Melissa S. DiFabio

Single-task and dual-task gait among collegiate athletes of different sport classifications: Implications for concussion management.

Gait impairments have been documented following sport-related concussion. Whether preexisting gait pattern differences exist among athletes who participate in different sport classifications, however, remains unclear. Dual-task gait examinations probe the simultaneous performance of everyday tasks (ie, walking and thinking), and can quantify gait performance using inertial sensors. The purpose of this study was to compare the single-task and dual-task gait performance of collision/contact and noncontact athletes. A group of collegiate athletes (n = 265) were tested before their season at 3 institutions (mean age= 19.1 ± 1.1 years). All participants stood still (single-task standing) and walked while simultaneously completing a cognitive test (dual-task gait), and completed walking trials without the cognitive test (single-task gait). Spatial-temporal gait parameters were compared between collision/contact and noncontact athletes using MANCOVAs; cognitive task performance was compared using ANCOVAs. No significant single-task or dual-task gait differences were found between collision/contact and noncontact athletes. Noncontact athletes demonstrated higher cognitive task accuracy during single-task standing (P = .001) and dual-task gait conditions (P = .02) than collision/contact athletes. These data demonstrate the utility of a dual-task gait assessment outside of a laboratory and suggest that preinjury cognitive task performance during dual-tasks may differ between athletes of different sport classifications.

Normative Tandem Gait in Collegiate Student-Athletes: Implications for Clinical Concussion Assessment

Background: Impaired balance is common after concussion. The third edition of the Sport Concussion Assessment Tool (SCAT-3) recommends the Balance Error Scoring System (BESS) and/or tandem gait for postconcussion balance assessment. The limitations of the BESS are well documented; however, tandem gait has received little attention throughout concussion literature. The purpose of this study was to provide normative data for tandem gait in collegiate student-athletes based on sport type, concussion history, and gender. Hypothesis: Tandem gait will be influenced by concussion history, sport, and gender. Study Design: Cohort study. Level of Evidence: Level 3. Methods: Four hundred collegiate student-athletes from both collision/contact (n = 200) and limited contact/noncontact (n = 200) sports performed 4 tandem gait trials, consistent with SCAT-3 guidelines. The dependent variables included the best of the 4 trials (BEST), the mean of the 4 trials (MEAN), and the mean of each of the trials individually (ORDER). Separate multivariate analyses of variance were performed for each of the independent variables to determine effect on BEST and MEAN trial times. Significant main effects were followed up with a 1-way analysis of variance (ANOVA). A separate 1-way ANOVA was used to assess ORDER differences. Results: The mean BEST was 10.37 ± 1.76 seconds, and the MEAN was 11.32 ± 0.70 seconds. There were no significant differences in BEST or MEAN tandem gait times, respectively, between those with and without concussion history (P = 0.41 and P = 0.69, respectively), sport type (P = 0.57 and P = 0.42, respectively), or gender (P = 0.73 and P = 0.49, respectively). There were significant differences (P < 0.05) between ORDER of the 4 tandem gait trials across the population, with improved times at each trial. Conclusion: The results of this study provide a normative data set for tandem gait in healthy collegiate student-athletes and suggest that common determinants of balance, including concussion history, collision sport participation, and gender do not appear to influence performance, but ORDER could have significant clinical implications. Clinical Relevance: Clinicians may use these data to distinguish important determinants of tandem gait performance and improve awareness when returning an individual to play after a concussion.

Concussion Management Plan Compliance: A Study of NCAA Power 5 Conference Schools

Background: In response to concerns over concussions and repeated head impacts that occur during sports, the National Collegiate Athletic Association (NCAA) mandated that all member institutions enact a concussion management plan (CMP). Although institutional and health care provider self-reports have been investigated, compliance with NCAA protocol recommendations has not been examined. Purpose: To examine the CMPs from the 65 institutions within the NCAA Power 5 conferences for compliance with the NCAA 2015 concussion guidelines. Study Design: Descriptive epidemiology study. Methods: Each institution’s publicly available CMP was obtained in 2015, reviewed, and coded for compliance with each of the required 47 components. Overall compliance rate, item-level, category-level, and institution-level compliance was assessed. Independent predictors of compliance, including each institution’s athletic training staff size, academic performance, and athletic performance, were examined with quasi-binomial regression. Results: CMPs varied substantially in length and level of detail. The overall compliance rate for all components across all institutions was 94.3% (2880/3055). Twelve components achieved 100% (65/65) compliance, and the lowest levels of compliance were clustered in “return to learn.” There were 22 institutions that achieved a 100% compliance rate; the lowest institutional compliance was 59.6%. There were no significant associations between the independent predictors and institutional compliance. Conclusion: Overall compliance with NCAA concussion management requirements was high, but there remains room for improvement. The lowest level of compliance was clustered in the return-to-learn section. There were limited details provided in the reducing head trauma component. Items with lower compliance (reducing head trauma, return to learn) tended to be outside the core competencies of the medical staff, indicating an area for improvement. Encouragingly, many institutions and specific components demonstrated full compliance.

Concussion management plan compliance: a study of ncaa power five conference schools

Objective To examine the concussions management protocols (CMPs) from the 65 institutions within the NCAA Power 5 conferences for compliance with the NCAA 2015 concussion guidelines. Design Descriptive Study. Setting N/A. Participants 65 universities of NCAA conferences: Atlantic Coast, Southeastern, Big Ten, Big 12, and Pacific-12 Interventions The 65 publicly-available CMPs were evaluated for compliance with the 47 NCAA rules and guidelines (combined N=3,055). Each CMP was reviewed and graded “yes” or “no” for each recommended or required item and compliance was reported descriptively. Outcome measures Overall compliance rate, mean, item-level, category-level, and institution-level compliance with the 47 items. Each institution’s athletic training staff size, academic performance, and athletic performance were examined as independent predictors with quasi-binomial regression. Main results CMPs varied substantially in length (range: 4-66 pages) and level of detail. The overall compliance rate for all components across all institutions was 94.3% (2,880/3,055). Twelve components achieved 100% institutional (65/65) compliance, and the lowest levels of compliance were clustered in “Return-to-Learn” (RTL). There were 22 institutions that achieved a 100% compliance rate; the lowest institutional compliance was 59.6%. There were no significant associations between the independent predictors and institutional compliance. Conclusions Overall compliance with NCAA concussion management requirements was high, but there remains room for improvement. There was low compliance with RTL as well as limited details provided in the reducing head trauma component. Items with lower compliance (reducing head trauma, return-to-learn) tended to be outside the core competencies of the medical staff, indicating an area for improvement. Competing interests None.