Skip to main content
SpringerLink
Log in

Effect of Concussion on Inter-joint Coordination During Divided-Attention Gait

  • Original Article
  • Published:
Journal of Medical and Biological Engineering Aims and scope Submit manuscript

Abstract

This study investigates the effect of concussion on the inter-joint coordination of the lower extremities during walking. Gait analyses were performed on 15 young adults who had suffered a concussion and 15 matched controls while walking on level ground with and without a concurrent cognitive task. The continuous relative phase (CRP), derived from phase planes of two adjacent joints, was used to assess the inter-joint coordination. Variability of coordination was assessed using the average value of all standard deviations calculated for each data point over the stance or swing phases from all CRP curves, namely the deviation phase. The results show that subjects who had had a concussion achieved a level of performance on the concurrent cognitive task similar to that of their matched controls, but had altered gait performance. The temporal–spatial gait control and the kinematic control of each individual joint were found to be altered immediately following a concussion. Patterns of the inter-joint coordination were similar to those of normal individuals. However, greater variability of inter-joint coordination patterns was found in swing phase hip–knee coordination. Examination of the inter-joint coordination could explain the observed deviations in gait performance and joint motion of individuals who had suffered a concussion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Bazarian, J. J., McClung, J., Shah, M. N., Cheng, Y. T., Flesher, W., & Kraus, J. (2005). Mild traumatic brain injury in the United States, 1998–2000. Brain Injury, 19, 85–91.

    Article  Google Scholar 

  2. Dvorak, J., McCrory, P., Aubry, M., Molloy, M., & Engebretsen, L. (2009). Concussion sans frontières. British Journal of Sports Medicine, 43, i1–i2.

    Article  Google Scholar 

  3. Frencham, K., Fox, A., & Maybery, M. (2005). Neuropsychological studies of mild traumatic brain injury: A meta-analytic review of research since 1995. Journal of Clinical and Experimental Neuropsychology, 27, 334–351.

    Article  Google Scholar 

  4. Slobounov, S., Sebastianelli, W., & Simon, R. (2002). Neurophysiological and behavioral concomitants of mild brain injury in collegiate athletes. Clinical Neurophysiology, 113, 185–193.

    Article  Google Scholar 

  5. Slobounov, S., Tutwiler, R., Sebastianelli, W., & Slobounov, E. (2006). Alteration of postural responses to visual field motion in mild traumatic brain injury. Neurosurgery, 59, 134–139.

    Article  Google Scholar 

  6. van der Naalt, J., van Zomeren, A. H., Sluiter, W. J., & Minderhoud, J. M. (1999). One year outcome in mild to moderate head injury: The predictive value of acute injury characteristics related to complaints and return to work. Journal of Neurology, Neurosurgery and Psychiatry, 66, 207–213.

    Article  Google Scholar 

  7. Emanuelson, I., Holmkvist, E. A., Bjorklund, R., & Stalhammar, D. (2003). Quality of life and post-concussion symptoms in adults after mild traumatic brain injury: A population-based study in western Sweden. Acta Neurologica Scandinavica, 108, 332–338.

    Article  Google Scholar 

  8. Guskiewicz, K. M., Weaver, N. L., Padua, D. A., & Garrett, W. E. (2000). Epidemiology of concussion in collegiate and high school football players. American Journal of Sports Medicine, 28, 643–650.

    Google Scholar 

  9. McCrory, P. R., & Berkovic, S. F. (1998). Second impact syndrome. Neurology, 50, 677–683.

    Article  Google Scholar 

  10. Pugh, K. G., & Lipsitz, L. A. (2002). The microvascular frontal-subcortical syndrome of aging. Neurobiology of Aging, 23, 421–431.

    Article  Google Scholar 

  11. Serrien, D., Ivry, R., & Swinnen, S. (2007). The missing link between action and cognition. Progress in Neurobiology, 82, 95–107.

    Article  Google Scholar 

  12. Parker, T., Osternig, L., Lee, H., Donkelaar, P., & Chou, L. S. (2005). The effect of divided attention on gait stability following concussion. Clinical Biomechanics, 20, 389–395.

    Article  Google Scholar 

  13. Parker, T. M., Osternig, L. R., Van Donkelaar, P., & Chou, L. S. (2006). Gait stability following concussion. Medicine and Science in Sports and Exercise, 38, 1032–1040.

    Article  Google Scholar 

  14. Cantin, J. F., McFadyen, B. J., Doyon, J., Swaine, B., Dumas, D., & Vallée, M. (2007). Can measures of cognitive function predict locomotor behaviour in complex environments following a traumatic brain injury. Brain Injury, 21, 327–334.

    Article  Google Scholar 

  15. Catena, R. D., van Donkelaar, P., & Chou, L. S. (2007). Altered balance control following concussion is better detected with an attention test during gait. Gait Posture, 25, 406–411.

    Article  Google Scholar 

  16. Saunders, J. B. D. M., Inman, V. T., & Eberhart, H. D. (1953). The major determinants in normal and pathological gait. The Journal of bone and Joint Surgery. American Volume, 35, 543–558.

    Google Scholar 

  17. Bernstein, N. A. (1967). The Coordination and regulation of movements. London: Pergamon Press.

    Google Scholar 

  18. Wang, T. M., Yen, H. C., Lu, T. W., Chen, H. L., Chang, C. F., Liu, Y. H., & Tsai, W. C. (2009). Bilateral knee osteoarthritis does not affect inter-joint coordination in older adults with gait deviations during obstacle-crossing. Journal of Biomechanics, 42, 2349–2356.

    Article  Google Scholar 

  19. Yen, H. C., Chen, H. L., Liu, M. W., Liu, H. C., & Lu, T. W. (2009). Age effects on the inter-joint coordination during obstacle-crossing. Journal of Biomechanics, 42, 2501–2506.

    Article  Google Scholar 

  20. American Academy of Neurology. (1997). Practice parameter: the management of concussion in sports (summary statement). Neurology, 48, 581–585.

    Article  Google Scholar 

  21. Bell, R., & Hall, R. C. W. (1977). Mental status examination. American Family Physician, 16, 145–152.

    Google Scholar 

  22. Woltring, H. J. (1986). A Fortran package for generalized, cross-validatory spline smoothing and differentiation. Advanced Engineering Software, 8, 104–113.

    Article  Google Scholar 

  23. Stergiou, N., Jensen, J. L., Bates, B. T., Scholten, S. D., & Tzetzis, G. (2001). A dynamical systems investigation of lower extremity coordination during running over obstacles. Clinical Biomechanics, 16, 213–221.

    Article  Google Scholar 

  24. Peters, B. T., Haddad, J. M., Heiderscheit, B. C., Van Emmerik, R. E. A., & Hamill, J. (2003). Limitations in the use and interpretation of continuous relative phase. Journal of Biomechanics, 36, 271–274.

    Article  Google Scholar 

  25. Kelso, J. A. S., Holt, K. G., Rubin, P., & Kugler, P. N. (1981). Patterns of human interlimb coordination emerge from the properties of non-linear, limit-cycle oscillatory processes-theory and data. Journal of Motor Behavior, 13, 226–261.

    Article  Google Scholar 

  26. Schoner, G., & Kelso, J. A. S. (1988). Dynamic pattern generation in behavioral and neural systems. Science, 239, 1513–1520.

    Article  Google Scholar 

  27. Burgesslimerick, R., Abernethy, B., & Neal, R. J. (1993). Relative phase quantifies interjoint coordination. Journal of Biomechanics, 26, 91–94.

    Article  Google Scholar 

  28. Stergiou, N., Scholten, S. D., Jensen, J. L., & Blanke, D. (2001). Intralimb coordination following obstacle clearance during running: The effect of obstacle height. Gait Posture, 13, 210–220.

    Article  Google Scholar 

  29. Kadaba, M. P., Ramakrishnan, H. K., Wootten, M. E., Gainey, J., Gorton, G., & Cochran, G. V. B. (1989). Repeatability of kinematic, kinetic, and electromyographic data in normal adult gait. Journal of Orthopaedic Research, 7, 849–860.

    Article  Google Scholar 

  30. Ebersbach, G., Dimitrijevic, M. R., & Poewe, W. (1995). Influence of concurrent tasks on gait—a dual-task approach. Perceptual and Motor Skills, 81, 107–113.

    Article  Google Scholar 

  31. Kelso, J. A. S., Schoner, G., Scholz, J. P., & Haken, H. (1987). Phase-locked modes, phase-transitions and component oscillators in biological motion. Physica Scripta, 35, 79–87.

    Article  Google Scholar 

  32. McFadyen, B. J., Cantin, J. F., Swaine, B., Duchesneau, G., Doyon, J., Dumas, D., & Fait, P. (2009). Modality-specific, multitask locomotor deficits persist despite good recovery after a traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 90, 1596–1606.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei City, 100, Taiwan, ROC

    Hao-Ling Chen

  2. Institute of Biomedical Engineering, National Taiwan University, Taipei City, 100, Taiwan, ROC

    Tung-Wu Lu

  3. Department of Orthopaedic Surgery, College of Medicine, National Taiwan University, Taipei City, 106, Taiwan, ROC

    Tung-Wu Lu

  4. Motion Analysis Laboratory, Department of Human Physiology, University of Oregon, Eugene, OR, USA

    Li-Shan Chou

Authors
  1. Hao-Ling Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tung-Wu Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Li-Shan Chou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hao-Ling Chen.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, HL., Lu, TW. & Chou, LS. Effect of Concussion on Inter-joint Coordination During Divided-Attention Gait. J. Med. Biol. Eng. 35, 28–33 (2015). https://doi.org/10.1007/s40846-015-0002-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40846-015-0002-2

Keywords

Search

Navigation