Abnormalities in Lower Extremity Muscle Recruitment Following Concussion Using Electromyography and Tandem Gait

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McCarley, Joseph

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2023

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Following sports-related concussion (SRC) athletes are 1.9-3.5x more likely to sustain a musculoskeletal (MSK) injury for up to one year following concussion. Surface electromyography(sEMG) can be used to measure abnormal muscle recruitment that may be the cause of the increased injury risk. Purpose: To examine abnormalities in lower extremity muscle recruitment between healthy, concussed, and symptom free individuals. Methods: 11 healthy NCAA Division I athletes and one University student (8 males, 3 females; Age: 19.5±1.31 years old) were recruited and compared to 9 NCAA Division I athletes (5 males, 4 females; Age: 20.22±1.79 years old. Average days following concussion: 1.11±0.33) of which 5 came back for a follow up symptom free appointment (3 males, 2 females; Age: 19.6±0.89 years old; Average days following concussion: 30.8±29.7). Participants had sEMG sensors (2000 Hz, 1-cm center-to-center distance, 1000 gain, Delsys, Natick, MA) applied to their tibialis anterior (TA), peroneal (PER), and medial gastrocnemius (M. GAST). To start, participants performed three self-paced walking trials (10m), along with three pseudorandomized trials of single task (ST), and three dual task (DT) trials. ST trials involved participants walking heel-to-toe for 3 meters, turning around, and walking back. DT trials have the same walking task with an addition cognitive task. All data was filtered, rectified, and normalized to the self-paced gait trials for analyzation. A series of one-way ANOVAs, Kruksal-Wallis, and RMANOVAs, were used to evaluate for statistical significance between concussion, healthy, and symptom free individuals. Results: There was significant differences in the TA turn phase in both ST and DT conditions in the healthy vs symptom free subjects (CONvSF ST Turn: p=0.03; CONvSF DT Turn: p=0.04). The trend in the data shows a decrease in TA recruitment followed by an increase in PER recruitment in the healthy vs concussion subjects. The concussion vs symptom free subjects shows a consistent pattern of increased TA and M. GAST recruitment, as well as a decrease in PER recruitment. Conclusion: The trends present in the data point to a decrease in gait velocity as well as an increase in medio-lateral instability following concussion with an observed recovery upon symptom free evaluation. While the symptom free athletes had improved medio-lateral stability, they are still less stable than their healthy counterparts, meaning they are beginning return to play with instability present. This indicates that rehabilitation professionals should consider implementing lower extremity stability exercises in stage I of return to play.

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