Turn Characteristics During Gait Differ With and Without a Cognitive Demand Among College Athletes

in Journal of Sport Rehabilitation
Restricted access

Purchase article

USD  $24.95

Student 1 year subscription

USD  $74.00

1 year subscription

USD  $99.00

Student 2 year subscription

USD  $141.00

2 year subscription

USD  $185.00

Context: Sports often involve complex movement patterns, such as turning. Although cognitive load effects on gait patterns are well known, little is known on how it affects biomechanics of turning gait among athletes. Such information could help evaluate how concussion affects turning gait required for daily living and sports. Objective: To determine the effect of a dual task on biomechanics of turning while walking among college athletes. Design: Cross-sectional study. Setting: University laboratory. Participants: Fifty-three participants performed 5 trials of a 20-m walk under single- and dual-task conditions at self-selected speed with a 180° turn at 10-m mark. The cognitive load included subtraction, spelling words backward, or reciting the months backward. Interventions: Not applicable. Main Outcome Measures: Turn duration, turning velocity, number of steps, SD of turn duration and velocity, and coefficient of variation of turn duration and velocity. Results: Participants turned significantly slower (155.99 [3.71] cm/s vs 183.52 [4.17] cm/s; P < .001) and took longer time to complete the turn (2.63 [0.05] s vs 2.33 [0.04] s; P < .001) while dual tasking, albeit taking similar number of steps to complete the turn. Participants also showed more variability in turning time under the dual-task condition (SD of turn duration = 0.39 vs 0.31 s; P = .004). Conclusions: Overall, college athletes turned slower and showed more variability during turning gait while performing a concurrent cognitive dual-task turning compared with single-task turning. The slower velocity increased variability may be representative of specific strategy of turning gait while dual tasking, which may be a result of the split attention to perform the cognitive task. The current study provides descriptive values of absolute and variability turning gait parameters for sports medicine personnel to use while they perform their concussion assessments on their college athletes.

Brown, Hall, and Ketcham are with the Department of Exercise Science, Elon University, Elon, NC, USA. Patel is with the Department of Athletics, Elon University, Elon, NC, USA. Buckley is with the Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA; and the Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, USA. Howell is lead researcher with the Sports Medicine Center, Orthopedics Institute Children’s Hospital Colorado, Aurora, CO, USA.

Vallabhajosula is with the Department of Physical Therapy Education, Elon University, Elon, NC, USA. Vallabhajosula (svallabhajosula@elon.edu) is corresponding author.
  • 1.

    Broglio SP, Cantu RC, Gioia GA, et al. National Athletic Trainers’ Association position statement: management of sport concussion. J Athl Train. 2014;49:245–265. PubMed ID: 24601910 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Howell DR, Stracciolini A, Geminiani E, Meehan WP. Dual-task gait differences in female and male adolescents following sport-related concussion. Gait Posture. 2017;54:284–289. PubMed ID: 28384609 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Buckley TA, Vallabhajosula S, Oldham JR, et al. Evidence of a conservative gait strategy in athletes with a history of concussions. J Sport Health Sci. 2016;5:417–423. PubMed ID: 30356549 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Howell DR, Beasley M, Vopat L, Meehan WP. The effect of prior concussion history on dual-task gait following a concussion. J Neurotrauma. 2017;34:838–844. PubMed ID: 27541061 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Fino PC, Nussbaum MA, Brolinson PG. Locomotor deficits in recently concussed athletes and matched controls during single and dual-task turning gait: preliminary results. J Neuroeng Rehabil. 2016;13:65. doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Howell DR, Osternig LR, Chou L-S. Dual-task effect on gait balance control in adolescents with concussion. Arch Phys Med Rehabil. 2013;94:1513–1520. PubMed ID: 23643687 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Howell DR, Osternig LR, Koester MC, Chou L-S. The effect of cognitive task complexity on gait stability in adolescents following concussion. Exp Brain Res. 2014;232:1773–1782. PubMed ID: 24531643 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Guskiewicz KM, Ross SE, Marshall SW. Postural stability and neuropsychological deficits after concussion in collegiate athletes. J Athl Train. 2001;36:263–273. PubMed ID: 12937495

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Register-Mihalik JK, Littleton AC, Guskiewicz KM. Are divided attention tasks useful in the assessment and management of sport-related concussion? Neuropsychol Rev. 2013;23:300–313. PubMed ID: 24242888 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Catena RD, van Donkelaar P, Chou L-S. Cognitive task effects on gait stability following concussion. Exp Brain Res. 2007;176:23–31. PubMed ID: 16826411 doi:

  • 11.

    Catena RD, van Donkelaar P, Chou L-S. Different gait tasks distinguish immediate vs long-term effects of concussion on balance control. J Neuroeng Rehabil. 2009;6:25. doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Fino PC. A preliminary study of longitudinal differences in local dynamic stability between recently concussed and healthy athletes during single and dual-task gait. J Biomech. 2016;49:1983–1988. PubMed ID: 27207386 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Grants L, Powell B, Gessel C, Hiser F, Hassen A. Gait deficits under dual-task conditions in the concussed adolescent and young athlete population: a systematic review. Int J Sports Phys Ther. 2017;12:1011–1022. PubMed ID: 29234553 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Parker TM, Osternig LR, Van Donkelaar P, Chou L-S. Gait stability following concussion. Med Sci Sports Exerc. 2006;38:1032–1040. PubMed ID: 16775541 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Howell D, Osternig L, Van Donkelaar P, Mayr U, Chou L-S. Effects of concussion on attention and executive function in adolescents. Med Sci Sports Exerc. 2013;45:1030–1037. PubMed ID: 23274602 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Howell DR, Osternig LR, Chou L-S. Single-task and dual-task tandem gait test performance after concussion. J Sci Med Sport. 2017;20:622–626. PubMed ID: 28169147 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Cicerone KD. Attention deficits and dual task demands after mild traumatic brain injury. Brain Inj. 1996;10:79–90. PubMed ID: 8696318 doi:

  • 18.

    Johnson B, Zhang K, Gay M, et al. Alteration of brain default network in subacute phase of injury in concussed individuals: resting-state fMRI study. Neuroimage. 2012;59:511–518. PubMed ID: 21846504 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Slobounov SM, Zhang K, Pennell D, Ray W, Johnson B, Sebastianelli W. Functional abnormalities in normally appearing athletes following mild traumatic brain injury: a functional MRI study. Exp Brain Res. 2010;202:341–354. PubMed ID: 20039023 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Al-Yahya E, Dawes H, Smith L, Dennis A, Howells K, Cockburn J. Cognitive motor interference while walking: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2011;35:715–728. PubMed ID: 20833198 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Nadkarni NK, Zabjek K, Lee B, McIlroy WE, Black SE. Effect of working memory and spatial attention tasks on gait in healthy young and older adults. Motor Control. 2010;14:195–210. PubMed ID: 20484770 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Sosnoff JJ, Broglio SP, Ferrara MS. Cognitive and motor function are associated following mild traumatic brain injury. Exp Brain Res. 2008;187:563–571. PubMed ID: 18301883 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Patla AE, Adkin A, Ballard T. Online steering: coordination and control of body center of mass, head and body reorientation. Exp Brain Res. 1999;129:629–634. PubMed ID: 10638436 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Malouin F, Richards CL, Jackson PL, Dumas F, Doyon J. Brain activations during motor imagery of locomotor-related tasks: a PET study. Hum Brain Mapp. 2003;19:47–62. PubMed ID: 12731103 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Fait P, Swaine B, Cantin J-F, Leblond J, McFadyen BJ. Altered integrated locomotor and cognitive function in elite athletes 30 days postconcussion: a preliminary study. J Head Trauma Rehabil. 2013;28:293–301. PubMed ID: 22495102 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Powers KC, Kalmar JM, Cinelli ME. Dynamic stability and steering control following a sport-induced concussion. Gait Posture. 2014;39:728–732. PubMed ID: 24231441 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Howell DR, Oldham JR, DiFabio M, et al. Single-task and dual-task gait among collegiate athletes of different sport classifications: implications for concussion management. J Appl Biomech. 2017;33:24–31. PubMed ID: 27705076 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Howell DR, Stillman A, Buckley TA, Berkstresser B, Wang F, Meehan WP. The utility of instrumented dual-task gait and tablet-based neurocognitive measurements after concussion. J Sci Med Sport. 2018;21(4):358–362. PubMed ID: 28919121 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Howell DR, Oldham JR, Meehan WP, DiFabio MS, Buckley TA. Dual-task tandem gait and average walking speed in healthy collegiate athletes [published online ahead of print October 4, 2017]. Clin J Sport Med. PubMed ID: 29023271 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Mancini M, Schlueter H, El-Gohary M, et al. Continuous monitoring of turning mobility and its association to falls and cognitive function: a pilot study. J Gerontol A Biol Sci Med Sci. 2016;71:1102–1108. PubMed ID: 26916339 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Salarian A, Horak FB, Zampieri C, Carlson-Kuhta P, Nutt JG, Aminian K. iTUG, a sensitive and reliable measure of mobility. IEEE Trans Neural Syst Rehabil Eng. 2010;18:303–310. PubMed ID: 20388604 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.

  • 33.

    Springer S, Giladi N, Peretz C, Yogev G, Simon ES, Hausdorff JM. Dual-tasking effects on gait variability: the role of aging, falls, and executive function. Mov Disord. 2006;21:950–957. PubMed ID: 16541455 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    van Iersel MB, Ribbers H, Munneke M, Borm GF, Rikkert MGO. The effect of cognitive dual tasks on balance during walking in physically fit elderly people. Arch Phys Med Rehabil. 2007;88:187–191. PubMed ID: 17270516 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Verghese J, Kuslansky G, Holtzer R, et al. Walking while talking: effect of task prioritization in the elderly. Arch Phys Med Rehabil. 2007;88:50–53. PubMed ID: 17207675 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Yogev-Seligmann G, Hausdorff JM, Giladi N. The role of executive function and attention in gait. Mov Disord. 2008;23:329–342; quiz 472. PubMed ID: 18058946 doi:

  • 37.

    Pashler H. Dual-task interference in simple tasks: data and theory. Psychol Bull. 1994;116:220–244. PubMed ID: 7972591 doi:

  • 38.

    Hollands KL, Agnihotri D, Tyson SF. Effects of dual task on turning ability in stroke survivors and older adults. Gait Posture. 2014;40:564–569. PubMed ID: 25086799 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Yang W-C, Hsu W-L, Wu R-M, Lin K-H. Immediate effects of clock-turn strategy on the pattern and performance of narrow turning in persons with Parkinson disease. J Neurol Phys Ther. 2016;40:249–256. PubMed ID: 27580078 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Harbourne RT, Stergiou N. Movement variability and the use of nonlinear tools: principles to guide physical therapist practice. Phys Ther. 2009;89:267–282. PubMed ID: 19168711 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Schmidt JD, Register-Mihalik JK, Mihalik JP, Kerr ZY, Guskiewicz KM. Identifying impairments after concussion: normative data versus individualized baselines. Med Sci Sports Exerc. 2012;44:1621–1628. PubMed ID: 22525765 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Howell DR, Osternig LR, Chou L-S. Return to activity after concussion affects dual-task gait balance control recovery. Med Sci Sports Exerc. 2015;47:673–680. PubMed ID: 25100340 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Berkner J, Meehan WP, Master CL, Howell DR. Gait and quiet-stance performance among adolescents after concussion symptom resolution. J Athl Train. 2017;52(12):1089–1095. PubMed ID: 29154694 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Crenna P, Carpinella I, Rabuffetti M, et al. The association between impaired turning and normal straight walking in Parkinson’s disease. Gait Posture. 2007;26:172–178. PubMed ID: 17532636 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Fuller JR, Adkin AL, Vallis LA. Strategies used by older adults to change travel direction. Gait Posture. 2007;25:393–400. PubMed ID: 17064904 doi:

  • 46.

    Huxham F, Baker R, Morris ME, Iansek R. Head and trunk rotation during walking turns in Parkinson’s disease. Mov Disord. 2008;23:1391–1397. PubMed ID: 18528897 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Paquette MR, Fuller JR, Adkin AL, Vallis LA. Age-related modifications in steering behaviour: effects of base-of-support constraints at the turn point. Exp Brain Res. 2008;190:1–9. PubMed ID: 18553073 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Vallabhajosula S, Buckley TA, Tillman MD, Hass CJ. Age and Parkinson’s disease related kinematic alterations during multi-directional gait initiation. Gait Posture. 2013;37:280–286. PubMed ID: 22917648 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Vaugoyeau M, Viallet F, Aurenty R, Assaiante C, Mesure S, Massion J. Axial rotation in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2006;77:815–821. PubMed ID: 16574736 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Chiu S-L, Osternig L, Chou L-S. Concussion induces gait inter-joint coordination variability under conditions of divided attention and obstacle crossing. Gait Posture. 2013;38:717–722. PubMed ID: 23578796 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51.

    Beauchet O, Dubost V, Aminian K, Gonthier R, Kressig RW. Dual-task-related gait changes in the elderly: does the type of cognitive task matter? J Mot Behav. 2005;37:259–264. PubMed ID: 15967751

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Hausdorff JM, Schweiger A, Herman T, Yogev-Seligmann G, Giladi N. Dual-task decrements in gait: contributing factors among healthy older adults. J Gerontol A Biol Sci Med Sci. 2008;63:1335–1343. PubMed ID: 19126846 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Bloem BR, Grimbergen YAM, van Dijk JG, Munneke M. The “posture second” strategy: a review of wrong priorities in Parkinson’s disease. J Neurol Sci. 2006;248:196–204. PubMed ID: 16806270 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 54.

    Baker K, Rochester L, Nieuwboer A. The effect of cues on gait variability—reducing the attentional cost of walking in people with Parkinson’s disease. Parkinsonism Relat Disord. 2008;14:314–320. PubMed ID: 17988925 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Yogev-Seligmann G, Rotem-Galili Y, Dickstein R, Giladi N, Hausdorff JM. Effects of explicit prioritization on dual task walking in patients with Parkinson’s disease. Gait Posture. 2012;35:641–646. PubMed ID: 22342204 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 108 108 15
Full Text Views 13 13 3
PDF Downloads 7 7 2