Examination of Balance, Vestibular, and Ocular Functions and Activity Following Concussion
Condition: Brain Concussion
MeSH terms: Brain Concussion
Study type: Observational

Summary: 
      Previous research and position statements have outlined the necessity of balance and gait
      testing in the post-concussion evaluation of athletes. However, many of the currently
      available balance testing techniques lack objectivity and sensitivity to the effects of
      concussion. Such balance impairments may exist following concussion due to disruption of
      vestibular and/or ocular motor systems. However, no clinically feasible tools have been
      longitudinally examined to detect gait balance control deficits or to investigate how
      vestibular or motor dysfunction may lead to gait imbalance. Additionally, participation in
      physical and cognitive activities post-concussion may affect recovery. While limited evidence
      exists to support this notion, further investigation is necessary to improve clinical
      management recommendations.

      The proposed study will allow for the examination of tools which add value to post-concussion
      clinical evaluations and study-related outcomes will enhance the understanding of dynamic
      balance control and vestibular/ocular motor recovery, and their potential for implementation
      into concussion management protocols.
    

Detailed description: 
      To address study hypotheses, the investigators plan to recruit subjects who have been
      diagnosed with a concussion by participating sports medicine physicians at the Boston
      Children's Hospital Sports Concussion Clinic. If patients elect to participate, they will
      undergo their regularly scheduled clinical examination along with two testing components
      requiring less than 15 minutes of additional time to complete: an instrumented gait balance
      assessment, a vestibular-ocular motor screen, and a weekly activity survey. Participants with
      concussion will be matched with control subjects who meet similar demographic characteristics
      and report to the clinic for other orthopedic injuries that do not affect brain function,
      gait, or either lower extremity.

      During the assessment, participants will complete a protocol which measures balance control
      while walking and simultaneously completing a cognitive task, a vestibular-ocular motor
      ability, and physical and cognitive activity levels. As a need exists to develop protocols
      which utilize inexpensive, objective, and sensitive measurements to track concussion
      recovery, this study seeks to incorporate innovative and clinically feasible methods into the
      clinical examination of concussion.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients will come from Boston Children's Hospital and The Micheli Center for Sports Injury
        Prevention. Concussion will be defined consistent with the latest best-practice consensus
        statement on concussion in sport as a brain injury defined as a complex pathophysiological
        process affecting the brain, induced by biomechanical forces. Informed consent will be
        obtained after study explanation and sufficient time to answer all study-related questions
        at each respective location.
      
Keywords: Gait; Mild Traumatic Brain Injury; Post-Concussion Syndrome; Recovery of Function; Locomotion; Motor Activity