Contents lists available at ScienceDirect Gait & Posture journal homepage: www.elsevier.com/locate/gaitpost Prognosis for Persistent Post Concussion Symptoms using a Multifaceted Objective Gait and Balance Assessment Approach David R. Howell (PhD) 1,2,3, *, Andrew R. Mayer (PhD) 4,5,6,7 , Christina L. Master (MD) 8,9,10 , John Leddy (MD) 11 , Roger Zemek (MD) 12,13 , Timothy B. Meier (PhD) 14 , Keith Owen Yeates (PhD) 15,16,17 , Kristy B. Arbogast (PhD) 8,10 , Rebekah Mannix (MDMPH) 18,19 , William P. Meehan III (MD) 3,20 1 Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA 2 Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA 3 The Micheli Center for Sports Injury Prevention, Waltham, MA, USA 4 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA 5 Neurology Department, University of New Mexico School of Medicine, Albuquerque, NM, USA 6 Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, NM, USA 7 Psychology Department, University of New Mexico, Albuquerque, NM, USA 8 Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA 9 Sports Medicine and Performance Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA 10 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA 11 UBMD Orthopaedics and Sports Medicine, State University of New York at Buffalo, Buffalo, NY, USA 12 Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON, Canada 13 Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada 14 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee WI, USA 15 Department of Psychology, University of Calgary, Calgary, Alberta, Canada 16 Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada 17 Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada 18 Departments of Emergency Medicine and Pediatrics, Harvard Medical School 19 Division of Emergency Medicine, Boston Children’s Hospital 20 Division of Sports Medicine, Boston Children’s Hospital ARTICLEINFO Keywords: mild traumatic brain injury dual-task postural stability ABSTRACT Background: Concussion prognosis is a challenging clinical task. Identifcation of measures useful for persistent symptom risk can help optimize treatment pathways and allow clinicians to ofer appropriate anticipatory guidance. Research Question: Can a multifaceted single/dual-task postural control assessment within one week of a diag- nosed concussion identify the odds of developing persistent post-concussion symptoms (PPCS; symptoms that persist for more than 28 days post-concussion)? Methods: Weconductedaprospectivecohortstudyofyouthandyoungadultathleteswhowereevaluatedwithin 7 days of injury, and followed until they no longer reported concussion symptoms. Participants were grouped into those who developed PPCS and those who did not. During the initial evaluation, participants completed a postural control evaluation in single/dual-task conditions. We calculated six gait performance variables (in single/dual-task conditions), nine quiet stance performance variables, and three cognitive task performance (standing and walking) variables. We conducted between-group comparisons to identify candidate PPCS prog- nostic variables, and multivariable models to adjust for covariates (age, post-injury evaluation time, history of concussion, and BMI). Results: Sixty-six participants completed the study: 24% reported PPCS (mean age =16.9 ± 3.5 years; 50% female; evaluated 4.2 ± 1.9 days post-injury) and 74% (mean age= 18.3 ± 3.0 years; 52% female; evaluated 3.5 ± 1.6 days post-injury) did not. Between-group comparisons indicated greater dual-task transverse plane center-of-mass (COM) range of motion (ROM) (13.1 ± 4.3 vs. 9.9 ± 2.5 degrees; p = 0.013) and lateral step https://doi.org/10.1016/j.gaitpost.2020.04.013 Received 2 December 2019; Received in revised form 27 March 2020; Accepted 15 April 2020 ⁎ Corresponding Author:David R. Howell, PhD, ATC. Sports Medicine Center, Children’s Hospital Colorado, Department of Orthopedics, University of Colorado School of Medicine. 13123 E. 16th Avenue, B060 Aurora, CO 80045 E-mail address: David.Howell@CUAnschutz.edu (D.R. Howell). Gait & Posture 79 (2020) 53–59 0966-6362/ © 2020 Elsevier B.V. All rights reserved. T