Single-Task and Dual-Task Tandem Gait Performance Across Clinical Concussion Milestones in Collegiate Student-Athletes

Context The tandem gait test is a method for assessing dynamic postural control and part of the Sport Concussion Assessment Tool, versions 3 and 5. However, its reliability among child and adolescent athletes has yet to be established. Objective To examine the test-retest reliability of the single-task and dual-task tandem gait test among healthy child and adolescent athletes. Design Descriptive laboratory study. Setting Sports injury-prevention center. Patients or Other Participants Uninjured and healthy athletes between the ages of 9 and 18 years. Intervention(s) Tandem gait measures repeated 3 times across the period of approximately 1 month. Main Outcome Measure(s) Participants completed the tandem gait test under single-task and dual-task (ie, while simultaneously executing a cognitive task) conditions. Our primary outcome measure was completion time during the single-task and dual-task conditions. We also assessed cognitive accuracy and response rate while participants completed the dual-task tandem gait test. Results Thirty-two child and adolescent athletes completed the study (mean age = 14.3 ± 2.4 years; females = 16). Single-task tandem gait times were similar across the 3 testing sessions (14.4 ± 4.8, 13.5 ± 4.2, and 13.8 ± 4.8 seconds; P = .45). Dual-task tandem gait times steadily improved across the test timeline (18.6 ± 6.9, 16.6 ± 4.5, and 15.8 ± 4.7 seconds; P = .02). Bivariate correlations indicated moderately high to high agreement from test 1 to test 2 (single-task r = .627; dual-task r = 0.655) and from test 2 to test 3 (single-task r = 0.852; dual-task r = 0.775). Both the single-task (intraclass correlation coefficient; ICC [3,1] = 0.86; 95% confidence interval [CI] = 0.73, 0.93) and dual-task (ICC [3,1] = 0.84; 95% CI = 0.69, 0.92) conditions demonstrated high reliability across testing sessions. Conclusions Tandem gait outcome measures demonstrated high test-retest reliability in both the single- and dual-task conditions. The overall reliability was within the acceptable range for clinical practice, but improvements across tests suggested a moderate practice effect. Tandem gait represents a reliable, dynamic, postural-control test that requires minimal space, cost, and time.

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Single and Dual-Task Tandem Gait Performance Throughout Concussion Recovery

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000536655.07088.83 ◽

2018 ◽

Vol 50 (5S) ◽

pp. 478

Author(s):

Jessie R. Oldham ◽

Melissa S. DiFabio ◽

Kelsey Bryk ◽

Ryan M. DeWolf ◽

Thomas W. Kaminski ◽

...

Keyword(s):

Dual Task ◽

Gait Performance ◽

Concussion Recovery ◽

Tandem Gait

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Clinical feasibility and utility of a dual-task tandem gait protocol for pediatric concussion management

Journal of Athletic Training ◽

10.4085/323-20 ◽

2020 ◽

Author(s):

Mathew J. Wingerson ◽

Corrine N. Seehusen ◽

Gregory Walker ◽

Julie C. Wilson ◽

David R. Howell

Keyword(s):

Dual Task ◽

Motor Performance ◽

Clinical Utility ◽

Correlation Coefficients ◽

Single Task ◽

Task Trial ◽

Task Conditions ◽

And Control ◽

Test Completion ◽

Tandem Gait

Abstract Context: Clinical management of sport-related concussion requires the assessment of various factors, including motor performance. The tandem gait test, a measure of post-injury motor performance, has demonstrated clinical utility, but is limited by time availability and test uniformity. Objective: To assess intrasession reliability between tandem gait test trials and determine the number trials necessary for optimal utility and feasibility in clinical decision-making following concussion. Design: Cross-Sectional Study Setting: Pediatric Sport Medicine Clinic Participants: Adolescent athletes who recently sustained a concussion (n=44; age=15.4±1.8 years; 39% female) and were seen for care within 14 days (7.3±3.2 days) of their injury, as well as uninjured control participants (n=73; age=15.8±1.3 years; 41% female). All participants completed three single-task and three dual-task tandem gait trials. Outcome Measures: We collected test completion time and cognitive performance for each trial and calculated Pearson correlation coefficients between trials and Intraclass Correlation Coefficients to determine intrasession reliability. We also compared performance between groups, and calculated area under the curve (AUC) values to identify the ability of each trial to distinguish between groups. Results: Both the concussion and control group demonstrated high intrasession reliability between tandem gait trials under single (R ≥ 0.82; ICC≥ 0.93) and dual-task conditions (R ≥ 0.79; ICC≥ 0.92). The greatest group classification values were obtained from the second single-task trial (AUC = 0.89) and first dual-task trial (AUC = 0.83). Test completion time provided excellent between-group discrimination in single-task and dual-task conditions. However, cognitive performance during dual-task trials demonstrated only marginally significant clinical utility (AUC ≤ 0.67). Conclusion: Tandem gait assessments may only require two trials under single-task and one trial under dual-task conditions to effectively discriminate between concussion and control groups. This approach may improve the feasibility (time requirement) of the test, while maintaining excellent discriminatory ability.

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Single-Task and Dual-Task Gait Among Collegiate Athletes of Different Sport Classifications: Implications for Concussion Management

Journal of Applied Biomechanics ◽

10.1123/jab.2015-0323 ◽

2017 ◽

Vol 33 (1) ◽

pp. 24-31 ◽

Cited By ~ 27

Author(s):

David R. Howell ◽

Jessie R. Oldham ◽

Melissa DiFabio ◽

Srikant Vallabhajosula ◽

Eric E. Hall ◽

...

Keyword(s):

Task Performance ◽

Dual Task ◽

Inertial Sensors ◽

Cognitive Task ◽

Collegiate Athletes ◽

Gait Pattern ◽

Cognitive Test ◽

Single Task ◽

Gait Performance ◽

Cognitive Task Performance

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.

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Single-task and dual-task tandem gait test performance after concussion

Journal of Science and Medicine in Sport ◽

10.1016/j.jsams.2016.11.020 ◽

2017 ◽

Vol 20 (7) ◽

pp. 622-626 ◽

Cited By ~ 31

Author(s):

David R. Howell ◽

Louis R. Osternig ◽

Li-Shan Chou

Keyword(s):

Dual Task ◽

Test Performance ◽

Single Task ◽

Tandem Gait

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Single-task and dual-task tandem gait test performance after concussion

British Journal of Sports Medicine ◽

10.1136/bjsports-2016-097270.148 ◽

2017 ◽

Vol 51 (11) ◽

pp. A57.1-A57

Author(s):

David R Howell ◽

Louis R Osternig ◽

Li-Shan Chou

Keyword(s):

Dual Task ◽

Test Performance ◽

Single Task ◽

Tandem Gait

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Single-Task or Dual-Task? Gait Assessment as a Potential Diagnostic Tool for Alzheimer’s Disease

Journal of Alzheimer s Disease ◽

10.3233/jad-210690 ◽

2021 ◽

pp. 1-10

Author(s):

Chorong Oh

Keyword(s):

Cognitive Load ◽

Dual Task ◽

Predictive Power ◽

Diagnostic Assessment ◽

Diagnostic Feature ◽

Multiple Logistic Regression ◽

Single Task ◽

Gait Performance ◽

Category Naming ◽

Variance Explained

Background: A person’s gait performance requires the integration of sensorimotor and cognitive systems. Therefore, a person’s gait may be influenced by concurrent cognitive load such as simultaneous talking. Although it has been known that gait performance of people with Alzheimer’s dementia (AD) is compromised when they attempt a dual-task walking task, it is unclear if using a dual-task gait performance during an AD assessment yields higher diagnostic accuracy. Objective: This study was designed to investigate the predictive power for AD of dual-task gait performance in an AD assessment. Methods: Participants (14 with AD and 15 healthy controls) walked across the GAITRite© Portable Walkway mat under three different cognitive load conditions: no simultaneous cognitive load, walking while counting numbers by ones, and walking while completing category naming. Results: Multiple logistic regression revealed that the high cognitive load (i.e., category naming) with or without the low cognitive load (i.e., concurrent counting) increased the proportion of variance explained by the FAP, SL, and DST. Conclusion: Dual-task walking and talking may be a more effective diagnostic feature than single-task walking in a comprehensive AD diagnostic assessment.

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Effects of Concurrent Manual Task Performance on Connected Speech Acoustics in Individuals With Parkinson Disease

Journal of Speech Language and Hearing Research ◽

10.1044/2019_jslhr-s-msc18-18-0190 ◽

2019 ◽

Vol 62 (7) ◽

pp. 2099-2117 ◽

Cited By ~ 2

Author(s):

Jason A. Whitfield ◽

Zoe Kriegel ◽

Adam M. Fullenkamp ◽

Daryush D. Mehta

Keyword(s):

Task Performance ◽

Speech Production ◽

Dual Task ◽

Motor Task ◽

Task Condition ◽

Connected Speech ◽

Speech Acoustics ◽

Single Task ◽

Manual Task ◽

Task Conditions

Purpose Prior investigations suggest that simultaneous performance of more than 1 motor-oriented task may exacerbate speech motor deficits in individuals with Parkinson disease (PD). The purpose of the current investigation was to examine the extent to which performing a low-demand manual task affected the connected speech in individuals with and without PD. Method Individuals with PD and neurologically healthy controls performed speech tasks (reading and extemporaneous speech tasks) and an oscillatory manual task (a counterclockwise circle-drawing task) in isolation (single-task condition) and concurrently (dual-task condition). Results Relative to speech task performance, no changes in speech acoustics were observed for either group when the low-demand motor task was performed with the concurrent reading tasks. Speakers with PD exhibited a significant decrease in pause duration between the single-task (speech only) and dual-task conditions for the extemporaneous speech task, whereas control participants did not exhibit changes in any speech production variable between the single- and dual-task conditions. Conclusions Overall, there were little to no changes in speech production when a low-demand oscillatory motor task was performed with concurrent reading. For the extemporaneous task, however, individuals with PD exhibited significant changes when the speech and manual tasks were performed concurrently, a pattern that was not observed for control speakers. Supplemental Material https://doi.org/10.23641/asha.8637008

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THE RELIABILITY OF CLINICAL BALANCE TESTS UNDER SINGLE-TASK AND DUAL-TASK TESTING PARADIGMS IN UNINJURED ACTIVE YOUTH AND YOUNG ADULTS

International Journal of Sports Physical Therapy ◽

10.26603/ijspt20200487 ◽

2020 ◽

Vol 15 (4) ◽

pp. 487-500

Author(s):

Thaer S. Manaseer ◽

Jackie L. Whittaker ◽

Codi Isaac ◽

Kathryn Schneider ◽

Mary Roduta Roberts ◽

...

Keyword(s):

Young Adults ◽

Dual Task ◽

Single Task ◽

Balance Tests ◽

Youth And Young Adults

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Digital Biomarkers of Cognitive Frailty: The Value of Detailed Gait Assessment Beyond Gait Speed

Gerontology ◽

10.1159/000515939 ◽

2021 ◽

pp. 1-10

Author(s):

He Zhou ◽

Catherine Park ◽

Mohammad Shahbazi ◽

Michele K. York ◽

Mark E. Kunik ◽

...

Keyword(s):

Older Adults ◽

Steady State ◽

Dual Task ◽

Gait Speed ◽

Stride Length ◽

Cognitive Frailty ◽

Single Task ◽

Double Support ◽

Gait Parameters ◽

Digital Biomarkers

Background: Cognitive frailty (CF), defined as the simultaneous presence of cognitive impairment and physical frailty, is a clinical symptom in early-stage dementia with promise in assessing the risk of dementia. The purpose of this study was to use wearables to determine the most sensitive digital gait biomarkers to identify CF. Methods: Of 121 older adults (age = 78.9 ± 8.2 years, body mass index = 26.6 ± 5.5 kg/m2) who were evaluated with a comprehensive neurological exam and the Fried frailty criteria, 41 participants (34%) were identified with CF and 80 participants (66%) were identified without CF. Gait performance of participants was assessed under single task (walking without cognitive distraction) and dual task (walking while counting backward from a random number) using a validated wearable platform. Participants walked at habitual speed over a distance of 10 m. A validated algorithm was used to determine steady-state walking. Gait parameters of interest include steady-state gait speed, stride length, gait cycle time, double support, and gait unsteadiness. In addition, speed and stride length were normalized by height. Results: Our results suggest that compared to the group without CF, the CF group had deteriorated gait performances in both single-task and dual-task walking (Cohen’s effect size d = 0.42–0.97, p < 0.050). The largest effect size was observed in normalized dual-task gait speed (d = 0.97, p < 0.001). The use of dual-task gait speed improved the area under the curve (AUC) to distinguish CF cases to 0.76 from 0.73 observed for the single-task gait speed. Adding both single-task and dual-task gait speeds did not noticeably change AUC. However, when additional gait parameters such as gait unsteadiness, stride length, and double support were included in the model, AUC was improved to 0.87. Conclusions: This study suggests that gait performances measured by wearable sensors are potential digital biomarkers of CF among older adults. Dual-task gait and other detailed gait metrics provide value for identifying CF above gait speed alone. Future studies need to examine the potential benefits of gait performances for early diagnosis of CF and/or tracking its severity over time.

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