Download PDF
Semin Speech Lang 2014; 35(03): 186-195
DOI: 10.1055/s-0034-1384680
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical Assessment of Balance in Adults with Concussion

Rebecca J. Reed-Jones
1   Department of Applied Human Sciences, Faculty of Science, University Prince Edward Island, Charlottetown, Prince Edward Island, Canada
,
Nicholas G. Murray
2   Interdisciplinary Health Sciences Ph.D. Program, University of Texas at El Paso, El Paso, Texas
,
Douglas W. Powell
3   Department of Physical Therapy, Campbell University, Buies Creek, North Carolina
› Author Affiliations
Further Information

Publication History

Publication Date:
12 August 2014 (online)

    Permissions and Reprints

Abstract

Balance is a key component to the assessment of concussion injury; however, the efficacies of clinical tests used are currently under debate. It is questionable whether currently accepted methods of standing balance assessment quantify balance disturbances sufficiently to support decisions on recovery and return to play. Recent evidence of balance abnormalities postconcussion that linger beyond the typical 3- to 5-day recovery period support arguments that currently available standing balance tests are not sensitive enough to determine recovery of function. This article discusses the current clinical tests used in the assessment of concussion in adults and their limitations and the evidence supporting continued balance dysfunction. Implications for the future of balance assessment in concussed adults and recommendations to clinicians for best practices are presented.

Keywords

Balance assessment - standing balance - vestibular - sensory integration - concussion
 

  • References

  • 1 Winter DA. Human balance and posture control during standing and walking. Gait Posture 1995; 3: 193-214
    CrossrefPubMedGoogle Scholar
  • 2 Horak FB. Clinical assessment of balance disorders. Gait Posture 1997; 6 (1) 76-84
    CrossrefPubMedGoogle Scholar
  • 3 Maskell F, Chiarelli P, Isles R. Dizziness after traumatic brain injury: overview and measurement in the clinical setting. Brain Inj 2006; 20 (3) 293-305
    CrossrefPubMedGoogle Scholar
  • 4 Marar M, McIlvain NM, Fields SK, Comstock RD. Epidemiology of concussions among United States high school athletes in 20 sports. Am J Sports Med 2012; 40 (4) 747-755
    CrossrefPubMedGoogle Scholar
  • 5 McCrea M, Guskiewicz KM, Marshall SW , et al. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA 2003; 290 (19) 2556-2563
    CrossrefPubMedGoogle Scholar
  • 6 Guskiewicz KM, Perrin DH, Gansneder BM. Effect of mild head injury on postural stability in athletes. J Athl Train 1996; 31 (4) 300-306
    PubMedGoogle Scholar
  • 7 Guskiewicz KM, Ross SE, Marshall SW. Postural stability and neuropsychological deficits after concussion in collegiate athletes. J Athl Train 2001; 36 (3) 263-273
    PubMedGoogle Scholar
  • 8 Guskiewicz KM. Balance assessment in the management of sport-related concussion. Clin Sports Med 2011; 30 (1) 89-102 , ix
    CrossrefPubMedGoogle Scholar
  • 9 Riemann BL, Guskiewicz KM. Effects of mild head injury on postural stability as measured through clinical balance testing. Journal of Athl Train 2000; 35 (1) 19-25
    PubMedGoogle Scholar
  • 10 McCrea M, Guskiewicz K, Randolph C , et al. Incidence, clinical course, and predictors of prolonged recovery time following sport-related concussion in high school and college athletes. Journal of the International Neuropsychological Society 2012; 19 (1) 22-23
    PubMedGoogle Scholar
  • 11 Cavanaugh JT, Guskiewicz KM, Stergiou N. A nonlinear dynamic approach for evaluating postural control: new directions for the management of sport-related cerebral concussion. Sports Med 2005; 35 (11) 935-950
    CrossrefPubMedGoogle Scholar
  • 12 Cavanaugh JT, Guskiewicz KM, Giuliani C, Marshall S, Mercer V, Stergiou N. Detecting altered postural control after cerebral concussion in athletes with normal postural stability. Br J Sports Med 2005; 39 (11) 805-811
    CrossrefPubMedGoogle Scholar
  • 13 Slobounov S, Tutwiler R, Sebastianelli W, Slobounov E. Alteration of postural responses to visual field motion in mild traumatic brain injury. Neurosurgery 2006; 59 (1) 134-139 , discussion 134–139
    CrossrefPubMedGoogle Scholar
  • 14 Slobounov S, Cao C, Sebastianelli W, Slobounov E, Newell K. Residual deficits from concussion as revealed by virtual time-to-contact measures of postural stability. Clin Neurophysiol 2008; 119 (2) 281-289
    CrossrefPubMedGoogle Scholar
  • 15 Parker TM, Osternig LR, VAN Donkelaar P, Chou LS. Gait stability following concussion. Med Sci Sports Exerc 2006; 38 (6) 1032-1040
    CrossrefPubMedGoogle Scholar
  • 16 Cavanaugh JT, Guskiewicz KM, Giuliani C, Marshall S, Mercer VS, Stergiou N. Recovery of postural control after cerebral concussion: new insights using approximate entropy. J Athl Train 2006; 41 (3) 305-313
    PubMedGoogle Scholar
  • 17 Alsalaheen BA, Mucha A, Morris LO , et al. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther 2010; 34 (2) 87-93
    CrossrefPubMedGoogle Scholar
  • 18 McCrory P, Johnston KM, Mohtadi NG, Meeuwisse W. Evidence-based review of sport-related concussion: basic science. Clin J Sport Med 2001; 11 (3) 160-165
    CrossrefPubMedGoogle Scholar
  • 19 Murray NG. Evaluation of Static and Dynamic Postural Control in Athletes with Concussions during Recovery [PhD Interdisciplinary Health Sciences]. El Paso, TX: The University of Texas at El Paso; 2014
    Google Scholar
  • 20 Powers KC, Kalmar JM, Cinelli ME. Recovery of static stability following a concussion. Gait Posture 2014; 39 (1) 611-614
    CrossrefPubMedGoogle Scholar
  • 21 Murray NG, Ambati VN, Contreras MM, Salvatore AP, Reed-Jones RJ. Assessment of oculomotor control and balance post-concussion: a preliminary study for a novel approach to concussion management. Brain Inj 2014; 28 (4) 496-503
    CrossrefPubMedGoogle Scholar
  • 22 Nashner LM, Black FO, Wall III C. Adaptation to altered support and visual conditions during stance: patients with vestibular deficits. J Neurosci 1982; 2 (5) 536-544
    CrossrefPubMedGoogle Scholar
  • 23 Shumway-Cook A, Horak FB. Assessing the influence of sensory interaction of balance. Suggestion from the field. Phys Ther 1986; 66 (10) 1548-1550
    PubMedGoogle Scholar
  • 24 Rogers JH. Romberg and his test. J Laryngol Otol 1980; 94 (12) 1401-1404
    CrossrefPubMedGoogle Scholar
  • 25 Lanska DJ, Goetz CG. Romberg's sign: development, adoption, and adaptation in the 19th century. Neurology 2000; 55 (8) 1201-1206
    CrossrefPubMedGoogle Scholar
  • 26 Bell DR, Guskiewicz KM, Clark MA, Padua DA. Systematic review of the balance error scoring system. Sports Health 2011; 3 (3) 287-295
    CrossrefPubMedGoogle Scholar
  • 27 Khasnis A, Gokula RM. Romberg's test. J Postgrad Med 2003; 49 (2) 169-172
    PubMedGoogle Scholar
  • 28 Finnoff JT, Peterson VJ, Hollman JH, Smith J. Intrarater and interrater reliability of the balance error scoring system (BESS). PM R 2009; 1 (1) 50-54
    CrossrefPubMedGoogle Scholar
  • 29 Valovich McLeod TC, Perrin DH, Guskiewicz KM, Shultz SJ, Diamond R, Gansneder BM. Serial administration of clinical concussion assessments and learning effects in healthy young athletes. Clin J Sport Med 2004; 14 (5) 287-295
    CrossrefPubMedGoogle Scholar
  • 30 Clark RA, Bryant AL, Pua Y, McCrory P, Bennell K, Hunt M. Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance. Gait Posture 2010; 31 (3) 307-310
    CrossrefPubMedGoogle Scholar
  • 31 Bartlett HL, Ting LH, Bingham JT. Accuracy of force and center of pressure measures of the Wii Balance Board. Gait Posture 2014; 39 (1) 224-228
    CrossrefPubMedGoogle Scholar
  • 32 Wikstrom EA. Validity and reliability of Nintendo Wii Fit balance scores. J Athl Train 2012; 47 (3) 306-313
    PubMedGoogle Scholar
  • 33 Reed-Jones RJ, Dorgo S, Hitchings MK, Bader JO. WiiFit™ Plus balance test scores for the assessment of balance and mobility in older adults. Gait Posture 2012; 36 (3) 430-433
    CrossrefPubMedGoogle Scholar
  • 34 Metcalfe JS, Clarke JE. Sensory information affords exploration of posture in newly walking infants and toddlers. Infant Behav Dev 2000; (23) 391-405
    PubMedGoogle Scholar
  • 35 Reed-Jones RJ, Vallis LA, Reed-Jones JG, Trick LM. The relationship between postural stability and virtual environment adaptation. Neurosci Lett 2008; 435 (3) 204-209
    CrossrefPubMedGoogle Scholar
  • 36 Powell D, Williams 3rd DS . Greater center of pressure excursions associated with negative-feedback balance training
    PubMed
  • 37 Stergiou N, Harbourne R, Cavanaugh J. Optimal movement variability: a new theoretical perspective for neurologic physical therapy. J Neurol Phys Ther 2006; 30 (3) 120-129
    CrossrefPubMedGoogle Scholar
  • 38 McCrory P, Meeuwisse W, Aubry M , et al. Consensus statement on concussion in sport-the 4th international conference on concussion in sport held in Zurich, November 2012. J Sci Med Sport
    PubMedGoogle Scholar
  • 39 Catena RD, van Donkelaar P, Chou LS. Different gait tasks distinguish immediate vs. long-term effects of concussion on balance control. J Neuroeng Rehabil 2009; 6: 25
    CrossrefPubMedGoogle Scholar