Impaired eye tracking is associated with symptom severity but not dynamic postural control in adolescents following concussion

Purpose:The purpose of the study was to(1)examine the relationship between self-reported symptoms and concussion-related eye tracking impairments,and(2)compare gait performance between(a)adolescents with a concussion who have normal eye tracking,(b)adolescents with a concussion who have abnormal eye tracking,and(c)healthy controls.Methods:A total of 30 concussed participants(age:14.4±2.2 years,mean±SD,50%female)and 30 controls(age:14.2±2.2 years,47%female)completed eye tracking and gait assessments.The BOX score is a metric of pupillary disconjugacy,with scores<10 classified as normal and≥10 abnormal.Symptoms were collected using the Post-Concussion Symptom Scale(PCSS),and gait speed was measured with triaxial inertial measurement units.We conducted a linear regression to examine the relationship between PCSS and BOX scores and a two-way mixed effects analysis of variance to examine the effect of group(abnormal BOX,normal BOX,and healthy control)on single-and dual-task gait speed.Results:There was a significant association between total PCSS score and BOX score in the concussion group(β=0.16,p=0.004,95%confidence interval(95%CI):0.06‒0.27),but not in the control group(β=0.21,p=0.08,95%CI:0.03 to 0.45).There were no significant associations between PCSS symptom profiles and BOX scores in the concussion or control groups.There were also no significant differences in singletask(Abnormal:1.00±0.14 m/s;Normal:1.11§0.21 m/s;Healthy:1.14±0.18 m/s;p=0.08)or dual-task(Abnormal:0.77±0.15 m/s;Normal:0.84±0.21 m/s;Healthy:0.90±0.18 m/s;p=0.16)gait speed.Conclusion:The concussed group with impaired eye tracking reported higher total symptom severity,as well as worse symptom severity across the 5 PCSS symptom domain profiles.However,eye tracking deficits did not appear to be driven by any particular symptom domain.While not statistically significant,the slower gait speeds in those with abnormal BOX scores may still be clinically relevant since gait-related impairments may persist beyond clinical recovery.

The diagnostic and prognostic utility of the dual-task tandem gait test for pediatric concussion

Background:The tandem gait test has gained interest recently for assessment of concussion recovery.The purpose of our study was to determine the prognostic and diagnostic use of the single-and dual-task tandem gait test,alongside other clinical measures,within 10 days of pediatric concussion.Methods:We assessed 126 patients post-concussion(6.3§2.3 days post-injury,mean§SD)at a pediatric sports medicine clinic and compared them to 58 healthy controls(age:15.6§1.3 years;43%female).We also compared the 31 patients with concussion who developed persistent post-concussion symptoms(PPCS)(age=14.9§2.0 years;48%female)to the 81 patients with concussion who did not develop PPCS following the initial assessment(age:14.1§3.0 years;41%female).All subjects completed a test battery,and concussion patients were monitored until they experienced concussion-symptom resolution.The test battery included tandem gait(single-task,dual-task(performing tandem gait while concurrently completing a cognitive test)conditions),modified Balance Error Scoring System(mBESS),and concussion symptom assessment(Health and Behavior Inventory).We defined PPCS as symptom resolution time>28 days post-concussion for the concussion group.Measurement outcomes included tandem gait time(single-and dual-task),dual-task cognitive accuracy,mBESS errors(single/double/tandem stances),and symptom severity.Results:The concussion group completed the single-task(mean difference=9.1 s,95%confidential interval(95%CI):6.1-12.1)and dual-task(mean difference=12.7 s,95%CI:8.716.8)tandem gait test more slowly than the control group.Compared to those who recovered within 28 days of concussion,the PPCS group had slower dual-task tandem gait test times(mean difference=7.9 s,95%CI:2.0-13.9),made more tandem-stance mBESS errors(mean difference=1.3 errors,95%CI:0.2-2.3),and reported more severe symptoms(mean difference=26.6 Health and Behavior Inventory rating,95%CI:21.1-32.6).Conclusion:Worse dual-task tandem gait test time and mBESS tandem stance performance predicted PPCS in pediatric patients evaluated within 10 days of concussion.Tandem gait assessments may provide valuable information augmenting common clinical practices for concussion management.