Reactive balance assessments complement clinical baseline concussion assessments in collegiate athletes

Context:Current clinical concussion evaluations assess balance deficits using static or dynamic balance tasks while largely ignoring reactive balance. Including a reactive balance assessment in current evaluations might provide a more comprehensive concussion evaluation.Objective:The purpose of this study was to determine if redundancy exists within current clinical baseline assessments of concussion and whether reactive balance adds unique information to these evaluations.Design:Cross Sectional StudySetting:Clinical AssessmentPatients or Other Participants:Two cohorts of data were collected at the beginning of the athletic season from healthy NCAA Division I athletes. Within the first cohort (n = 191), correlation analyses with clinical scores and inertial measurements were run between the ImPACT (Immediate Post-Concussion Assessment and Cognitive Tool), the BESS (Balance Error Scoring System), the modified Push and Release (mP&R), and instrumented mP&R (I-mP&R) to determine the strength of a relationship between these concussion tests. Within the second cohort (n = 88), correlation analyses were run between the BESS, the mP&R, Timed Tandem Gait, Walking with eyes closed, and clinical reaction time to determine the strength of the relationship between these concussion evaluation tests.Main Outcome Measures:ImPACT cognitive indices, BESS and mP&R clinical score and instrumented measures (BESS sway; I-mP&R time to stability, latency, and step length), TTG and Walking time to completion, and clinical reaction time.Results:The strongest inter-instrument correlation value was r= 0.347, which was considered a weak correlation, between clinical reaction time and single task time to stability from the I-mP&R. The I-mP&R and mP&R clinical scores were weakly associated with the other assessments.Conclusion:The weak correlations between inter-assessment variables indicates that there is little redundancy within the current clinical evaluations. Furthermore, reactive balance represents a unique domain of function that may improve the comprehensiveness of clinical assessments.