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Updated: Jan 22, 2026
A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
Association of Simple Step Test With Readiness for Exercise in Youth After Concussion
Andrew Fyffe1, Tina Bogg, Rhonda Orr
1Sydney Children's Hospital Network, Children's Hospital Institute of Sports Medicine, The Royal Alexandra Hospital for Children, Children's Hospital Westmead, Sydney, Australia (Messrs Fyffe and Browne and Ms Bogg); Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, and The Children's Hospital at Westmead Clinical School, Sydney Medical School, The University of Sydney, Australia (Dr Orr); and Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Australia (Prof Browne).
Objectives:
We hypothesized that a submaximal step test would be associated with readiness to commence graded exercise in children and adolescents with concussion.
Methods:
Children and adolescents aged 8 to 18 years performed standard concussion clinical assessment for vestibular/ocular and balance impairment, and exercise examination utilizing the 3-minute Kasch Pulse Recovery test (KPR) and a symptom-limited graded exercise test (GXT). Outcome measures included activity readiness and symptom exacerbation.
Results:
Forty-five participants (mean age 13.2 ± 2.1 years, 76% male) had a confirmed concussion (73% sports-related). Some participants required follow-up testing giving 75 clinical presentations. Sensitivity and specificity of the KPR were 100% and 95.7%, respectively. Area under the receiver operating characteristics curve was 0.979. Activity readiness to GXT and KPR was strongly associated (χ = 21.672, P < .001), while symptom exacerbation showed a significant correlation between testing methods (r = 0.796, P < .001). Better exercise performance on GXT and KPR was significantly correlated with normal Vestibular/Ocular Motor Screening (rs = -0.380, P = .010, and rs = -0.281, P = .017, respectively) and Modified Balance Error Scoring System (rs = -0.452, P < .001, and rs = -0.301, P = .010, respectively).
Conclusion:
The KPR is a simple and practical tool to determine whether it is appropriate for a child or adolescent with concussion to commence graded exercise.
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