Gagnon I, Swaine B, Friedman D, Forget R. Children show decreased dynamic balance after mild traumatic rain injury. Arch Phys Med Rehabil 2004;85:444–52.
To compare the balance skills of children after mild traumatic brain injury (TBI) with that of noninjured children matched for age, sex, and premorbid level of physical activity.
Pediatric trauma center.
Thirty-eight children aged 7 to 16 years (mean, 12.2±2.8y) were recruited in each group. Children with mild TBI had a mean Glasgow Coma Scale score of 14.8 and were considered normal on a neurologic assessment at hospital discharge. Noninjured children were friends of those with mild TBI.
Assessments of balance were conducted at 1, 4, and 12 weeks after mild TBI and at corresponding time intervals for the controls.
Main outcome measures
The balance subtest of the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), the Pediatric Clinical Test of Sensory Interaction for Balance (P-CTSIB), and the Postural Stress Test (PST) were used.
Over the time interval of the study, analyses of variance revealed that children with mild TBI performed significantly worse than the noninjured group on the BOTMP balance subtest (P<.001) and on the PST (P=.031), as well as on the eyes-closed conditions in the P-CTSIB tandem position (P=.05).
Children with a mild TBI still showed balance deficits at 12 weeks postinjury. These deficits should be taken into consideration when planning a return to physical activities, particularly to those that require subtle balance skills.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Archives of Physical Medicine and Rehabilitation
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Changes in postural sway and performance of functional tasks during rehabilitation after traumatic brain injury.Arch Phys Med Rehabil. 1997; 78: 1107-1111
- Motor performance following a mild traumatic brain injury in children.Brain Inj. 1998; 12: 843-853
- Balance findings in a child before and after a mild head injury.J Head Trauma Rehabil. 2001; 16: 595-602
- Balance findings after a mild head injury in children.Neurorehabil Neural Repair. 2002; 16 ([abstract]): 22-23
- Clinical measurement of postural control in adults.Phys Ther. 1987; 67: 1881-1884
- Changing theories of postural development.in: Woollacott M.H. Shumway-Cook A. Development of posture and gait across the life span. Univ South Carolina Pr, Columbia1989: 3-24
- Concepts and methods for assessing postural instability.J Aging Phys Activity. 1996; 4: 214-233
- Postural perturbation, new insights for the treatment of balance disorders.Phys Ther. 1997; 77: 517-533
- Central programming of postural movements.J Neurophysiol. 1986; 55: 1369-1381
- Motor performance in children after traumatic brain injury.Arch Phys Med Rehabil. 1993; 74: 161-164
- Factors associated with balance deficits on admission to rehabilitation after traumatic brain injury.J Head Trauma Rehabil. 2001; 16: 238-252
- A systems analysis of postural dyscontrol in traumatically brain injured patients.J Head Trauma Rehabil. 1990; 5: 51-62
- The effects of closed head injury on postural sway.Med Sci Sports Exerc. 1992; 24: 739-743
- Posturographic measurements of body sway in survivors of severe closed head injury.Arch Phys Med Rehabil. 1993; 74: 1151-1156
- Neuropathology of head injury.in: Narayan R.K. Wilberger J.E. Povlishock J.T. Neurotrauma. McGraw Hill, New York1996: 43-59
- Mild head injury. Oxford Univ Pr, New York1989
- Sustained attention following mild closed head injury.J Clin Exp Neuropsychol. 1991; 13: 789-811
- Mild head injury in children and adolescents.Psychol Bull. 1997; 122: 107-131
- Alternative approaches to the assessment of mild head injury in athletes.Med Sci Sports Exerc. 1997; 29: S213-S221
- Postural stability assessment following concussion.Clin J Sport Med. 2001; 11: 182-189
- Identification of static and dynamic postural instability following traumatic brain injury.Arch Phys Med Rehabil. 1996; 77: 639-644
- Is postural control associated with mental functioning in the persistent postconcussion syndrome.Arch Phys Med Rehabil. 1999; 80: 144-149
- Mild pediatric brain injury.Arch Phys Med Rehabil. 1993; 74: 895-901
- Definition of mild traumatic brain injury.J Head Trauma Rehabil. 1993; 8: 86-87
- Relation of cardiovascular fitness and physical activity to cardiovascular disease risk factors in children and adults.Am J Epidemiol. 1988; 127: 933-941
- Practice parameter: the management of concussion in sports (summary statement). Report of the Quality Standards Subcommittee.Neurology. 1997; 48: 581-585
- The Bruininks-Oseretsky Test of Motor Performance. American Guidance Service, Circle Pines (MN)1978
- Interrater reliability of the Pediatric Clinical Test of Sensory Interaction for Balance.Phys Occup Ther Pediatr. 1990; 10: 1-27
- Test-retest reliability of the Pediatric Clinical Test of Sensory Interaction for Balance (P-CTSID).Phys Occup Ther Pediatr. 1994; 14: 1-22
- Stressing the postural response.J Am Geriatr Soc. 1986; 34: 845-850
- Assessing the influence of sensory Interaction on balance.Phys Ther. 1986; 66: 1548-1550
- Post-concussion symptoms.Clin Rehabil. 1994; 8: 149-156
- The Rivermead Post Concussion Symptoms Questionnaire.J Neurol. 1995; 242: 587-592
- Activity restrictions as part of the discharge management for children with a traumatic brain injury.J Head Trauma Rehabil. 2001; 16: 292-301
- Outcome from mild head injury.in: Narayan R.K. Wilberger J.E. Povlishock J.T. Neurotrauma. McGraw Hill, New York1996: 749-754
- Development of feedback and feedforward control of upright stance.Dev Med Child Neurol. 1989; 31: 481-488
- Anticipatory postural adjustment in the absence of normal peripheral feedback.Brain Res. 1990; 508: 176-179
- Development of anticipatory postural adjustments during locomotion in children.J Neurophysiol. 1991; 66: 12-19
- Perceptual-motor contributions to static and dynamic balance control in children.J Mot Behav. 2002; 34: 161-170
- Postural adjustments associated with different unloadings of the forearm.Can J Physiol Pharmacol. 1995; 73: 285-294
- Balance performance on the postural stress test.Phys Ther. 1990; 70: 410-415
- Clinical applicability and test-retest reliability of an external perturbation test of balance in stroke subjects.Arch Phys Med Rehabil. 1995; 76: 317-323
- Déficits de l’attention et de la vitesse du traitement de I’information chez des enfants ayant subi un traumatisme crâniocérébral léger.Ann Réadaptation Méd Phys. 2000; 43: 236-245
- Reversible neuropsychological deficits after mild traumatic brain injury.J Neurol Neurosurg Psychiatry. 2000; 68: 761-764
- Neuropsychological test performance prior to and following sports-related mild traumatic brain injury.Clin J Sports Med. 2001; 11: 23-31
☆Supported by the Fondation Marie Robert pour la Recherche sur les Traumatisés Crâniens, Réseau Provincial de Recherche en Adaptation-Réadaptation, Ordre Professionnel des Physiothérapeutes du Québec, and the Physiotherapy Foundation of Canada.
© 2004 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.