To examine sex differences in TG performance among collegiate student-athletes acutely post-concussion relative to pre-injury performance.

Postural control impairments are common following concussion and traditionally assessed using the Balance Error Scoring System (BESS). Tandem gait (TG) has successfully identified impairments in postural control acutely post-concussion that were undetected by the BESS; thus, TG may be a more robust postural control assessment following concussion. While sex differences in BESS performance after concussion have been explored, there is no literature regarding sex differences in post-concussion TG.

Forty-eight concussed collegiate student-athletes (30 females) and twenty-five healthy controls (13 females) completed TG tests during pre-season and again acutely post-concussion. Participants walked heel-to-toe down a 3-meter line, turned, and returned as quickly as possible, completing four single-task (ST) and dual-task (DT) TG trials. During DT trials, they simultaneously answered mini-mental style questions. The best ST and DT times were recorded. A 2x2 (group*sex) ANOVA was used to examine TG change between pre-injury and post-injury tests (positive value=slower/worsening; negative value=faster/improving). 

The change in TG time from pre-injury to post-injury was significantly higher for the concussion group relative to the control group during both ST (Concussion: 1.6±2.6 seconds, Controls: -1.1±0.8 seconds, p<0.001) and DT (Concussion: 2.0±3.8 seconds, Controls: -0.9±1.7 seconds, p<0.001) TG. There were no significant interactions (ST: p=0.17, DT: p=0.23) or main effects for sex (ST: p=0.63, DT: p=0.91). 

There were no sex-specific differences in TG performance acutely post-concussion. However, all concussed participants, regardless of sex, performed significantly worse on TG than male and female controls after injury relative to baseline, while controls did not demonstrate such a change. These results suggest that TG can appropriately identify postural control impairments following concussion; however, there do not appear to be differences in performance between males and females.