Objective To compare the diagnostic utility of balance testing (BT) with a dual-task cognitive challenge to concussion symptom scores (SS).

Design Observational clinical trial.

Setting Concussion clinic, Sioux Falls, SD, USA.

Subjects 18 subjects (12–20 years) diagnosed with a concussion, examined within 10 days of injury and seen for ≥4 visits; 26 healthy, age- and gender-matched controls (BT evaluated 2X).

Outcome Measures SS and BT from each clinical visit. Postural stability (AMTI force platform) assessed by velocity (V) of movement and 95% ellipse area (EA) during four BT conditions: eyes open (O), eyes open+cognitive challenge (recite the months of the year backwards; OC), eyes closed (C), and eyes closed+cognitive challenge (CC).

Results Concussed group: all tests were abnormal at visit one, with progressive improvement of SS over four visits (mean=35.7, 31.4, 18.5, 10.6) and progressive resolution of postural stability (1.0 SD±normative mean). By visit two, V had resolved in all four conditions; however, all four conditions were still abnormal when measured as EA. By visit three, EA for O, OC, and C tasks returned to normal, while the CC task remained abnormal. By visit four, all BT means had returned to normal.

Conclusions Improvements in postural stability coincide (though resolve earlier) with reductions in SS. Although more variable, SS and EA were, more sensitive to abnormality than V. Further validation of this novel methodology may help to establish BT as an effective tool in concussion management and research.

Competing interests None.