A Longitudinal Examination of Postural Impairments in Children With Mild Traumatic Brain Injury: Implications for Acute Testing

Rhine, Tara; Quatman‐Yates, Catherine; Clark, Ross

doi:10.1097/htr.0000000000000192

Cited by 12 publications

(10 citation statements)

References 21 publications

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“…28 In addition, this plane has also been shown to be sensitive to time postconcussion in a pediatric hospital setting. 17 A similar pattern emerged on the individual level. Whereas the BESS and ImPACT were also sensitive to changes in balance and neurocognition, respectively, across the 3 time points, our individual-level analysis (Figure 2) showed that, at day 3 postconcussion, the WBB classified 1 athlete (participant 12) as nonrecovered who would have been classified as recovered by the BESS and ImPACT.…”

Section: Discussionsupporting

confidence: 48%

“…13 Thus, the WBB may be a useful tool for assessing postconcussion balance impairments, given that force platforms have previously shown their utility. 11,14 However, few researchers have quantified postconcussion balance symptoms using a WBB, [15][16][17] and no studies have included prospective data, with preinjury and postconcussion balance assessments. Furthermore, given that cognitive testing is widely used in concussion management, we aimed to determine the extent to which the WBB measures provide additional information about concussion recovery that is not captured by cognitive testing.…”

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confidence: 99%

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Evaluation of Nintendo Wii Balance Board as a Tool for Measuring Postural Stability After Sport-Related Concussion

Merchant‐Borna¹,

Jones

Janigro³

et al. 2017

Journal of Athletic Training

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Context: Recent changes to postconcussion guidelines indicate that postural-stability assessment may augment traditional neurocognitive testing when making return-to-participation decisions. The Balance Error Scoring System (BESS) has been proposed as 1 measure of balance assessment. A new, freely available software program to accompany the Nintendo Wii Balance Board (WBB) system has recently been developed but has not been tested in concussed patients.Objective: To evaluate the feasibility of using the WBB to assess postural stability across 3 time points (baseline and postconcussion days 3 and 7) and to assess concurrent and convergent validity of the WBB with other traditional measures (BESS and Immediate Post-Concussion Assessment and Cognitive Test [ImPACT] battery) of assessing concussion recovery.Design: Cohort study. Setting: Athletic training room and collegiate sports arena. Patients or Other Participants: We collected preseason baseline data from 403 National Collegiate Athletic Association Division I and III student-athletes participating in contact sports and studied 19 participants (age ¼ 19.2 6 1.2 years, height ¼ 177.7 6 8.0 cm, mass ¼ 75.3 6 16.6 kg, time from baseline to day 3 postconcussion ¼ 27.1 6 36.6 weeks) who sustained concussions. Main Outcome Measure(s):We assessed balance using single-legged and double-legged stances for both the BESS and WBB, focusing on the double-legged, eyes-closed stance for the WBB, and used ImPACT to assess neurocognition at 3 time points. Descriptive statistics were used to characterize the sample. Mean differences and Spearman rank correlation coefficients were used to determine differences within and between metrics over the 3 time points. Individual-level changes over time were also assessed graphically.Results: The WBB demonstrated mean changes between baseline and day 3 postconcussion and between days 3 and 7 postconcussion. It was correlated with the BESS and ImPACT for several measures and identified 2 cases of abnormal balance postconcussion that would not have been identified via the BESS.Conclusions: When accompanied by the appropriate analytic software, the WBB may be an alternative for assessing postural stability in concussed student-athletes and may provide additional information to that obtained via the BESS and ImPACT. However, verification among independent samples is required.

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Section: Discussionsupporting

confidence: 48%

mentioning

confidence: 99%

Evaluation of Nintendo Wii Balance Board as a Tool for Measuring Postural Stability After Sport-Related Concussion

Merchant‐Borna¹,

Jones

Janigro³

et al. 2017

Journal of Athletic Training

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“…4 In mild pediatric TBI, postural instability has been noted one month after injury, 5 deficits in visual-motor response time and dynamic balance have been observed up to 12 weeks post-injury, 6,7 and dynamic balance issues and tremors have been reported for up to six months post-injury. 8 Additionally, in a cohort of children with mild to moderate TBI, even subtle motor deficits that were present two months post-injury had largely resolved by one year post-injury.…”

Section: Introductionmentioning

confidence: 99%

Preliminary findings of altered functional connectivity of the default mode network linked to functional outcomes one year after pediatric traumatic brain injury

Stephens

Salorio

Barber

et al. 2017

Developmental Neurorehabilitation

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Purpose and Method This study examined functional connectivity of the default mode network (DMN) and examined brain–behavior relationships in a pilot cohort of children with chronic mild to moderate traumatic brain injury (TBI). Results Compared to uninjured peers, children with TBI demonstrated less anti-correlated functional connectivity between DMN and right Brodmann Area 40 (BA 40). In children with TBI, more anomalous less anti-correlated) connectivity between DMN and right BA 40 was linked to poorer performance on response inhibition tasks. Conclusion Collectively, these preliminary findings suggest that functional connectivity between DMN and BA 40 may relate to longterm functional outcomes in chronic pediatric TBI.

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“…With regard to motor sequelae, children with more severe injuries who require inpatient rehabilitation often experience marked motor deficits in fine motor control and strength and gross motor skills (e.g., balance and gait) which persist throughout and beyond the first year postinjury (Ahlander, Persson, & Emanuelson, 2013; Katz-Leurer, Rotem, Keren, & Meyer, 2010; Kuhtz-Buschbeck, Hoppe, et al, 2003). Conversely, in mild TBI literature behavior problems (Taylor et al, 2015) and cognitive issues (Loher, Fatzer, & Roebers, 2014) are typically studied, but motor deficits are also examined (Babikian et al, 2011; Gagnon, Swaine, Friedman, & Forget, 2004a, 2004b; Howell, Osternig, Koester, & Chou, 2014; Rhine, Quatman-Yates, & Clark, 2015; Wallen, Mackay, Duff, McCartney, & O’Flaherty, 2001). …”

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confidence: 99%

“…Babikian et al (2011) also found no deficits on pure motor speeded measures but when collapsing data collected one, six, and 12 months postinjury did observe small differences between children with mild TBI and uninjured controls on motor tasks with cognitive components (e.g., Color Trails). In subacute stages (i.e., 1–3 months postinjury) of mild TBI, multiple authors have identified gross motor deficits including postural instability (Rhine et al, 2015) and impaired dynamic balance (Gagnon et al, 2004a; Howell et al, 2014); longer term follow-up of these findings has not been reported, though in adults, motor findings have been identified years after mild TBI (Martini et al, 2011). In summary, following mild pediatric TBI, subtle motor deficits may be observed in the months postinjury, but less is known about the longitudinal course of these findings.…”

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confidence: 99%

Subtle Motor Findings During Recovery from Pediatric Traumatic Brain Injury: A Preliminary Report

Stephens

Salorio

Denckla

et al. 2016

Journal of Motor Behavior

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Pediatric traumatic brain injury (TBI) is a heterogeneous condition, varying in both severity and sequelae. The long-term motor deficits following severe TBI requiring inpatient rehabilitation are better established than those following milder forms of TBI. The authors examined motor performance 2 and 12 months postinjury in children without overt motor impairment using standard measures of upper limb function and the Physical and Neurological Examination for Subtle Signs (PANESS). The PANESS was sensitive to differences between children with TBI and uninjured children as well as to changes in children with TBI over time. These data suggest that subtle motor deficits are present after milder forms of TBI and, particularly those related to balance and gait, may persist even 12 months postinjury.

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A Longitudinal Examination of Postural Impairments in Children With Mild Traumatic Brain Injury: Implications for Acute Testing

Cited by 12 publications

References 21 publications

Evaluation of Nintendo Wii Balance Board as a Tool for Measuring Postural Stability After Sport-Related Concussion

Evaluation of Nintendo Wii Balance Board as a Tool for Measuring Postural Stability After Sport-Related Concussion

Preliminary findings of altered functional connectivity of the default mode network linked to functional outcomes one year after pediatric traumatic brain injury

Subtle Motor Findings During Recovery from Pediatric Traumatic Brain Injury: A Preliminary Report

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