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Peripheral Vestibular and Balance Function in Athletes With and Without Concussion

Christy, Jennifer B. PT, PhD; Cochrane, Graham D. BA; Almutairi, Anwar PT, MS, PhD; Busettini, Claudio PhD; Swanson, Mark W. OD, MSPH, FAAO; Weise, Katherine K. OD, MBA, FAAO

Journal of Neurologic Physical Therapy: July 2019 - Volume 43 - Issue 3 - p 153–159
doi: 10.1097/NPT.0000000000000280
Research Articles

Background and Purpose: According to the most recent consensus statement on management of sport-related concussion (SRC), athletes with suspected SRC should receive a comprehensive neurological examination. However, which measures to include in such an examination are not defined. Our objectives were to (1) evaluate test-retest reliability and normative data on vestibular and balance tests in athletes without SRC; (2) compare athletes with and without SRC on the subtests; and (3) identify subtests for concussion testing protocols.

Methods: Healthy athletes (n = 87, mean age 20.6 years; standard deviation = 1.8 years; 39 female and 48 male) and athletes with SRC (n = 28, mean age 20.7 years; standard deviation = 1.9 years; 11 female and 17 male) were tested using rotary chair, cervical vestibular-evoked myogenic potential (c-VEMP), and the Sensory Organization Test (SOT). A subset (n = 43) were tested twice. We analyzed reliability of the tests, and compared results between athletes with and without SRC.

Results: Reliability ranged from poor to strong. There was no significant difference between athletes with and without SRC for tests of peripheral vestibular function (ie, rotary chair and c-VEMP). Athletes with SRC had significantly worse scores (P < 0.05) on vestibular-ocular reflex (VOR) cancellation gain, subjective visual vertical and horizontal variance, and all conditions of the SOT.

Discussion and Conclusion: SRC did not affect medium frequency VOR or saccular function. SRC did affect the ability to use vestibular inputs for perception of vertical and postural control, as well as ability to cancel the VOR.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at:

Department of Physical Therapy (J.B.C., G.D.C., A.A.), Department of Optometry and Vision Science (C.B., M.W.S., K.K.W.), and Vision Science Research Center (C.B.), University of Alabama at Birmingham.

Correspondence: Jennifer B. Christy, PT, PhD, Department of Physical Therapy, University of Alabama at Birmingham, SHPB 346, 1720 2nd Ave South, Birmingham, AL 35294 (

This research was funded by a grant from the Health Service Foundation General Endowment Fund to James Johnston, MD, and Claudio Busettini, PhD, the NIH-NEI P30 EY-03039 Vision Science Research Center Core Grant, and an Alabama Department of Commerce grant.

The preliminary data for this work were presented as 2 poster presentations at the APTA's Combined Sections Meeting in February 2017 (San Antonio, Texas).

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 (

© 2019 Academy of Neurologic Physical Therapy, APTA