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Related Experiment Video

Updated: Jan 29, 2026

Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
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Balance Testing Following Concussion: Postural Sway versus Complexity Index.

Sushmita Purkayastha1,2, Heather Adair2, Amanda Woodruff1

  • 1Department of Applied Physiology and Wellness, Simmons School of Education and Human Development, Southern Methodist University, Dallas, TX, 75205.

PM & R : the Journal of Injury, Function, and Rehabilitation
|February 8, 2019
PubMed
Summary

Post-concussion syndrome can impair postural control, but nonlinear dynamics, measured by complexity index, may offer a more sensitive biomarker for subtle recovery changes than traditional sway measures. This finding has implications for return-to-play decisions.

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Area of Science:

  • Neurology
  • Sports Medicine
  • Biomechanics

Background:

  • Post-concussion syndrome frequently causes postural control deficits.
  • Current clinical assessments for postural control often normalize within 3-10 days post-injury.
  • There's a need for sensitive tools to detect subtle postural control changes during concussion recovery.

Purpose of the Study:

  • To investigate sway and complexity index of postural control in collegiate athletes post-concussion.
  • To compare postural control metrics at 3, 21, and 90 days post-injury with non-injured controls.

Main Methods:

  • A prospective longitudinal case-control study was conducted.
  • Center of pressure (COP) data were collected during quiet standing (eyes open/closed) using a force plate.
  • Postural sway (range, variability) and complexity index (multiscale entropy) of AP COP were analyzed.

Main Results:

  • Higher anteroposterior (AP) sway range and variability were observed in concussed athletes on day 3 compared to controls (P=.03, P=.04).
  • Postural sway normalized by day 21 post-injury.
  • Complexity index was significantly lower on day 3 (P<.001), persisting at day 21 (P<.006) and day 90 (P<.02) post-concussion.

Conclusions:

  • Nonlinear dynamics, specifically complexity index, may serve as a more sensitive biomarker for assessing postural control deficits after concussion.
  • These findings suggest potential implications for return-to-play protocols and targeted interventions.
  • Further research with larger sample sizes is recommended to validate these results.