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Self-reported Balance Disturbance and Performance-Based Balance Impairment After Concussion in the General Population

Inness, Elizabeth L., PT, PhD; Sweeny, Michelle, MSc; Habib Perez, Olinda, PhD; Danells, Cynthia, BScPT, MSc; Chandra, Tharshini, BSc; Foster, Evan, BSc; Saverino, Cristina, PhD; Comper, Paul, PhD, C.Psych; Bayley, Mark, MD; Mochizuki, George, PhD

The Journal of Head Trauma Rehabilitation: May/June 2019 - Volume 34 - Issue 3 - p E37–E46
doi: 10.1097/HTR.0000000000000431
Focus on Clinical Research and Practice

Objective: To characterize the prevalence of, and relationship between, self-reported balance disturbance and performance-based balance impairment in the general population with concussion.

Setting: Rehabilitation hospital outpatient concussion clinic.

Participants: One hundred six individuals with concussion (49 males, mean age = 32.4; SD = 11.5 years), mean (SD) = 5 (1.8) days postinjury.

Design: Cross-sectional observational study.

Main Measures: SCAT3 Symptoms Subscale, Balance Error Scoring System, modified Balance Error Scoring System, and center-of-pressure root-mean-square amplitude and velocity in eyes open and closed conditions.

Results: The majority of participants reported balance or dizziness symptoms (54% and 63%, respectively) and demonstrated balance impairment on the Balance Error Scoring System and modified Balance Error Scoring System (66% and 58%, respectively). The prevalence of balance impairment across center-of-pressure measures varied from 32% to 48%. There was no effect of balance or dizziness symptom severity on any of the balance measures (F2,103 = 1.02; P = .44) and (F2,103 = 1.45; P = .10), respectively. There was poor agreement between self-report of balance/dizziness symptoms and identified balance impairment across all balance measures (all κ ≤ 0.26 and κ ≤ 0.20, respectively).

Conclusions: There was no clear relationship between the subjective experience of balance disturbance and objective measures of balance impairment in the general population. These results have implications for clinical evaluation of postconcussive deficits and determination of recovery.

Toronto Rehabilitation Institute—University Health Network, Toronto, Ontario, Canada (Drs Inness, Habib Perez, Saverino, Comper, Bayley and Mochizuki, and Mss Sweeny, Danells and Chandra, and Mr Foster); Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Drs Inness and Mochizuki, and Ms Danells); Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada (Ms Sweeny and Drs Comper and Mochizuki); Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada (Dr Comper); Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Dr Bayley); and Sunnybrook Research Institute, Toronto, Ontario, Canada (Dr Mochizuki).

Corresponding Author: Elizabeth L. Inness, PT, PhD, Toronto Rehabilitation Institute—University Health Network, 550 University Ave, Room 5-200, Toronto ON Canada M5G 2A2 (

The authors acknowledge the assistance of Bachelor of Science (Kinesiology) students Alana Coutts, Heidi Gulka, Benjamin Rudy-Froese, and Jason Shi, who have assisted with data collection, analysis, and entry for this study.

This research was supported by the Toronto Rehab Foundation of the University Health Network.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

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