Balance Assessment in the Management of Sport-Related Concussion

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Role of the central nervous system in maintaining postural equilibrium

Understanding the central nervous system’s (CNS) feedback mechanism for maintaining postural equilibrium is the first step in building a case for objective balance testing in the management of sport concussion. Maintaining equilibrium requires the CNS to process and integrate afferent information from the visual, somatosensory (proprioceptive), and vestibular systems to execute appropriate and coordinated musculoskeletal responses. Feedback, obtained from sensors housed within the 3 systems,

Balance deficits following TBI

Disruption of static and dynamic balance in nonathletic populations has been identified and described following pathologic conditions, such as moderate-severe traumatic brain injury,23, 24, 25, 26, 27, 28, 29, 30, 31 hemiplegia and craniocerebral injury,32 cerebellar atrophy and ataxia,33 and whiplash.25, 34 It is thought that communication between the 3 sensory systems is lost in many of these individuals, causing moderate to severe postural instability in either the anterior-posterior

High-technology balance assessment following sport-related concussion

Studies of postural stability and balance following concussion have used a variety of methodologies and metrics. For example, in one of the earliest studies assessing balance deficits in concussed athletes, the author used a modified CTSIB on a force plate to systematically remove or conflict sensory inputs.37 The author recorded 2 indices of center of pressure displacement about a fixed, central reference point to quantify impairments in postural stability in college and high school athletes

Low-technology (clinical) balance assessment following sport-related concussion

In an attempt to provide a more cost-effective, yet quantifiable method of assessing balance in athletes, the Balance Error Scoring System (BESS) was developed by researchers at the University of North Carolina at Chapel Hill. This clinical balance test can be performed on the sideline, with the use of only a stopwatch and a piece of medium-density foam (Power Systems Airex Balance Pad 81,000, Knoxville, TN, USA). Testing involves 3 different stances (double, single, and tandem) completed

Dual-task, virtual reality, and gait assessment following TBI

More contemporary, and perhaps functional, approaches for identifying postural instability and movement dysfunction following TBI have focused on gait and balance assessment in a virtual environment or during conditions of divided attention (dual task). Researchers53, 54 have identified alternative approaches to using SOT as the balance portion of a dual task with attention divided between the balance task of the SOT and a cognitive task given either verbally or visually while taking the SOT.

Summary

Balance assessment, whether through the use of a force plate or a clinical balance test, such as the BESS, is useful in identifying neurologic impairment in athletes following concussion. In many cases, this impairment lasts only a few days after injury; however, in a small number of cases in which there are lingering vestibular issues, the deficits can last significantly longer. In such cases, balance/vestibular training may be indicated for assuring a full return to activity for the athlete.

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