Use of Reactive Balance Assessments With Clinical Baseline Concussion Assessments in Collegiate Athletes

Abstract

Context: Current clinical concussion evaluations assess balance deficits using static or dynamic balance tasks while largely ignoring reactive balance. Including a reactive balance assessment might provide a more comprehensive concussion evaluation.

Objectives: To identify redundancy in current clinical baseline assessments of concussion and determine whether reactive balance adds unique information to these evaluations.

Design: Cross-sectional study.

Setting: Clinical assessment.

Patients or other participants: A total of 279 healthy National Collegiate Athletic Association Division I athletes.

Intervention(s): Two cohorts of data were collected at the beginning of the athletic season. For cohort 1 (n = 191), the Immediate Post-Concussion Assessment and Cognitive Tool, instrumented modified push and release (I-mP&R), and Balance Error Scoring System (BESS) were administered. For cohort 2 (n = 88), the I-mP&R, BESS, timed tandem gait, walking with eyes closed, and clinical reaction time were administered.

Main outcome measure(s): The strengths of the relationships between the Immediate Post-Concussion Assessment and Cognitive Tool cognitive indices, mP&R clinical score, instrumented measures (BESS sway; I-mP&R time to stability, latency, and step length), BESS score, timed tandem gait, walking time to completion, and clinical reaction time were characterized.

Results: The strongest interinstrument correlation value was between single-task time to stability from the I-mP&R and clinical reaction time but was considered weak (r = 0.35, P = .001). The mP&R and I-mP&R clinical scores were weakly associated with the other assessments.

Conclusions: Weak correlations between interassessment variables indicated that little redundancy was present in the current clinical evaluations. Furthermore, reactive balance represents a unique domain of function that may improve the comprehensiveness of clinical assessments.

Keywords: Balance Error Scoring System; ImPACT; clinical reaction time; mild traumatic brain injury assessment; timed tandem gait.