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Comparison of Uninjured and Concussed Adolescent Athletes on the Concussion Balance Test (COBALT)

Massingale, Shelly, PT, MPT; Alexander, Amy, PT; Erickson, Steven, MD; McQueary, Elizabeth, MOT; Gerkin, Richard, MD; Kisana, Haroon, MS; Silvestri, Briana, PA-C; Schodrof, Sarah, MEd, ATC; Nalepa, Bryce, MEd, ATC; Pardini, Jamie, PhD

Journal of Neurologic Physical Therapy: July 2018 - Volume 42 - Issue 3 - p 149–154
doi: 10.1097/NPT.0000000000000225
Research Articles

Background and Purpose: Dizziness and balance problems are common symptoms following sports-related concussion (SRC). Most sports require high-level balance skills that integrate the sensory inputs used for balance. Thus, a comprehensive assessment of postural control following SRC is recommended as an integral part of evaluation and management of the injury. The purpose of this exploratory study was to examine performance differences between uninjured and concussed athletes on the Concussion Balance Test (COBALT), as well as complete preliminary analyses of criterion-related validity and reliability of COBALT.

Methods: COBALT is an 8 condition test developed for both preseason and postinjury assessment using force plate technology to measure sway velocity under dynamic postural conditions that challenge the vestibular system. Retrospective COBALT data obtained through chart review for 132 uninjured athletes and 106 concussed age-matched athletes were compared.

Results: All uninjured athletes were able to complete the assessment, compared with only 55% of concussed athletes. Concussed athletes committed significantly more errors than uninjured athletes. Sway velocity for concussed athletes was higher (worse) than that for uninjured athletes on 2 conditions in COBALT.

Discussion and Conclusions: By examining an athlete's ability to complete the protocol, error rate, and sway velocity on COBALT postinjury, the clinician can identify balance function impairment, which may help the medical team develop a more targeted treatment plan, and provide objective input regarding recovery of balance function following SRC.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A204).

Banner University Sports Medicine and Concussion Specialists, Phoenix, Arizona (S.M., A.A., S.E., E.M., H.K., B.S., S.S., B.N., J.P.); and Banner University Medical Center Phoenix, Phoenix, Arizona (R.G.).

Correspondence: Elizabeth McQueary, MOT, Banner—University Sports Medicine and Concussion Specialists, 1320 N 10th St, Ste B, Phoenix, AZ 85006 (elizabeth.mcqueary@bannerhealth.com).

This study was presented, in part, as a poster presentation at the American Physical Therapy Association NEXT Conference 2017—June 2017, Boston, Massachusetts.

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.jnpt.org).

© 2018 Academy of Neurologic Physical Therapy, APTA