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Balance and Gait Alternations Observed More than 2 Weeks after Concussion

A Systematic Review and Meta-analysis

Wood, Tyler A1; Hsieh, Katherine L1; An, Ruopeng1; Ballard, Randy A2; Sonoff, Jacob J1

American Journal of Physical Medicine & Rehabilitation: February 5, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001152
Research Article: PDF Only

Objective To systematically review and quantitatively synthesize the existing evidence of balance and gait alternations lasting more than two weeks following concussion in adults.

Design A systematic review was conducted through PubMed, CINAHL, SPORTDiscus, and Web of Science. Investigations must include adult participants with at least 1 concussion, were measured over 14 days after injury, and reported balance or gait measures. Balance error scoring system (BESS) scores, center of pressure (COP) sway area and displacement, and gait velocity were extracted for the meta-analysis.

Results 22 studies were included. Balance alterations were observed over two weeks after concussion when participants were tested with eyes closed, for longer durations of time, and with nonlinear regulatory statistics. The meta-analysis of COP sway area with no visual feedback indicated that concussed individuals had greater sway area (p<0.001). Various gait alterations were also observed, which may indicate concussed individuals adopt a conservative gait strategy. The meta-analysis revealed that concussed participants walked 0.12 m/s (p<0.001) and 0.06 m/s (p=0.023) slower in single and dual task conditions, respectively.

Conclusions Subtle balance and gait alterations were observed after two weeks following a concussion. Understanding these alterations may allow clinicians to improve concussion diagnosis and prevent subsequent injury.

1 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801 USA

2 Division of Intercollegiate Athletics, University of Illinois at Urbana-Champaign, 1206 S. Fourth St., Champaign, IL 61820 USA

Corresponding Author: Jacob J. Sosnoff, PhD Permanent Address: 901 S Goodwin Ave, Urbana, IL, 61801 Phone: 217-244-7006 Fax: 217-244-6086 Email:

Competing Interests: None of the authors declare competing financial interests.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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