2B or Not 2B: Results of the Study 2B in Motion Examining Balance after Mild Traumatic Brain Injury in Children and Adolescents

Background/Purpose: Pediatric mild traumatic brain injury (pmTBI) represents a major health issue worldwide. Even if subtile, impairment in postural control is frequently reported after mTBI and may set patients at risk of sustaining a re-mTBI and of persistent post-concussion symptoms. To explore differences in postural control between children after mTBI and healthy controls, we set up an explorative prospective longitudinal clinical study in our interdisciplinary pediatric concussion clinic.

Methods: Assessment of postural control was performed within 72 hours (T1), 2 weeks (T2), and 3 months (T3) after mTBI by instrumented BESS (balance error scoring system) on a 2D-Leonardo Mechanograph GRFP LT force plate (Novotec) and simultaneous 3D markerless posturography using ReFit Gamo of ReFit Systems GmbH with the Microsoft Azure Kinect. Outcome parameters derive from the participant's center of pressure (COP) and 3D velocity of center of mass (COM) displacement.

Results: By the time of submission, 45 (T1/T2) and 23 datasets (T3) were available for analysis. BESS did not detect any significant change (p = 0.39). 2D testing showed decrease of body sway in the more challenging testing positions: e.g., RomEC1 (Rom = Romberg stance, EC = eyes closed, 1 = foam pad) in path length mediolateral (p = 0.036) and ellipse area (p = 0.029). 3D testing revealed significant decreases in body sway in several testing positions in between T2 and T3: COM speed in 1LEC1 (1 L = one legged) (p = 0.009), TanEC1 (Tan = tandem) (p = 0.03), and 1LEO (EO = eyes open) (p = 0.04), as well as TanEO (p = 0.005).

Conclusion: Preliminary analysis demonstrates changes in balance performance during the trajectory after mTBI reflected by parameters in the more challenging testing condition. Particularly markerless 3D posturography may represent a valuable instrument in future to follow up the recovery after pmTBI. This is of great importance for clinicians to give personalized advice for individual return to protocols to prevent re-trauma and minimize long-term effects on health and quality of life.

Publication History

Article published online:
13 November 2023