Acute and Longitudinal Effects of Concussion on Reactive Balance in Collegiate Athletes

Abstract

Background: Postural instability is a common observation after concussions, with balance assessments playing a crucial role in clinical evaluations. Widely used post-concussion balance tests focus primarily on static and dynamic balance, excluding the critical aspect of reactive balance. Objectives: This study investigated the acute and longitudinal effects of concussion on reactive balance in collegiate athletes. Methods: Concussed and healthy matched controls NCAA division I athletes were assessed at pre-season baseline and 4 post-concussion timepoints: acute, pre-return-to-play (RTP), post-RTP, and 6 months post-concussion. The instrumented-modified Push and Release test measured reactive balance during single- and dual-task conditions. Longitudinal effects of concussions on time to stability and step latency metrics were investigated applying Generalized Estimating Equations. Results: Acutely after concussion, athletes demonstrated impaired reactive balance, indicated by longer times to stability, in dual-task conditions (P =.004). These acute impairments were transient and recovered over time. Exploratory analyses revealed that athletes who sustained their first lifetime concussion exhibited both acute (P =.037) and longitudinal (P =.004 at post-RTP) impairments in single- and dual-task compared to controls with no lifetime concussion. Conclusions: This comprehensive evaluation provides insights into the multifaceted nature of post-concussion impairments and emphasizes the importance of considering cognitive demand and history of concussions in assessing athletes’ balance.