Dizziness, psychosocial function, and gait assessment following sport-related concussion

Background: Dizziness after concussion can be detrimental to both the physical and psychosocial wellbeing of patients. Vestibular symptoms, in particular, can amplify postural instability, which may create a greater sense of mental and physical abnormality post-concussion. Purpose: To examine the three-way association between self-reported dizziness with concussion symptoms, depression and anxiety severity, and gait deficits within two weeks post-concussion. We hypothesized that participants who endorsed a moderate/severe level of dizziness would report a more severe concussion symptom burden, more severe depression and anxiety, and worse postural stability. Methods: For this cross-sectional study, participants ages 14-21, were recruited from either a regional sports concussion clinic or emergency department, and tested within 14 days of a diagnosed concussion. Participants completed the Dizziness Handicap Inventory (DHI), Post-Concussion Symptom Inventory (PSCI), and Hospital Anxiety and Depression Scale (HADS).They also completed an instrumented single/dual-task gait assessment (three trials per condition). The gait assessment included walking at a self-selected pace towards a target 8m ahead, then returning to the start line. Dual task trials included a cognitive task (months in reverse order, serial 7’s, and spelling a 5-letter word backwards) while walking. Descriptive statistics, independent t-tests, and Mann Whitney U tests were used to compare between those with moderate/severe dizziness (DHI score ≥36) and those with mild/no dizziness (DHI score <36), p<0.05. Results: 40 participants completed the study. 19 self-reported moderate/severe dizziness (63% female, 17.1±2.4 years of age, average DHI score 48.4±12.6) and 21 mild/no dizziness (38% females, 16.5±1.9 years of age, average DHI score 18.7±9.3). Those with moderate/severe dizziness reported significantly more severe symptoms (PSCI: 43.0±20.6 vs. 22.8±15.7, p=0.001), and had higher median HADS anxiety (6 vs. 2, p<0.001) and depression (6 vs. 1, p=0.001) scores than those with no/minimal dizziness. During steady-state gait, the moderate/severe dizziness group walked with significantly lower single-task cadence (Figure 1B) and dual-task cadence (Figure 1E) than the no/mild dizziness group. Conclusion: Participants who self-reported a moderate to severe level of dizziness within 14 days of a concussion reported worse symptom severity, anxiety, and depression than those with no/mild dizziness. Further, cadence during gait is negatively affected by the level of dizziness reported. Clinicians should be aware of the psychosocial and physical effects dizziness symptoms may play in a patient’s recovery. Gait deficits in the moderate/severe dizziness group further indicate the importance of evaluating how the feeling of postural instability affects gait following concussion. Word Count: 389/400 [Figure: see text]