Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
John Walter Scott Library, University of Alberta, Edmonton, AB, Canada.
Clin J Sport Med. 2020 Mar;30 Suppl 1:S11-S28. doi: 10.1097/JSM.0000000000000537.
Gait deviations resulting from concussion are important to consider in the diagnosis, treatment progression, and return to activity after a concussion.
To identify quantifiable gait deviations associated with concussion across populations and time since injury.
Six electronic databases were systematically searched from January 1974 to September 2016. Studies selected included original data, had an analytic design, and reported a quantifiable gait parameter in individuals who had sustained a concussion as defined by the American Congress of Rehabilitation Medicine or related definitions. Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines were followed. Two independent authors assessed study quality [Downs and Black (DB) criteria] and level of evidence (Oxford Center of Evidence-Based Medicine Model).
Of 2650 potentially relevant articles, 21 level 4 studies were included. The median DB score was 12/33 (range 10-16). Heterogeneity in gait parameters and timing of postconcussion testing precluded meta-analysis. There is consistent level 4 evidence of increased medial-lateral center-of-mass displacement, and inconsistent level 4 evidence of decreased gait velocity after concussion. Further, there is preliminary level 4 evidence that gait deficits may exist beyond the typical 10-day recovery period and return to activity.
These findings suggest that individuals who have suffered a concussion may sway more in the frontal plane, and walk slower compared to healthy controls. Consensus about the most important gait parameters for concussion diagnosis and clinical management are lacking. Further, high-quality prospective cohort studies evaluating changes in gait from time of concussion to return to activity, sport, recreation and/or work are needed.
脑震荡导致的步态偏差在脑震荡的诊断、治疗进展和康复后重返活动中非常重要。
确定与脑震荡相关的可量化步态偏差，并按人群和受伤后时间进行分类。
从 1974 年 1 月至 2016 年 9 月，系统地检索了 6 个电子数据库。选择的研究包括原始数据，具有分析设计，并报告了符合美国康复医学大会或相关定义的脑震荡患者的可量化步态参数。研究遵循了系统评价和荟萃分析的首选报告项目（PRISMA）指南。两名独立的作者评估了研究质量[唐斯和布莱克（Downs and Black，DB）标准]和证据水平（牛津循证医学中心模型）。
在 2650 篇可能相关的文章中，有 21 项 4 级研究被纳入。DB 评分中位数为 12/33（范围 10-16）。步态参数和脑震荡后测试时间的异质性排除了荟萃分析。有一致的 4 级证据表明，脑震荡后身体质量中心的横向偏移增加，而步态速度降低的证据不一致。此外，有初步的 4 级证据表明，步态缺陷可能存在于典型的 10 天恢复期之外，并在重返活动时持续存在。
这些发现表明，脑震荡患者可能在额状面摇摆更大，与健康对照组相比，行走速度较慢。缺乏用于脑震荡诊断和临床管理的最重要步态参数的共识。此外，需要进行高质量的前瞻性队列研究，评估从脑震荡到重返活动、运动、娱乐和/或工作时步态的变化。
