Effect of mild head injury on postural stability in athletes

J Athl Train. 1996 Oct;31(4):300-6.


Objective: Athletic trainers and team physicians are often faced with the dilemma of when to return athletes to participation following mild head injury. Unfortunately, clinicians rarely have quantitative information on which to base their decisions. The purpose of this investigation was to identify postural stability changes in athletes with acute mild head injury.

Design and setting: High school and college male athletes were prescreened for postural stability before the start of their season. Subjects suffering injury during the season returned for testing on days 1, 3, 5, and 10 following injury, and 1 month postseason. Control subjects were selected for comparisons.

Subjects: Ten prescreened subjects (age = 17.4 +/- 2.2 yr; ht = 183.8 + 8.1 cm; wt = 87.7 + 17.3 kg) returned for testing following an injury. Ten matched control subjects (age = 18.6 +/- 2.6 yr; ht = 185.7 +/- 6.7 cm; wt = 84.5 +/- 19.5 kg) were selected for comparisons. Additionally, nine subjects (eight male and one female) (age = 19.9 +/- 4.2 yr; ht = 182.3 + 10.9 cm; wt = 89.6 +/- 25.2 kg) who had sustained a mild head injury from other varsity sports teams were recruited. Nine matched controls (age = 22.1 +/- 3.3 yr; ht = 181.0 +/- 9.9 cm; wt = 84.9 +/- 25.6 kg) were again utilized.

Measurements: Sway index and center of balance were measured using the Chattecx Balance System during three eye conditions and three surface conditions for all subjects.

Results: Repeated measures analyses of variance (ANOVA) for each prescreened subject's sway index revealed significant differences between injured subjects and control subjects on day 1 postinjury as compared with the prescreening and/or subsequent tests. The analysis for sway index and center of balance inclusive of all 19 subjects with mild head injury and all 19 control subjects demonstrated increased postural sway compared with control subjects on day 1 postinjury during all plafform conditions, and on day 3 during the foam platform condition. The analysis for center of balance using the same subjects revealed that injured subjects maintained their center of balance farther away on day 1 postinjury compared with subsequent tests (p < .05).

Conclusions: These findings suggest that computerized dynamic posturography is a useful tool in objectively assessing postural stability in subjects with mild head injuries. Subjects with mild head injury appear to demonstrate impaired postural stability 1 to 3 days following injury. This information should aid clinicians in determining when an athlete can safely return to participation.