Balance and Gait Alterations Observed More Than 2 Weeks After Concussion: A Systematic Review and Meta-Analysis.

ABSTRACT

OBJECTIVE: The aim of the study was to systematically review and quantitatively synthesize the existing evidence of balance and gait alterations lasting more than 2 wks after concussion in adults. DESIGN: A systematic review was conducted through PubMed, CINAHL, SPORTDiscus, and Web of Science. Investigations must include adult participants with at least one concussion, were measured for 14 days after injury, and reported balance or gait measures. Balance error scoring system scores, center of pressure sway area and displacement, and gait velocity were extracted for the meta-analysis. RESULTS: Twenty-two studies were included. Balance alterations were observed for 2 wks after concussion when participants were tested with eyes closed, for longer durations of time, and with nonlinear regulatory statistics. The meta-analysis of center of pressure sway area with no visual feedback indicated that concussed individuals had greater sway area (P < 0.001). Various gait alterations were also observed, which may indicate that concussed individuals adopt a conservative gait strategy. The meta-analysis revealed that concussed participants walked 0.12 m/sec (P < 0.001) and 0.06 m/sec (P = 0.023) slower in single and dual-task conditions, respectively. CONCLUSIONS: Subtle balance and gait alterations were observed after 2 wks after a concussion. Understanding these alterations may allow clinicians to improve concussion diagnosis and prevent subsequent injury.