Decreased Anticipatory Postural Adjustments During Gait Initiation Acutely Post-Concussion

Publication date: Available online 3 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Thomas A. Buckley, Jessie R. Oldham, Barry A. Munkasy, Kelsey E. Evans
ObjectiveThe purpose of this study was to investigate anticipatory postural adjustments (APA) during the transitional movement task of gait initiation (GI) in individuals acutely following a concussion.DesignCohort Study.SettingUniversity Research Center.ParticipantsA population based sample of 84 participants divided into two equal groups of acutely post-concussion (CONC) and healthy student athletes.InterventionParticipants were tested on two occasions – a pre-injury baseline test and then the CONC group was retested acutely post-concussion and the control group again at a similar time. All participants completed 5 trials of GI on 4 forceplates.Main Outcome MeasuresThe dependent variables were the displacement and velocity of the center of pressure (COP) during the APA phase and initial step kinematics. Comparisons were made with a 2 (Group) x 2 (Time) repeated measures ANOVA.ResultsThere was a significant interaction for COP posterior displacement (P<0.001) and lateral displacement (P<0.001). Posteriorly, post-hoc testing identified a significant reduction in CONC (PRE: 5.7 + 1.6 cm and POST: 2.6 + 2.1 cm, P<0.001), but no difference in Control (PRE: 4.0 + 1.6 cm and POST: 4.0 + 2.5 cm, P=0.921). Laterally, post-hoc testing identified a significant reduction in CONC (PRE: 5.8 + 2.1 cm and POST: 3.8 + 1.8 cm, P<0.001), but no difference in Control (PRE: 5.0 + 2.5 cm and POST: 5.2 + 2.4 cm, P=0.485).ConclusionsThe results of this study suggest difficulty in the planning and execution of GI acutely post-concussion and posterior APA displacement and velocity are highly effective measures of impaired postural control. Finally, the APA phase is linked to the supplementary motor area which suggests a supraspinal contribution to post-concussion impaired postural control.



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