Dual-Task Gait Recovery after Concussion among Female and Male Collegiate Athletes

Abstract

Purpose: Few studies have investigated recovery between sexes using objective outcome measures. Our purpose was to examine the independent association between biological sex and recovery of postconcussion gait among collegiate athletes.

Methods: We evaluated participants with a diagnosed concussion <7 d postinjury, and approximately 1.5 months and 3.5 months postinjury. Participants completed a single/dual-task gait evaluation and symptom inventory. During dual-task trials, they completed a mental task (backward subtraction, spelling, or month recitation). The primary outcome measure was height-adjusted gait velocity recovery, defined as achieving normal gait velocity using established values: >0.56 and >0.50 gait velocity (m·s)/height (m) under single and dual-task conditions, respectively. We used a multivariable Cox proportional hazard model to identify associations between sex and dual-task recovery, controlling for age, concussion history, symptom severity, and loss of consciousness at the time of injury.

Results: Ninety-four individuals participated in the study: 47 (50%) were female athletes (mean age = 20.1, SD = 1.3 yr) and 47 (50%) were male athletes (mean age = 20.3, SD = 1.3 yr). Sex was not independently associated with height-adjusted single-task gait velocity recovery after controlling for potential confounders (hazard ratio = 1.62, 95% confidence interval = 0.87-3.01). However, male sex was independently associated with longer dual-task gait recovery time after controlling for potential confounders (hazard ratio = 2.43, 95% confidence interval = 1.11-5.35).

Conclusion: Male athletes required a longer duration of time after concussion to achieve dual-task gait recovery than female athletes. Thus, functional dual-task abilities after concussion may be affected differentially by sex and should be accounted for within individualized concussion management strategies.

Conflict of interest statement

Conflict of Interest

Unrelated to this work, Dr. Howell has received research support from the National Institutes of Health (R03HD094560 and R41NS103698). Dr. Meehan receives royalties from 1) ABC-Clio publishing for the sale of his books, Kids, Sports, and Concussion: A guide for coaches and parents, and Concussions; 2) Springer International for the book Head and Neck Injuries in the Young Athlete and 3) Wolters Kluwer for working as an author for UpToDate. His research is funded, in part, by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament and a grant from the National Football League. The remaining authors have conflicts to disclose. The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation.

Figures

Figure 1.

Height-adjusted single-task and dual-task average gait velocity recovery for female and male athletes. Data presented as means, error bars represent 95% confidence intervals.

Figure 2.

Kaplan-Meier Survival Curve for duration of time required for recovery of dual-task height-adjusted gait velocity.

Figure 3.

Cognitive accuracy data during dual-task gait for female and male athletes. Data presented as means, error bars represent 95% confidence intervals.