A Proposal for Complex Gait Evaluation Using Dual-Task Gait Termination Time

in Journal of Sport Rehabilitation
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Context: Gait termination time (GTT) has been used to predict falls in older adults but has not been explored in the sport rehabilitation setting. The incorporation of a concurrent cognitive task as a complex measure of gait in this clinical population could lead to better health-related outcomes. Objective: To compare the effect of planned and unplanned gait termination with and without a concurrent cognitive task on reaction time (RT), gait velocity, and GTT. Design: Cross-sectional. Setting: Laboratory. Participants: Twenty young adults (females 60.0%, age 20.1 [0.9] y, height 169.5 [8.8] cm, mass 67.4 [10.8] kg). Intervention: Participants completed 6 planned and 6 unplanned gait termination trials on an instrumented gait mat with and without a cognitive task. Main Outcome Measures: The authors measured RT (s), gait velocity (m/s), GTT (s), and normalized GTT (s2/m). A 2 (motor) × 2 (cognitive) repeated-measures analysis of variance (α = .05) was used; significant interaction effects were explored using Bonferroni-corrected t tests (α < .008). Results: Participants walked more slowly during dual-task trials compared with single-task trials (F1,19 = 4.401, P = .050). Participants walked significantly more slowly with a cognitive task during planned (P < .001, mean difference = −0.184 m/s, 95% CI, −0.256 to −0.111) and unplanned (P = .001, mean difference = −0.111 m/s, 95% CI, −0.173 to −0.050) gait termination. Participants walked significantly more slowly (P < .001, mean difference = −0.142 m/s, 95% CI, −0.210 to −0.075) when performing the most difficult task, unplanned termination with a cognitive task, than when performing the least difficult task, planned termination with no cognitive task. We observed a cognitive task main effect such that adding a cognitive task increased RT (F1,19 = 16.375, P = .001, mean difference = −0.118 s, 95% CI, −0.178 to −0.057) and slowed normalized GTT (F1,19 = 5.655, P = .028, mean difference = −0.167 s2/m, 95% CI, −0.314 to −0.020). Conclusions: Overall, participants displayed more conservative gait strategies and slower RT, normalized GTT, and gait velocity as task difficulty increased. More investigation is needed to truly understand the clinical meaningfulness of these measures in athletic injuries.

The authors are with the UGA Biomechanics Laboratory, University of Georgia, Athens, GA, USA. Johnson and Lynall are also with the UGA Concussion Research Laboratory; and the Department of Kinesiology, University of Georgia, Athens, GA, USA.

Johnson (Rachel.johnson1@uga.edu) is corresponding author.
  • 1.

    Roeing KL, Moon Y, Sosnoff JJ. Unplanned gait termination in individuals with multiple sclerosis. Gait Posture. 2017;53:168172. PubMed ID: 28167388 doi:

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

    Sparrow WA, Tirosh O. Gait termination: a review of experimental methods and the effects of ageing and gait pathologies. Gait Posture. 2005;22(4):362371. PubMed ID: 16274920 doi:

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

    Wrightson JG, Schafer L, Smeeton NJ. Dual-task prioritization during overground and treadmill walking in healthy adults. Gait Posture. 2020;75:109114. PubMed ID: 31669806 doi:

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

    Williams G, Chmielewski T, Rudolph K, Buchanan T, Snyder-Mackler L. Dynamic knee stability: current theory and implications for clinicians and scientists. J Orthop Sports Phys Ther. 2001;31(10):546566. PubMed ID: 11665743 doi:

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

    Buttner F, Howell DR, Ardern CL, et al. Concussed athletes walk slower than non-concussed athletes during cognitive-motor dual-task assessments but not during single-task assessments 2 months after sports concussion: a systematic review and meta-analysis using individual participant data. Br J Sports Med. 2020;54(2):94101. PubMed ID: 31331944

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

    Howell DR, Beasley M, Vopat L, Meehan WP, 3rd. The effect of prior concussion history on dual-task gait following a concussion. J Neurotrauma. 2017;34(4):838844. PubMed ID: 27541061 doi:

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

    Howell DR, Buckley TA, Lynall RC, Meehan WP, 3rd. Worsening dual-task gait costs after concussion and their association with subsequent sport-related injury. J Neurotrauma. 2018;35(14):16301636. PubMed ID: 29490564 doi:

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

    Fino PC, Parrington L, Pitt W, et al. Detecting gait abnormalities after concussion or mild traumatic brain injury: a systematic review of single-task, dual-task, and complex gait. Gait Posture. 2018;62:157166. PubMed ID: 29550695 doi:

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

    Wikstrom EA, Bishop MD, Inamdar AD, Hass CJ. Gait termination control strategies are altered in chronic ankle instability subjects. Med Sci Sports Exerc. 2010;42(1):197205. PubMed ID: 20010113 doi:

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

    Myer GD, Paterno MV, Ford KR, Quatman CE, Hewett TE. Rehabilitation after anterior cruciate ligament reconstruction: criteria-based progression through the return-to-sport phase. J Orthop Sports Phys Ther. 2006;36(6):385402. PubMed ID: 16776488 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Manaseer TS, Gross DP, Mrazik M, Schneider K, Whittaker JL. Re-conceptualizing postural control assessment in sport-related concussion: transitioning from the reflex/hierarchical model to the systems model. Physiother Theory Pract. 2019:112. doi:

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

    McKeon PO, Hertel J. Dynamical systems approach to athletic injury. Athl Ther Today. 2006;11(1):3133. doi:

  • 13.

    De Beaumont L, Lassonde M, Leclerc S, Theoret H. Long-term and cumulative effects of sports concussion on motor cortex inhibition. Neurosurgery. 2007;61(2):329337; discussion 336–327. PubMed ID: 17762745 doi:

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

    Parker TM, Osternig LR, Heng-Ju L, van Donkelaar P, Chou L-S. The effect of divided attention on gait stability following concussion. Clin Biomech. 2005;20(4):389395. doi:

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

    Parker TM, Osternig LR, Donkelaar PV, Chou L-S. Gait stability following concussion. Med Sci Sports Exerc. 2006;38(6):10321040. PubMed ID: 16775541 doi:

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

    Lynall RC, Zukowski LA, Plummer P, Mihalik JP. Reliability and validity of the protokinetics movement analysis software in measuring center of pressure during walking. Gait Posture. 2017;52:308311. PubMed ID: 28033577 doi:

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

    Eagle SR, Kontos AP, Pepping GJ, et al. Increased risk of musculoskeletal injury following sport-related concussion: a perception-action coupling approach. Sports Med. 2020;50(1):1523. PubMed ID: 31228023 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Morris M, Huxham F, McGinley J, Dodd K, Iansek R. The biomechanics and motor control of gait in Parkinson’s disease. Clin Biomech. 2001;16(6):459470. doi:

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

    Oldham JR, Munkasy BA, Evans KM, Wikstrom EA, Buckley TA. Altered dynamic postural control during gait termination following concussion. Gait Posture. 2016;49:437442. PubMed ID: 27522565 doi:

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

    Buckley TA, Munkasy BA, Tapia-Lovler TG, Wikstrom EA. Altered gait termination strategies following a concussion. Gait Posture. 2013;38(3):549551. PubMed ID: 23489951 doi:

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

    Conte C, Serrao M, Casali C, et al. Planned gait termination in cerebellar ataxias. Cerebellum. 2012;11(4):896904. PubMed ID: 22274811 doi:

  • 22.

    Kelly VE, Eusterbrock AJ, Shumway-Cook A. Factors influencing dynamic prioritization during dual-task walking in healthy young adults. Gait Posture. 2013;37(1):131134. PubMed ID: 22940543 doi:

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

    Buckley T, Oldham J, Munkasy B, Evans K. Decreased anticipatory postural adjustments during gait initiation acutely postconcussion. Arch Phys Med Rehab. 2017;98(10):19621968. doi:

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

    Peebles AT, Reinholdt A, Bruetsch AP, Lynch SG, Huisinga JM. Dynamic margin of stability during gait is altered in persons with MS. J Biomech. 2016;49(16):39493955. PubMed ID: 27889188 doi:

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

    Lynall RC, Mauntel TC, Padua DA, Mihalik JP. Acute lower extremity injury rates increase after concussion in college athletes. Med Sci Sports Exerc. 2015;47(12):24872492. PubMed ID: 26057941 doi:

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

    Howell DR, Lynall RC, Buckley TA, Herman DC. Neuromuscular control deficits and the risk of subsequent injury after a concussion: a scoping review. Sports Med. 2018;48(5):10971115. PubMed ID: 29453743 doi:

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

    Oldham JR, Howell DR, Knight CA, Crenshaw JR, Buckley TA. Gait performance is associated with subsequent lower extremity injury following concussion. Med Sci Sports Exerc. In Press.

    • Search Google Scholar
    • Export Citation
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