Efficacy of Tandem Gait to Identify Impaired Postural Control following Concussion

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The purpose was to evaluate tandem gait (TG), Balance Error Scoring System (BESS), and modified Balance Error Scoring System (mBESS) performance acutely post-concussion in collegiate student-athletes. Additionally, we sought to evaluate the psychometric properties of TG, including minimal detectable change (MDC), sensitivity, and specificity.


Seventy-six NCAA student-athletes performed TG and BESS tests: 38 acutely post-concussion and 38 controls. Participants were tested at baseline (Time 1) and again acutely post-concussion, or the following year for controls (Time 2). Ten controls, tested simultaneously by two researchers, established a TG interrater MDC. A 2 x 2 mixed design ANOVA compared each outcome variable. An ROC curve analysis was utilized to evaluate sensitivity, specificity, and area under the curve (AUC).


There was a significant interaction (F= 8.757, p= 0.004) for TG whereby the concussion group was slower post-concussion (10.59 ± 1.53 vs. 11.80 ± 2.67 seconds), while there was no difference for controls (10.13 ± 1.72 vs. 9.93 ± 1.85 seconds). There was no significant interaction for BESS (F= 0.235, p= 0.630) or mBESS (F= 0.007, p= 0.935). TG had a sensitivity of 0.632, specificity of 0.605, and AUC of 0.704. BESS had a sensitivity of 0.447, specificity of 0.500, and AUC of 0.508. mBESS had a sensitivity of 0.474, specificity of 0.632, and AUC of 0.535.


Participants completed TG significantly slower following concussion, while no change across time was detected for controls. In contrast, BESS and mBESS performances were similar at both testing times in both groups. Our AUC analysis was acceptable for TG, but a failure for both BESS and mBESS; thus, TG may be a useful alternative for clinicians conducting post-concussion postural control assessments.

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