse W.H.
        • Aubry M.
        • et al.
        Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.
        Br J Sports Med. 2013; 47: 250-258
        • Howell D.R.
        • Osternig L.R.
        • Chou L.S.
        Return to activity after concussion affects dual-task gait balance control recovery.
        Med Sci Sports Exerc. 2015; 47: 673-680
        • Howell D.R.
        • Osternig L.R.
        • Christie A.D.
        • Chou L.S.
        Return to physical activity timing and dual-task gait stability are associated 2 months following concussion.
        J Head Trauma Rehabil. 2016; 31: 262-268
        • Howell D.R.
        • Osternig L.R.
        • Chou L.S.
        Single-task and dual-task tandem gait test performance after concussion.
        J Sci Med Sport. 2017; 20: 622-626
        • Halterman C.I.
        • Langan J.
        • Drew A.
        • et al.
        Tracking the recovery of visuospatial attention deficits in mild traumatic brain injury.
        Brain. 2006; 129: 747-753
        • Stache S.
        • Howell D.
        • Meehan W.P.
        Concussion management practice patterns among sports medicine physicians.
        Clin J Sport Med. 2016; 26: 381-385
        • Kelly K.C.
        • Jordan E.M.
        • Joyner A.B.
        • Burdette G.T.
        • Buckley T.A.
        National Collegiate Athletic Association Division I athletic trainers’ concussion-management practice patterns.
        J Athl Train. 2014; 49: 665-673
        • Iverson G.L.
        • Brooks B.L.
        • Collins M.W.
        • Lovell M.R.
        Tracking neuropsychological recovery following concussion in sport.
        Brain Inj. 2006; 20: 245-252
        • Lovell M.R.
        • Iverson G.L.
        • Collins M.W.
        • et al.
        Measurement of symptoms following sports-related concussion: reliability and normative data for the post-concussion scale.
        Appl Neuropsychol. 2006; 13: 166-174
        • Howell D.R.
        • Stracciolini A.
        • Geminiani E.
        • Meehan III, W.P.
        Dual-task gait differences in female and male adolescents following sport-related concussion.
        Gait Posture. 2017; 54: 284-289
        • Benedict P.A.
        • Baner N.V.
        • Harrold G.K.
        • et al.
        Gender and age predict outcomes of cognitive, balance and vision testing in a multidisciplinary concussion center.
        J Neurol Sci. 2015; 353: 111-115
        • Field M.
        • Collins M.W.
        • Lovell M.R.
        • Maroon J.
        Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes.
        J Pediatr. 2003; 142: 546-553
        • Vos P.E.
        • Jacobs B.
        • Andriessen T.M.
        • et al.
        GFAP and S100B are biomarkers of traumatic brain injury: an observational cohort study.
        Neurology. 2010; 75: 1786-1793
        • Sambasivan K.
        • Grilli L.
        • Gagnon I.
        Balance and mobility in clinically recovered children and adolescents after a mild traumatic brain injury.
        J Pediatr Rehabil Med. 2015; 8: 335-344
        • Fait P.
        • Swaine B.
        • Cantin J.F.
        • Leblond J.
        • McFadyen B.J.
        Altered integrated locomotor and cognitive function in elite athletes 30 days postconcussion: a preliminary study.
        J Head Trauma Rehabil. 2013; 28: 293-301
        • Lynall R.C.
        • Mauntel T.C.
        • Padua D.A.
        • Mihalik J.P.
        Acute lower extremity injury rates increase after concussion in college athletes.
        Med Sci Sports Exerc. 2015; 47: 2487-2492
        • Cross M.
        • Kemp S.
        • Smith A.
        • Trewartha G.
        • Stokes K.
        Professional Rugby Union players have a 60% greater risk of time loss injury after concussion: a 2-season prospective study of clinical outcomes.
        Br J Sports Med. 2016; 50: 926-931
        • Parker T.M.
        • Osternig L.R.
        • van Donkelaar P.
        • Chou L.
        Recovery of cognitive and dynamic motor function following concussion.
        Br J Sports Med. 2007; 41: 868-873
        • McClincy M.P.
        • Lovell M.R.
        • Pardini J.
        • Collins M.W.
        • Spore M.K.
        Recovery from sports concussion in high school and collegiate athletes.
        Brain Inj. 2006; 20: 33-39
        • Howell D.R.
        • Beasley M.
        • Vopat L.
        • Meehan W.
        The effect of prior concussion history on dual-task gait following a concussion.
        J Neurotrauma. 2017; 34: 838-844