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Research Objectives
People with persistent symptoms after mild traumatic brain injury (mTBI) often complain
of imbalance when walking with head turns, an activity that challenges the vestibular
system. The purpose of this study was 1) to compare gait speed during usual walk and
during walking with head turns (HT) between people with mTBI and controls, 2) and
to compare the cognitive workload during usual walk and during HT walk between people
with mTBI and controls.
Participants
Twenty-three individuals (mean age 55.7 ± 9.3 years) with persistent symptoms after
mTBI, who were between 3 months to 2 years post-injury and 23 age and sex-matched
controls.
Interventions
Gait speed was recorded while walking a 12-inch wide, 60-foot walkway, during walking
when looking ahead and when walking with HT to identify letters and their colors that
were placed every 5 feet on the wall.
Main Outcome Measures
Gait speed during usual walk, HT walk, and the dual-task cost for gait speed were
calculated. The number of steps outside the path during both walks and number of missed
letters were collected. Pupillary responses during both walks were collected by the
TOBII® eye tracker and the Index of Cognitive Activity (ICA) was calculated using
EyeWorks™ software. The Post-Concussion Symptom Scale (PCSS) was used to collect symptom
severity.
Results
Participants in the mTBI group had slower usual gait speed (p<0.001), and slower HT
gait speed (p<0.001) compared to controls, however, the dual task cost for gait speed
was not different between groups (p=0.88). More people with mTBI took steps off the
path during usual walk and during HT walking compared to control subjects. No differences
were noted between groups in ICA in the right or left eye for usual walk or HT walk,
or the DTC for ICA. Within group analysis showed that gait speed was lower during
HT walk compared to usual walk in the people with mTBI (p<0.001) as well as in controls
(p<0.001). Average ICA was higher with HT compared to usual walk in the mTBI group
in the right eye (p=0.01) and left eye (p=0.001), and in controls in the right eye
(p=0.01) and left eye (p=0.01).
Conclusions
People with persistent symptoms after mTBI have slower usual gait speed which is further
reduced when they must move their head to scan for objects. The cognitive workload
increased with a dual task compared to a single task, however, the dual-task cost
for gait speed and cognitive workload were similar between groups, showing that both
groups responded in a similar manner to dual tasking.
Clinical Relevance
Walking with head turns to identify objects in our surroundings, at home, in the grocery
store are part of daily life. Increased time required, poorer stability, and higher
mental effort required to walk with head turns may reduce community participation
in people with mTBI and persistent symptoms.
Keywords
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Copyright
© 2022 Published by Elsevier Inc.
