Dizziness, Psychosocial Function, and Postural Stability Following Sport-Related Concussion

Wingerson

Medicine &Amp; Science in Sports &Amp; Exercise

et al. 2022

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PurposePhysical activity (PA) after concussion is an important aspect of appropriate clinical management. However, symptoms or functional deficits may reduce patient propensity toward PA, thereby negatively affecting recovery. Our purpose was to examine whether postconcussion dizziness, total symptom severity, or postural stability predicts PA level in the 2 wk after initial evaluation.MethodsWe evaluated adolescent athletes within 14 d of concussion on assessments of symptoms, dizziness, and postural stability. Athletes were provided an activity monitor to track PA for 2 wk after the evaluation. Our primary outcome was step count (mean steps per day). Potential predictor variables included sex, Post-Concussion Symptom Inventory (PCSI) total symptom severity, individual PCSI ratings of dizziness and balance impairment, and postural stability assessments (single- and dual-task tandem gait, modified Balance Error Scoring System). To examine predictors of PA, we calculated correlation coefficients between steps per day and each potential predictor and included significantly correlated variables in a multivariable regression model.ResultsParticipants were ages 12–18 yr (n = 35, 15.2 ± 1.7 yr, 49% female) and initially evaluated 7.3 ± 3.0 d after concussion. Upon univariable evaluation, PCSI dizziness rating (Pearson R = −0.49, P = 0.003) and sex (mean difference, 2449 steps per day; P = 0.05) were associated with steps per day. Within the multivariable regression analysis, PCSI dizziness rating (β = −1035; 95% confidence interval, −191 to −1880; P = 0.018), but not sex, predicted average steps per day in the 2 wk after initial evaluation.ConclusionsSelf-reported dizziness, but not overall symptom severity or postural stability, assessed within 14 d of concussion predicted daily step count in the subsequent 2 wk. Given the importance of PA for concussion recovery, treating acute postconcussion dizziness can potentially reduce a barrier to PA and improve recovery trajectories.

Section: Methodsmentioning

confidence: 99%

Postconcussion Dizziness Severity Predicts Daily Step Count during Recovery among Adolescent Athletes

Wingerson

Medicine &Amp; Science in Sports &Amp; Exercise

et al. 2022

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“…Patients with concussion were included if they still had symptoms at the time of enrollment, defined as a Post-Concussion Symptom Inventory (PCSI) score .9, to ensure they had not recovered before assessment. 8 This cutoff threshold was selected because concussion symptoms are nonspecific and many high school athletes without a recent concussion history commonly report concussion symptoms at baseline (eg, headache, fatigue, difficulty concentrating). 18 Athletes were included as healthy, uninjured control participants if they were cleared during their sport preparticipation physical evaluation for full sport participation by the Sports Medicine Center's physicians at the time of enrollment, confirming their healthy status.…”

Section: Participants and Study Designmentioning

confidence: 99%

“…Among the many symptoms that can occur, dizziness is one of the most commonly reported symptoms postconcussion. 5,6 It can negatively affect quality of life 7 and is associated with a greater overall concussion symptom burden 8 and prolonged recovery. 5 Dizziness is a complex symptom that is multifactorial.…”

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confidence: 99%

“…Dizziness, impaired sleep, and postural instability individually relate to poor outcomes postconcussion. 7,8,[11][12][13]16 Given the overlap in systems implicated in the presence of each symptom, we sought to examine associations among dizziness, sleep impairment, and postural instability after concussion. Specifically, the 2 purposes of this study were to examine the association of self-reported postconcussion dizziness with sleep quality and postural stability among adolescents with concussion and uninjured adolescents.…”

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confidence: 99%

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Postconcussion Dizziness, Sleep Quality, and Postural Instability: A Cross-Sectional Investigation

Wilson

Journal of Athletic Training

et al. 2021

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Context Dizziness, poor sleep quality, and postural instability are all commonly reported postconcussion and individually relate to poor outcomes. Objective To examine sleep quality and postural stability among adolescents who did and those who did not report dizziness within 2 weeks of concussion. Design Cross-sectional study. Setting Research laboratory. Patients or Other Participants Participants were individuals 12 to 18 years old and either within 14 days of concussion (n = 58; girls = 29, boys = 29, age = 15.2 ± 1.8 years, time postinjury = 7.1 ± 3.1 days) or uninjured control recruits (n = 73, girls = 31, boys = 42, age = 15.8 ± 1.3 years). Main Outcome Measure(s) Participants rated preinjury and current dizziness using the Post-Concussion Symptom Inventory (PCSI) and current sleep quality using the Pittsburgh Sleep Quality Index. They also completed postural stability assessments (single-task and dual-task tandem gait and modified Balance Error Scoring System[mBESS]). Results We divided patients with concussion into dizzy (n = 21) or not-dizzy (n = 37) groups based on PCSI dizziness ratings (difference between current and preinjury dizziness rating: dizzy = >3, not dizzy = <3). The dizzy and not-dizzy groups both reported worse sleep quality compared with the control group (Pittsburgh Sleep Quality Index score: dizzy = 9.6 ± 3.7 versus not dizzy = 7.2 ± 3.5 versus control = 4.3 ± 2.6; P < .001) via univariable comparison. Similarly, the dizzy group performed slowest, followed by the not-dizzy group, and then the control group on single-task tandem gait (dizzy = 27.2 ± 11.7 seconds versus not dizzy = 21.2 ± 6.3 seconds versus control = 14.7 ± 3.6 seconds, P < .001) and dual-task tandem gait (dizzy = 38.4 ± 16.2 seconds versus not dizzy = 29.9 ± 7.2 seconds versus control = 21.6 ± 7.5 seconds, P < .001). Both concussion groups demonstrated more errors than the control group on the mBESS (dizzy = 9.8 ± 5.1 versus not dizzy = 6.9 ± 5.8 versus control = 3.8 ± 3.5, P < .001). After controlling for total symptom severity in the multivariable model, we observed that tandem gait, but not mBESS score or sleep quality, was associated with dizziness. Conclusions Individuals with postconcussion dizziness demonstrated impaired tandem-gait performance, whereas poor sleep quality was associated with total symptom severity. Identifying and treating the underlying dysfunction contributing to dizziness and postural instability may guide customized rehabilitation strategies and facilitate recovery.

“…7,8 Self-reported dizziness is associated with poor concussion outcomes, including greater overall symptom severity, longer symptom duration, and impaired postural stability. [9][10][11] Cervical spine injuries can also occur simultaneously with concussion and present a clinical challenge, given the overlapping symptoms experienced during both injuries (eg, neck pain, headache, or dizziness). 12 Following concussion, self-reported neck pain may increase the risk of persistent symptoms, 13,14 and pediatric patients with neck and/or shoulder pain after concussion have reported more sleep problems and greater overall symptom ratings than those not reporting neck/shoulder pain.…”

Section: Introductionmentioning

confidence: 99%

Dizziness Is Associated With Neck/Shoulder Pain Following Pediatric Concussion

Wingerson

Clinical Journal of Sport Medicine

et al. 2022

Objective:To examine the association between dizziness and neck/shoulder pain after concussion and if differences in postural stability and oculomotor function exist among patients reporting dizziness with or without concurrent neck/shoulder pain.Design:Cross sectional.Setting:Sports medicine clinic.Patients:Pediatric patients ≤14 days post concussion.Interventions:N/A.Outcome Measures:Patients completed the Health and Behavior Inventory (HBI) symptom rating and separately rated neck/shoulder pain (scale 0-3; 0 = no pain). We grouped patients by HBI dizziness rating (0 = not-dizzy; 1-3 = dizzy) and compared neck/shoulder pain ratings between the groups. We then compared oculomotor and postural stability outcomes between dizzy patients with and without neck/shoulder pain.Results:We included 153 patients: dizzy (n = 100; age = 14.6 ± 2.2 years; 48% female) and not-dizzy (n = 53, age = 14.4 ± 3.1 years; 38% female). The dizzy group reported significantly higher neck/shoulder pain (1.4 ± 1.1 vs 0.5 ± 0.9 points, P < 0.001) and total symptom score (25.7 ± 11.2 vs 11.7 ± 9.3 points, P < 0.001) than the not-dizzy group. After adjusting for total symptom score and preinjury anxiety, depression, and migraines, dizziness was associated with higher odds of neck/shoulder pain (odds ratio = 1.9, 95% CI, 1.2-3.0; P = 0.004). No differences were observed between dizzy patients with and without neck/shoulder pain for near point of convergence (10.0 ± 7.5 vs 8.5 ± 6.7 cm, P = 0.43), modified Balance Error Scoring System (8.9 ± 5.5 vs 6.8 ± 4.7 errors, P = 0.09), or tandem gait (single-task: 26.0 ± 12.3 vs 24.2 ± 11.9 seconds, P = 0.56; dual-task: 35.1 ± 14.3 vs 35.6 ± 18.6 seconds, P = 0.90).Conclusions:In concussion patients experiencing dizziness, evaluating neck/shoulder pain may help identify individuals who would benefit from cervical spine rehabilitation. However, other potential causes of dizziness should also be evaluated to facilitate timely recovery.