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Brain Injury Volume 34, 2020 - Issue 10
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Research Article

The Toronto Concussion Study: a longitudinal analysis of balance deficits following concussion in community-dwelling adults

Michelle Sweenya Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada;b Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, CanadaView further author information
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Elizabeth L. Innessa Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada;c Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaORCID Iconhttps://orcid.org/0000-0002-9217-4619View further author information
ORCID Icon,
Jonathan Singerd Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, CanadaView further author information
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Olinda Habib Pereza Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, CanadaView further author information
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Cynthia Danellsa Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada;c Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaView further author information
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Tharshini Chandraa Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, CanadaView further author information
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Evan Fostera Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, CanadaView further author information
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Paul Compera Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada;b Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada;e Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, CanadaView further author information
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Mark Bayleya Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada;f Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaORCID Iconhttps://orcid.org/0000-0001-7860-9463View further author information
ORCID Icon &
George Mochizukia Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada;b Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada;g School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, CanadaCorrespondence[email protected]
View further author information
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Pages 1384-1394 | Received 23 Aug 2019, Accepted 25 Jul 2020, Published online: 11 Aug 2020
 
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ABSTRACT

Objective

To characterize recovery of balance deficits in community-dwelling adults with concussion.

Hypothesis

Balance measures will improve 2 weeks after injury and persist over 12 weeks.

Design

Prospective longitudinal observational study.

Methods

Assessments included the Balance Error Scoring System (BESS) and quiet standing during eyes open, eyes closed, and a cognitive dual task. Recovery was determined using a Hierarchical Growth Curve Model (HGCM) at Week1 (n = 61), Week2 (n = 58), Week4 (n = 53), Week8 (n = 51), and Week12 (n = 39) post-injury. Within-individual follow-up analysis was conducted using the coefficient of variation (quiet standing measures) and a reliable change index (BESS) on 28 individuals with concussion assessed at all 5 time points.

Results

Self-reported symptom score recovered between Week 4–8. Anteroposterior COP velocity (eyes closed) was the only variable to show statistically significant (p < .05) recovery in the HGCM. The within-individual analysis identified fewer than 43% (12/28) of participants recovered by Week 12, relative to their own Week 1 assessment.

Conclusions

While recovery of balance deficits was observed in 1 variable over 12 weeks, less than half of the participants included in all assessments demonstrated improvement in balance outcomes. Future research and clinical practice should focus on the unique characteristics of community-dwelling adults with concussion to optimize recovery in this cohort.

Conflicts of interest

The authors have no conflicts of interest to disclose.

Additional information

Funding

The authors acknowledge funding from the Hull–Ellis Concussion and Research Clinic and the TorontoRehab Foundation.

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