The aim of this study was to assess gait initiation (GI) performance longitudinally across clinical concussion recovery milestones through return to participation (RTP). We recruited 54 collegiate student-athletes, 27 with concussions and 27 matched controls (15 female and 12 male per group). Participants performed five trials of GI at baseline and again at five post-concussion clinical milestones: 1) Acute, the day clinical tests achieved baseline values on the 2) Balance Error Scoring System (BESS), 3) Immediate Post-Concussion Assessment and Cognitive Test ImPACT, 4) Asymptomatic, and 5) RTP Day. GI performance on six outcome measures (anterior/posterior and medial/lateral center of pressure displacements and velocities during the anticipatory postural adjustment [APA] phase and initial step length and velocity) with repeated-measures mixed model and pair-wise post hoc. A reliable change index (RCI) was calculated, and post-concussion participant's performance was compared to the RCI at milestones. There were significant interactions for APA posterior and lateral displacement, APA posterior velocity, step length, and step velocity. The post-hoc tests identified significant deficits across clinical milestones and at RTP for APA posterior and lateral displacement, step length, and step velocity. There were no post-hoc differences for any outcome measure in the control group. At RTP, 85.2–88.9% of concussion participants had at least one outcome measure which exceeded the 80% or 95% RCI. The primary finding of this study was persistent impairments in dynamic postural control, suggesting ongoing neurophysiological impairment despite clinical recovery. These results suggest that collegiate student-athletes may be RTP before neurophysiological recovery and potentially exposing themselves to elevated risk of recurrent concussion or subsequent musculoskeletal injury.

中文翻译：

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跨脑震荡临床里程碑的动态姿势控制受损。

本研究的目的是通过恢复参与 (RTP) 纵向评估跨临床脑震荡恢复里程碑的步态启动 (GI) 表现。我们招募了 54 名大学生运动员，27 名脑震荡和 27 名匹配的对照组（每组 15 名女性和 12 名男性）。参与者在基线和五个脑震荡后临床里程碑进行了五次 GI 试验：1) 急性期，临床测试在 2) 平衡误差评分系统 (BESS) 上达到基线值，3) 即刻脑震荡后评估和认知测试 ImPACT、4) 无症状和 5) RTP 日。使用重复测量混合模型和成对事后测量在六种结果测量（预期姿势调整 [APA] 阶段和初始步长和速度期间压力位移和速度的前/后和内侧/外侧中心）的胃肠道表现。计算了可靠变化指数 (RCI)，并将脑震荡后参与者的表现与里程碑时的 RCI 进行了比较。APA 后向和侧向位移、APA 后向速度、步长和步速存在显着的相互作用。事后测试确定了临床里程碑和 RTP 的 APA 后向和侧向位移、步长和步速的显着缺陷。对照组的任何结果测量都没有事后差异。在 RTP，85.2-88。9% 的脑震荡参与者至少有一项结果指标超过 80% 或 95% RCI。这项研究的主要发现是动态姿势控制的持续损害，表明尽管临床恢复，但仍存在神经生理损害。这些结果表明，大学生运动员在神经生理恢复之前可能是 RTP，并可能使自己面临更高的复发性脑震荡或随后的肌肉骨骼损伤的风险。