Longitudinal Locomotor and Postural Control Following Mild Traumatic Brain Injury

Abstract

Millions of people sustain a mild traumatic brain injury (concussion) each year. While most clinical signs and symptoms resolve within 7-10 days for the majority of typical concussions, some gait and balance tasks have shown abnormalities lasting beyond the resolution of clinical symptoms. These abnormalities can persist after athletes have been medically cleared for competition, yet the implications of such changes are unclear. Most prior research has examined straight gait and standard measures of balance, yet there is a lack of knowledge regarding potential persistent effects on non-straight maneuvers or on indicators of motor control variability or complexity. To expand the knowledge of post-concussion locomotor and postural changes, this investigation examined the recovery of recently concussed athletes longitudinally, over the course of one year, in three domains: 1) path selection and body kinematics during turning gait, 2) non-linear local dynamic stability during straight gait, and 3) postural control complexity during quiet standing. Compared to matched health controls, concussed athletes exhibited significant and persistent differences in turning kinematics, local dynamic stability, and postural complexity over the initial six weeks following injury. These motor differences may increase the risk of injury to concussed athletes who are cleared to return to play. Given the persistent nature of these effects, future clinical tests may benefit from incorporating gait assessments before returning athletes to competition. Future research should prospectively and longitudinally monitor locomotor and postural control in conjunction with structural and functional changes within the brain to better understand the pathophysiology of concussions and potential rehabilitation strategies.