Balance Performance After Mild Traumatic Brain Injury in Children and Adolescents: Instrumented BESS in the Acute...

Area of Science:

• Pediatric neurology
• Sports medicine
• Biomechanics

Background:

• Mild traumatic brain injury (mTBI) is a common pediatric concern, often leading to persistent post-concussion symptoms like postural instability.
• Current Balance Error Scoring System (BESS) assessments lack objective metrics, hindering accurate diagnosis and return-to-play decisions.
• Instrumenting BESS with force plates may improve diagnostic accuracy for pediatric mTBI.

Purpose of the Study:

• To evaluate postural control in children with mTBI compared to healthy controls using an instrumented BESS.
• To examine postural recovery trajectories in pediatric mTBI patients over time.
• To identify specific BESS conditions and metrics sensitive to mTBI-related postural deficits.

Main Methods:

• A prospective, longitudinal study involving 31 children with mTBI and 31 controls.
• Postural control assessed via instrumented BESS on a force plate at 72 hours, 2 weeks, and 3 months post-injury.
• Measured posturographic parameters (ellipse area, path length, mean velocity) and symptom burden (PCSI).

Main Results:

• No significant difference in overall BESS scores between mTBI and control groups.
• Significant improvement in BESS errors over time noted only in the two-legged stance on a soft surface.
• Instrumented BESS detected increased body sway in the mTBI group, particularly in single-leg and two-legged stances on soft surfaces, with differences in path length and mean velocity.

Conclusions:

• Instrumented BESS enhances detection of subtle postural deficits in pediatric mTBI.
• Demanding conditions with altered sensory input and path length are key metrics for assessment.
• Objective, quantitative, and tailored balance assessments are crucial for improving diagnostic precision in pediatric mTBI.