Finding Balance: An Exploration of Factors Related to Balance Impairment in Children after Concussion

Abstract

Introduction: Balance impairment is a commonly reported symptom of concussion. Very little research has been undertaken regarding the complexities of balance impairment after concussive injury in the pediatric population. Purpose: The objectives of this study were: 1) to identify the factors that are associated with balance impairments in children with concussion; 2) to review and evaluate four commonly used balance measures; and 3) to provide recommendations for the best methods of clinical evaluation of balance in children and youth after concussive injury. Methods: A cross-sectional balance evaluation was completed on 104 children, ages 5-18 who had a confirmed diagnosis of concussion. Four balance measures were examined to determine which was the most appropriate for evaluating balance post-concussion. Results: 37% of children were found to have balance impairment according to the BOT-2. The full logistic regression model was found to be not statistically significant however, mechanism of injury with an odds ratio of 2.1 and 95% CI [0.810, 5.027] indicates that children with sport-related injuries are twice as likely to have balance impairment than those with a non-sports-related injury. Chi-Square analyses showed a statistically significant association for mechanism of injury (χ2=11.05, p = 0.03) and age (χ2 = 0.04, p =-0.02) for children who presented with balance impairments and those who did not. Children with balance impairment may present with different symptom profiles than children without. Conclusion: Using a single method of assessment may not provide an accurate representation of balance impairment in children and youth after concussion. Based on the comparison of measurement properties and application of each measure to 104 children with concussion, the BOT-2 and the CB&M when used together provide the most comprehensive assessment of balance and postural instability in children with concussive injury. Age, mechanism of injury and site of impact may be leading factors in the development of balance impairment.