How Male and Female Teens Respond to Concussions Differently

The long-term effects of concussions have received more and more attention in recent years, especially for professional football players who may be at higher risk for chronic traumatic encephalopathy (CTE). However, it isn’t just the pros who are at risk for serious injury. Teens who play contact sports, especially football and soccer players, are at a high risk for concussion. In fact, teens are five times more likely to report a concussion than all other age groups combined.

This is a major problem. As many as 20 percent of teens have received a concussion diagnosis at some point in their life, and around 6 percent report multiple concussions. Concussions are a type of mild traumatic brain injury, which means they have a potentially lifelong effect on memory, cognition and motor function. While concussion education is becoming more widespread, more research is still needed to elucidate the particular effects that concussions have on teen athletes.

Concussions and Their Effect on Dual-Task Gait in Male and Female Teens

A 2017 study conducted by Howell, Stracciolini, Geminiani, and Meehan III sought to uncover any differences in dual-task gait between male and female teen athletes who had been recently diagnosed with concussions. Prior research studies have reached conflicting conclusions about such gender differences.

Participants

For this study, the control group was comprised of 51 teens who did not report concussions in the previous year, and the experimental group was comprised of 35 teens who had sought care for a concussion within two weeks of their initial injury. On average, participants in the experimental group were diagnosed 7.5 days after the onset of their concussions. These participants acquired concussions from a wide range of sports, including soccer, football, ice hockey, basketball, lacrosse and volleyball.

The average age of the control and experimental groups was 14.4 and 15, respectively. Both groups also had a nearly 50/50 female-male split.

Measures

The researchers utilized three different gait measurements over the course of their study. Instead of simply comparing healthy and post-concussion gaits, their ultimate goal was to compare the dual-task costs between male and female teens who had already experienced concussions.

To do this, they recorded:

• Single-task gait – Walking style without the burden of a cognitive challenge (i.e., just walking)
• Dual-task gait – Walking style while completing a simple cognitive challenge (i.e., walking and thinking)
• Dual-task cost – The percent change between the single-task gait and dual-task gait measurements

Dual-task gait measurements model real-life scenarios since most people are required to move and think at the same time in their day-to-day lives, not just walk from point A to point B over short distances.

Variables

The human gait is a wildly complex series of movements requiring the coordinated efforts of multiple muscle groups and different neural pathways. For this study, the researchers settled on just four aspects of the human gait:

• Average walking speed
• Stride length
• Cadence – the number of footsteps each minute
• Double support time – how long both feet were on the ground at the same time

The researchers hypothesized that female teens with concussions would have greater dual-task costs than their male counterparts. In other words, they thought female teens with concussions would display a bigger change in their average walking speed, stride length, cadence and double support time when thinking and walking at once rather than just walking when compared to male teens with concussions.

Methods

Individuals who had been recently diagnosed with a concussion were asked to complete a post-concussion symptom scale (PCSS). They were asked to rate 22 common concussion symptoms on a scale from 0 to 6.

Then, both the control and experimental groups participated in a gait assessment using wearable sensors. Participants were first instructed to walk toward a target, go around the target, and come back to the starting position. The second time, participants had to complete one of three cognitive challenges while walking – either spelling a five-letter word backward, subtracting 6 or 7 from a 2-digit number or saying the months in reverse starting at a random point in the year.

Using wireless portable inertial sensors attached to the participants on the tops of both feet and near the small of the back, the researchers received real-time synchronized data through APDM’s Mobility Lab software.

Findings

The researchers originally set out to compare the dual-task costs of concussed female teens to those of concussed male teens. Their hypothesis was only partially supported, as they discovered that female teens with concussions had a higher cadence dual-task cost. In other words, these female teens had a greater percent change in their footsteps per minute between their single-task gait and dual-task gait than male teens with concussions.

The dual-task costs of both average walking speed and double support time were greater in females as well, but these findings were not statistically significant. There was no significant difference in dual-task costs between the control and experimental group, between the males and females in the control group, or within either of the female or male gender groups.

When looking at unadjusted values, the researchers also discovered both male and female teens with concussions walked with shorter strides in a steady-state gait than the healthy control group. Additionally, unlike previous studies, the researchers found no significant difference in the symptoms reported between female and male teens with concussions, including those related to balance and dizziness.

How Gait Assessment Can Help Teens Recover Motor Function

This research study contributes important data to ongoing concussion and gait research. Still, there is much to learn, like when one should rely on traditional gait metrics versus dual-task costs for determining the appropriate amount of recovery time before an athlete returns to play.

Luckily, any researcher can replicate the findings of this study or others with the proper technology. APDM Wearable Technologies produces highly sensitive and accurate wearable sensors that measure all aspects of gait, balance and postural transitions. The data collected by Opal wearable sensors is wirelessly transferred to Mobility Lab, which generates automated reports with actionable outcome measures. The Opal sensors are light-weight and have a long battery life for collecting data outside of the lab, including in participants’ day-to-day lives.

For more information on APDM Wearable Technologies, please call us at 888-988-2736. With your help, we can contribute to the growing body of gait, balance and kinematics research.