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J Athl Train. 2000 Jan-Mar; 35(1): 19–25.
PMCID: PMC1323433

Effects of Mild Head Injury on Postural Stability as Measured Through Clinical Balance Testing

Bryan L. Riemann, MA, ATC and Kevin M. Guskiewicz, PhD, ATC



Although force-platform measures of postural stability provide objective information concerning mild head injury (MHI) resolution, their application has remained limited due to the high costs and impracticality for sideline use. Therefore, we investigated the efficacy of a clinical balance testing procedure for the detection of acute postural stability disruptions after MHI.

Design and Setting:

We used a posttest control group design with repeated measures. Postural stability was tested at 3 postinjury time intervals (days 1, 3, and 5) using 2 procedures in a sports medicine laboratory: 1) a clinical balance battery consisting of 3 stances (double leg, single leg, and tandem) on 2 surfaces (firm and foam), and 2) the Sensory Organization Test using a sophisticated force-platform system.


Sixteen MHI and 16 matched control subjects participated in this study.


We measured performance with the Balance Error Scoring System for each of the clinical balance tests and the NeuroCom Smart Balance Master for Sensory Organization Testing.


We found significantly higher postural instability in the MHI subjects revealed through the clinical test battery, with the 3 stances on the foam surface eliciting significant differences through day 3 postinjury. Results of the Sensory Organization Test revealed significant group differences on day 1 postinjury.


Our results revealed that the Balance Error Scoring System may be a useful clinical procedure to assist clinicians in making return-to-play decisions in athletes with MHI in the absence of force-platform equipment.

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Articles from Journal of Athletic Training are provided here courtesy of National Athletic Trainers Association