A simple balance and gait assessment used by therapists and athletic trainers to detect subtle impairments in children and teens who have sustained a concussion may help identify whether they are ready to return to normal activities or athletic competition.
But being able to drill down deeper and identify which of the specific balance and walking tasks within this assessment is most effective could help clinicians distinguish symptomatic children from those who have clinically recovered better and faster, new research concludes.
A recent study from the University at Buffalo suggests that the 30-second, single-leg stance is a task worthy of being singled out for its effectiveness in detecting subtle deficiencies in a child’s postural control, or their ability to balance and coordinate with other muscle groups in the body.
“Balance deficits exist in some children even after clinical recovery,” said Dr Ghazala Saleem, lead author of the study, and an assistant professor of rehabilitation science in UB’s School of Public Health and Health Professions.
“This research emphasises the use of assessments that can identify balance deficits appropriately, both in symptomatic and clinically, but not physiologically-recovered, children.”
Identifying abnormalities in the way a child’s brain organises information to help them sit, stand and walk is critical, Dr Saleem says.
“Postural control includes both balance and walking. These are essential abilities that are required to complete the activities of daily living,” she said.
“If children continue to experience balance deficits even after recovery, it may influence their ability to return to play or return to school.”
The Physical and Neurological Examination of Subtle Signs (PANESS) is a measurement used frequently by clinicians and researchers to identify functional limitations in motor control because it requires only paper and pencil and a stopwatch, and includes both static (balance) and dynamic (walking) tasks.
The balance task requires the patient to stand on one foot for 30 seconds – 20 seconds is still the standard in many concussion clinics – and then stand on the other; an observer records any errors the subject makes, such as stumbling.
The dynamic tasks include having the patient walk at their normal speed with different variations such as heel-to-toe walking.
Dr Saleem’s study looked at whether static or dynamic tests on the PANESS best identify anomalies in symptomatic and clinically recovered youth after concussion, a finding that could lead to faster assessment approaches for clinicians.
The study included 60 children aged between ten and 17, who were split into three groups: those who displayed concussion symptoms, youths who were clinically recovered, and age and gender-matched controls who had never had a concussion.
In addition to the PANESS, which measures residual signs of motor control deficits, the team also looked at the Post-Concussion Symptom Inventory, a 26-item parent report measure that assesses the severity of post-concussion symptoms. The three groups differed significantly on parent-reported overall symptoms.
The team’s initial hypothesis was that dynamic gait tasks would better identify symptomatic and clinically recovered youth.
However, the results suggest that only the standing-on-one-foot test discriminated never-concussed controls from symptomatic and clinically recovered youth after concussion. It did not discriminate between the two concussion groups.
“The ability to perform single-leg stance without losing balance demonstrates adequate neuromuscular control and sufficient lower-extremity strength, attributes needed to return to high-risk activities safely,” the researchers write.
