Evaluation of Abnormal Gait in Post-Concussion Patients

Immediate Assessment and Red Flags

• The British Journal of Sports Medicine recommends immediate assessment for structural brain injury, vestibular dysfunction, and cervical spine pathology in patients with gait abnormality after concussion, as it may signal incomplete recovery or complications requiring urgent intervention 1
• The presence of prolonged disturbance of conscious state, focal neurological deficits, seizure activity, persistent clinical symptoms, or signs of increased intracranial pressure warrants immediate neuroimaging, according to the British Journal of Sports Medicine 1
• The American Academy of Pediatrics recommends obtaining a CT head immediately to evaluate for intracranial hemorrhage if any red flags are present, as CT is the test of choice within the first 24-48 hours post-injury for detecting hemorrhage and skull fractures 3
• Signs of increased intracranial pressure, such as worsening headache, repeated vomiting, increased sleepiness, or abnormal behavior, should be evaluated promptly, as suggested by Praxis Medical Insights 2

Comprehensive Physical Examination Components

• The British Journal of Sports Medicine suggests performing structured balance testing using validated tools, such as the Balance Error Scoring System (BESS), to assess concussion-related balance deficits 1
• Dual-task gait assessment, which involves walking while performing a cognitive task, can help unmask subtle deficits, according to PM&R (The Journal of Injury Function & Rehabilitation) 4
• The American Academy of Pediatrics recommends that balance testing should occur more than 15 minutes after cessation of exercise and not on the sideline, as immediate post-exercise testing reduces reliability 3

Cognitive and Symptom Assessment

• The British Journal of Sports Medicine recommends using the Post-Concussion Symptom Scale (PCSS) to quantify symptom burden and the Standardized Assessment of Concussion (SAC) to evaluate cognitive function 1
• Cognitive screening, including orientation, memory, concentration, and information processing speed, should be performed, as suggested by Praxis Medical Insights and the British Journal of Sports Medicine 1, 2

Timing Considerations and Immediate Management

• The typical concussion recovery timeline is 2-4 weeks, and gait abnormality persisting beyond the acute period suggests unresolved concussion or specific subsystem injury, according to PM&R (The Journal of Injury Function & Rehabilitation) 5
• The British Journal of Sports Medicine recommends removing patients from all physical activity immediately and mandating cognitive rest, as well as arranging specialist referral and providing monitoring instructions 1, 2, 3