title: Normative Tandem Gait in Collegiate Student-Athletes: Implications for Clinical Concussion Assessment.
abstract: BACKGROUND
  Impaired balance is common after concussion. The third edition of the Sport Concussion Assessment Tool (SCAT-3) recommends the Balance Error Scoring System (BESS) and/or tandem gait for postconcussion balance assessment. The limitations of the BESS are well documented; however, tandem gait has received little attention throughout concussion literature. The purpose of this study was to provide normative data for tandem gait in collegiate student-athletes based on sport type, concussion history, and gender.
  
  
  OBJECTIVE
  Tandem gait will be influenced by concussion history, sport, and gender.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Level 3.
  
  
  METHODS
  Four hundred collegiate student-athletes from both collision/contact (n = 200) and limited contact/noncontact (n = 200) sports performed 4 tandem gait trials, consistent with SCAT-3 guidelines. The dependent variables included the best of the 4 trials (BEST), the mean of the 4 trials (MEAN), and the mean of each of the trials individually (ORDER). Separate multivariate analyses of variance were performed for each of the independent variables to determine effect on BEST and MEAN trial times. Significant main effects were followed up with a 1-way analysis of variance (ANOVA). A separate 1-way ANOVA was used to assess ORDER differences.
  
  
  RESULTS
  The mean BEST was 10.37 ± 1.76 seconds, and the MEAN was 11.32 ± 0.70 seconds. There were no significant differences in BEST or MEAN tandem gait times, respectively, between those with and without concussion history ( P = 0.41 and P = 0.69, respectively), sport type ( P = 0.57 and P = 0.42, respectively), or gender ( P = 0.73 and P = 0.49, respectively). There were significant differences ( P < 0.05) between ORDER of the 4 tandem gait trials across the population, with improved times at each trial.
  
  
  CONCLUSIONS
  The results of this study provide a normative data set for tandem gait in healthy collegiate student-athletes and suggest that common determinants of balance, including concussion history, collision sport participation, and gender do not appear to influence performance, but ORDER could have significant clinical implications.
  
  
  CONCLUSIONS
  Clinicians may use these data to distinguish important determinants of tandem gait performance and improve awareness when returning an individual to play after a concussion.
authors.affiliation: Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware.
authors.forename: Jessie R
authors.initials: JR
authors.lastname: Oldham
authors.affiliation: Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware.|Biomechanics & Movement Science, University of Delaware, Newark, Delaware.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: DiFabio
authors.affiliation: Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Kaminski
authors.affiliation: Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: DeWolf
authors.affiliation: Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware.|Biomechanics & Movement Science, University of Delaware, Newark, Delaware.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buckley
mesh_terms: D056352:Athletes; D001265:Athletic Injuries / Q000175:diagnosis*; D001924:Brain Concussion / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D004856:Postural Balance; D012016:Reference Values; D012737:Sex Factors; D013334:Students; D055815:Young Adult
keywords: balance; brain; mild traumatic brain injury; postural control