Will Smith’s new movie “Concussion” terrifies the NFL. Here’s the trailer.

Gait and Concussions.

The big movie trailer just came out yesterday, click on the link above to watch the trailer for “Concussion” with Will Smith, slated for theater release in December 2015.  Hopefully this will raise even more awareness to TBI (traumatic brain injury), and remember, minimal TBI falls into these categories and discussions.  

Here is just a small sampling of some of the complications of concussions on human gait.  Head injuries are no joke, their effects on dynamic motor control and sensory-motor integration are potentially serious issues.  From the first 4 references that came up on the pubmed search this is what was mentioned:

– “the ability to control and maintain stability in the frontal plane during walking is diminished under divided attention” (1)

– “Adolescents with concussion displayed increased center-of-mass medial/lateral displacement and velocity during dual-task walking after RTA (return to activity), suggesting a regression of recovery in gait balance control. This study reinforces the need for a multifaceted approach to concussion management and continued monitoring beyond the point of clinical recovery.” (2)

– “concussion may have long-term observable and measurable effects on the control of gait stability”(3)

– “persons with a history of concussion adopt a more conservative gait strategy”.(4)

Do you see something strange on  your client’s gait analysis ?  Have you asked them about previous concussions and head injuries? Perhaps you should.  Take mTBI seriously, this is not a trivial matter. 

Dr. Shawn Allen, one of the gait guys

References:

1. Clin Biomech (Bristol, Avon). 2005 May;20(4):389-95. Epub 2005 Jan 28.The effect of divided attention on gait stability following concussion.Parker TM1, Osternig LR, Lee HJ, Donkelaar Pv, Chou LS.

2. Med Sci Sports Exerc. 2015 Apr;47(4):673-80. doi: 10.1249/MSS.0000000000000462.Return to activity after concussion affects dual-task gait balance control recovery.Howell DR1, Osternig LR, Chou LS.

3.Med Sci Sports Exerc. 2006 Jun;38(6):1032-40.Gait stability following concussion.Parker TM1, Osternig LR, VAN Donkelaar P, Chou LS.

4. Arch Phys Med Rehabil. 2011 Apr;92(4):585-9. doi: 10.1016/j.apmr.2010.11.029.The chronic effects of concussion on gait.Martini DN1, Sabin MJ, DePesa SA, Leal EW, Negrete TN, Sosnoff JJ, Broglio SP.

Will Smith’s new movie “Concussion” terrifies the NFL. Here’s the trailer.

People tend to forget about the peroneal muscles. This is what it looks like when the brain forgets.

This client came to see us for obvious reasons but the case details are not what we are focusing on today. Gait gets pretty messed up when a critical component or phase is lost or forgotten.  

In last weeks teleseminar on www.onlineCE.com we discussed several gait cases. In these cases 5 things kept coming up when it came to looking at (specifically) neurologic gait compensations:

  1. slowing of gait
  2. wider based gait
  3. increased ancillary movements 
  4. utilizing support when needed or available
  5. shorted step length and stride length

In this video, it is clear that this person has some serious neurologic problems engaging the peroneal muscles and controlling ankle and foot function and as a consequence you see evidence of some of the itemized issues above, namely, calculated movements, nearly zero arm swing and step length from left to right is abbreviated. 

It can go both ways. The neurologic problem can affect one’s gait, but one’s resultant gait can then affect cortical function, driving an endless loop. Recently, five studies presented at the Alzheimer’s Association International Conference in Vancouver Canada provided striking evidence that when a person’s walk gets slower or becomes more variable or less controlled, his cognitive function is also suffering.(2)  

A person’s gait and their neurologic function cannot be separated. The stuff just run’s too deep.  This is why we love gait so much, because to fully understanding someone’s clinical problems we must understand how and why they move.  There are clues in everyone’s gait that can help you clinically. The question is, will you notice them ? Do you know what normal gait is to begin with ? Will you understand what you are seeing and realize it is a compensation? Will you fix what you see or look deeper to find the cause of what you see ? 

Shawn and Ivo,

The Gait Guys

Gait Posture. 2013 Jul;38(3):549-51. doi: 10.1016/j.gaitpost.2013.02.008. Epub 2013 Mar 11.

Altered gait termination strategies following a concussion.

Buckley TA1, Munkasy BATapia-Lovler TGWikstrom EA.

2.  http://www.nytimes.com/2012/07/17/health/research/signs-of-cognitive-decline-and-alzheimers-are-seen-in-gait.html?_r=1&

The effect of footwear and sports-surface on dynamic neurological screening (click for link)

Shoes make the man, or in this case, the athlete. This study shows that shoes (much like skis) allow us to perform faster than our brain is able to compensate ( in other words, we lack the skill) and allow us to sometimes stretch our  abilities, often at the cost of an injury. We must remember that technology must keep pace with the rate of neural learning, not the opposite.

J Sci Med Sport. 2010 Jul;13(4):382-6. Epub 2010 Mar 15.

The effect of footwear and sports-surface on dynamic neurological screening (click for link)

Shoes make the man, or in this case, the athlete. This study shows that shoes (much like skis) allow us to perform faster than our brain is able to compensate ( in other words, we lack the skill) and allow us to sometimes stretch our  abilities, often at the cost of an injury. We must remember that technology must keep pace with the rate of neural learning, not the opposite. J Sci Med Sport. 2010 Jul;13(4):382-6. Epub 2010 Mar 15.

The effect of footwear and sports-surface on dynamic neurological screening (click for link)