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How can a team trainer, team doctor or coach tell whether a young player sidelined by a concussion is really ready to return to the field? Try measuring the player’s postural sway complexity.
“We believe we have found a better way to tell when young players are safe to return to action,” says Catherine Quatman-Yates, PhD, a physical therapist at Cincinnati Children’s and lead author of an award-winning study about the after-effects of concussion.
Hospital emergency departments treat approximately 800,000 pediatric sports and recreation-related head injuries a year. After a concussion, a child’s brain remains vulnerable for a longer time than many might realize. If a child returns to play during this vulnerable period, a second head injury could cause much more serious damage, including death in some cases.
To evaluate recovery, the study compared the postural sway of 20 athletes, aged 10 to 16, who had been diagnosed with concussions to 20 non-concussed athletes of similar age. To measure sway patterns, athletes stood for two minutes on a force platform, once with eyes open and once with eyes closed.
Researchers were surprised to see that the sway patterns of athletes still recovering from concussions were measurably less random and more “robot-like” than those without concussions. Study results were published in December 2013 in the International Journal of Sports Physical Therapy.
Quatman-Yates believes less sway occurs because of how the brain tells the body to react to its surroundings. “It’s part of the subconscious,” she says. “We believe it’s the body’s attempt to hunker down because the brain is not ready to process the information around it; therefore, it controls the body more tightly.”
Quatman-Yates says the sway testing is more accurate than the most popular concussion screening method in use today, the Balance Error Scoring System (BESS). The sway tests rely more upon objective measures while BESS relies heavily on observation.
“No one is really using this technique to determine readiness to get back in the game following a concussion. They tend to use observational tools,” Quatman-Yates says. “The concern is there could be long-term damage if they return to the game too soon. That’s one of the things this study tells us – a child may need more time to heal even when visible balance problems are no longer present.”
This groundbreaking study has attracted attention in the sports medicine world. The study received an Award of Excellence at this year’s annual meeting of the American Physical Therapy Association’s Orthopaedic Section.
More research is planned, Quatman-Yates says. The next step will be to expand the project to involve up to 750 healthy athletes in a benchmarking study that will help establish healthy postural sway patterns for various age groups.
Catherine Quatman-Yates, PhD
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