Table 4 Overview of reliability, validity and measurement error for gait assessments used to monitor movement changes following a concussion
| Â | Time taken | Equipment | Test procedure | Outcome variable | Reliability | Validity | Measurement error | Optimal conditions |
|---|---|---|---|---|---|---|---|---|
Non-instrumented gait assessments | ||||||||
Community balance and mobility scale | ||||||||
 ~ 10–15-min | Stopwatch, rigid box, 1–3-kg weight | Tasks: unilateral stance, tandem walk, 180° tandem pivot, lateral foot scooting, hopping forward, crouch and walk, lateral dodging, walk and look, run with stop, forward/backward walk, walk, look and carry, descend stairs, step-ups Scoring on scale 0–5 | Number of errors, time to complete | – | Sens = 0.78–1.00 Spec = 0.88–0.91 AUC = 0.92–0.98 | – | Performed on adult population Perform within 2 weeks post-concussion | |
Timed up and go (TUG) | ||||||||
[82] | 1–2-min | Chair Tape measure | Seated in chair, participant stands and walks 3 m, turns 180° and sits back down | Time to complete, errors | r = 0.85 Inter-tester: r = 0.99 | – | – |  |
Walking on balance beam | ||||||||
[82] | 1–2-min | Balance beam, stopwatch | Participants walk on balance beam | Number of errors | r = 0.87 Inter-tester: r = 0.35 | – | – |  |
Tandem gait | ||||||||
2–5-min | Stopwatch, measuring tape | Heel to toe walking | Time to complete, number of errors | r = 0.46–0.98 Inter-tester: r = 0.70 | Sens = 0.63–0.88 Spec = 0.61–0.72 AUC = 0.55–0.86 Between-group differences: p =  < 0.001 | SEM = 0.07 |  | |
Dual task tandem gait | ||||||||
2–5-min | Stopwatch, measuring tape | Heel and toe walk with addition of cognitive task (count back in 7’s, recite alphabet backwards etc.) | Time to complete, number of motor and cognitive errors | r = 0.84–0.92 | Sens = 0.85 Spec = 0.72 AUC = 0.80–0.87 Between-group differences: p = 0.002- < 0.001 | SEM = 0.06 | Cognitive tasks need to be age-specific | |
Complex tandem gait | ||||||||
[56] | 2–5-min | Stopwatch, measuring tape | Normal gait with addition of cognitive task (count back in 7’s, recite alphabet backwards etc.) | Time to complete, number of errors | – | Sens = 0.41 Spec = 0.90 | – | Cognitive tasks need to be age-specific |
Gait | ||||||||
[58] | 2–5-min | Stopwatch, measuring tape | Normal gait | Time to complete | – | Between-group differences: p = 0.006 | – |  |
Dual task gait | ||||||||
2–5-min | Stopwatch, measuring tape | Normal gait with addition of cognitive task (count back in 7’s, recite alphabet backwards etc.) | Time to complete, number of motor and cognitive errors | – | Sens = 0.77 Spec = 1.00 Between-group differences: p = 0.29 | – | Cognitive tasks need to be age-specific | |
Instrumented gait assessments | ||||||||
Battery combined: berg balance, balance evaluation systems Test (BESTest), dynamic gait index, high-level mobility assessment tool (HiMat) | ||||||||
[79] |  ~ 60-min | HiMat, tape measure, step, chair, ramp, obstacle | Berg balance: sit to stand, stand, sit, stand to sit, transfer, stand with eyes closed, stand with feet together, reach forward, reach to floor, turn to look behind, turn 360°, step, tandem stance, single leg stance BESTest: 36 items assessing bio-mechanical constraints, stability limits, anticipatory response, postural response, sensory orientation, stability in gait DGI: 8 items—walking on level surface, changing speed, head turn horizontal, head turn vertical, 180° turn, step over, step around, stair ascent, descent HiMat: 13 items—walk, walk backward, walk on toes, over obstacle, run, skip, hop, bound, stair ascent, descent | Number of errors, time to complete | – | Score ‘no impairment’ = 89% concussed | – | 10 trials |
Battery combined: gait, tandem gait, dual-task tandem gait | ||||||||
[58] |  ~ 10–20-min | Smartphone | Gait: assessing cadence and velocity (instrumented) Tandem gait: assessing time to complete (non-instrumented) Dual-task tandem gait: assessing time to complete (non-instrumented) | Time to complete, COM displacement | – | AUC = 0.91 | SEM = 0.05 | Combined score displayed highest AUC |
Instrumented dual task tandem gait | ||||||||
2–5-min | IMU | Heel to toe walk with addition of cognitive task (count back in 7’s, recite alphabet backwards etc.) | COM displacement, accelerometer metrics, number of cognitive errors | r = 0.73–0.94 | – | SE = -0.080–1.355 | Cognitive tasks need to be age-specific | |
Instrumented gait | ||||||||
2–5-min | IMU, 3D motion capture, GAITRite, smartphone, virtual reality | Normal gait | Time to complete, COM or COP displacement | r = 0.10–0.99 Internal consistency: r = 0.76–0.97 | Sens = 0.26–0.63 Spec = 0.62–0.85 AUC = 0.76–0.79 Between-group differences: p = 0.99–0.002 | MDC = 0.875–7.42 SEM = -1.32–0.08 |  | |
Instrumented dual task gait | ||||||||
2–5-min | IMU or 2D motion analysis | Normal gait with addition of cognitive task (count back in 7’s, recite alphabet backwards etc.) | COM or COP displacement, time to complete, number of motor and cognitive errors | Internal consistency: r = 0.61–0.97 | Sens = 0.26–0.70 Between-group differences: p = 0.93–0.07 | MDC = 0.839–6.76 | Cognitive tasks need to be age-specific | |
Functional gait assessment | ||||||||
5–20-min | Stopwatch, measuring tape, 22 cm high obstacle, stairs | 10 items; 6-m gait, 6-m gait alternating speed, gait with horizontal head turns, gait with vertical head turns, gait and pivot turn, step over obstacle, gait with narrow base of support, gait with eyes closed, backwards gait, ascend/descend stairs | Time to complete, number of errors | – | Sens = 0.05–0.88 Spec = 0.75–1.00 | – | Performed on adult population | |