Clinical Bottom Line
“How should I apply this information?”
Clinically, this work is an important step in the ability to reliably assess functional gait and balance in high school–aged adolescents who have sustained a concussion, have complaints of dizziness, and may have vestibular dysfunction. Previous studies assessing gait and balance have demonstrated reliability and normative scores for middle-age and older adults; these data provide a benchmark to compare assessment scores in an adolescent population. The results of each assessment were reported in the form of percentiles, allowing for a relative grading of scores from above average to below average. A comparison to percentile ranks would be most helpful in tracking improvement across treatments or with recovery, but perhaps the most important application of these data would be for adolescents below the normative values. The authors recommend the use of certain assessments on the basis of their lack of a ceiling effect and good reliability. These measures may be more sensitive to changes in status as a patient progresses; however, the presence of a ceiling effect in healthy adolescents should not preclude a clinician from using an assessment tool to determine whether impairment exists.
“What should I be mindful about in applying this information?”
These data represent a range of scores in an unimpaired population, but they do not address the capacity of each measure to identify balance impairments in the injured population. Sensitivity and specificity of each of the clinical measures are necessary using scores obtained in an adolescent population with vestibular disorders and adolescents who are healthy. Although between tester reliability was relatively good, the testers in this study had experience administering the measures. Clinicians should determine inter- and intrarater reliability when using these measures.
A clinician must use caution when using these data to determine an athlete's ability to return to sports participation. Athletic participation requires a high level of performance and presents a greater risk for reinjury. Therefore, a clinician must use higher standards to ensure full neural and functional recovery before returning an athlete to their sport.
Aimee M. Diaz, PT, DPT, SCS, ATC
Susan Sigward, PT, PhD, ATC
University of Southern California
Los Angeles, California