Research papers that support the present guideline recommendations:
Alberts, J. L., Thota, A., Hirsch, J., Ozinga, S., Dey, T., Schindler, D. D., … Linder, S. M. (2015). Quantification of the Balance Error Scoring System with Mobile Technology. Medicine and Science in Sports and Exercise, 47(10), 2233–2240. https://doi.org/10.1249/MSS.0000000000000656
Alsalaheen, B. A., Haines, J., Yorke, A., Stockdale, K., & Broglio, S. P. (2015). Reliability and concurrent validity of instrumented balance error scoring system using a portable force plate system. Physician and Sportsmedicine, 43(3), 221–226. https://doi.org/10.1080/00913847.2015.1040717
Alsalaheen, B. A., Whitney, S. L., Marchetti, G. F., Furman, J. M., Kontos, A. P., Collins, M. W., & Sparto, P. J. (2016). Relationship between cognitive assessment and balance measures in adolescents referred for vestibular physical therapy after concussion. Clinical Journal of Sport Medicine, 26(1), 46–52. https://doi.org/10.1097/JSM.0000000000000185
Alsalaheen, B., McClafferty, A., Haines, J., Smith, L., & Yorke, A. (2016). Reference values for the balance error scoring system in adolescents. Brain Injury, 30(7), 914–918. https://doi.org/10.3109/02699052.2016.1146965
Anzalone, A. J., Blueitt, D., Case, T., McGuffin, T., Pollard, K., Garrison, J. C., … Oliver, J. M. (2017). A Positive Vestibular/Ocular Motor Screening (VOMS) Is Associated with Increased Recovery Time after Sports-Related Concussion in Youth and Adolescent Athletes. American Journal of Sports Medicine, 45(2), 474–479. https://doi.org/10.1177/0363546516668624
Brett, B. L., Zuckerman, S. L., Terry, D. P., Solomon, G. S., & Iverson, G. L. (2018). Normative Data for the Sway Balance System. Clinical Journal of Sport Medicine, (00), 1. https://doi.org/10.1097/jsm.0000000000000632
Conder, R. L., Conder, A. A., Register-Mihalik, J., Conder, L. H., & Newton, S. (2015). Preliminary Normative Data on the Penn State University Symbol Cancellation Task With Nonconcussed Adolescents. Applied Neuropsychology: Child, 4(3), 141–147. https://doi.org/10.1080/21622965.2013.816849
Corwin, D. J., Wiebe, D. J., Zonfrillo, M. R., Grady, M. F., Robinson, R. L., Goodman, A. M., & Master, C. L. (2015). Vestibular deficits following youth concussion. Journal of Pediatrics, 166(5), 1221–1225. https://doi.org/10.1016/j.jpeds.2015.01.039
Corwin, D. J., Zonfrillo, M. R., Wiebe, D. J., Master, C. L., Grady, M. F., & Arbogast, K. B. (2018). Vestibular and oculomotor findings in neurologically-normal, non-concussed children. Brain Injury, 32(6), 794–799. https://doi.org/10.1080/02699052.2018.1458150
Cossette, I., Gagné, M.-È., Ouellet, M.-C., Fait, P., Gagnon, I., Sirois, K., … McFadyen, B. J. (2016). Executive dysfunction following a mild traumatic brain injury revealed in early adolescence with locomotor-cognitive dual-tasks. Brain Injury, 30(13–14), 1648–1655. https://doi.org/10.1080/02699052.2016.1200143
Dematteo, C., Greenspoon, D., Levac, D., Harper, J. A., & Rubinoff, M. (2014). Evaluating the Nintendo Wii for assessing return to activity readiness in youth with mild traumatic brain injury. Physical and Occupational Therapy in Pediatrics, 34(3), 229–244. https://doi.org/10.3109/01942638.2014.885103
Dorman, J. C., Valentine, V. D., Munce, T. A., Tjarks, B. J., Thompson, P. A., & Bergeron, M. F. (2015). Tracking postural stability of young concussion patients using dual-task interference. Journal of Science and Medicine in Sport, 18(1), 2–7. https://doi.org/10.1016/j.jsams.2013.11.010
Ellis, M. J., Cordingley, D. M., Vis, S., Reimer, K. M., Leiter, J., & Russell, K. (2017). Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion. Journal of Neurosurgery: Pediatrics, 19(1), 38–45. https://doi.org/10.3171/2016.7.PEDS16310
Ellis, M. J., Cordingley, D., Vis, S., Reimer, K., Leiter, J., & Russell, K. (2015). Vestibulo-ocular dysfunction in pediatric sports-related concussion. Journal of Neurosurgery: Pediatrics, 16(3), 248–255. https://doi.org/10.3171/2015.1.PEDS14524
Fabri, T. L., Wilson, K. E., Holland, N., Hickling, A., Murphy, J., Fait, P., & Reed, N. (2017). Using a dual-task protocol to investigate motor and cognitive performance in healthy children and youth. Gait and Posture, 54, 154–159. https://doi.org/10.1016/j.gaitpost.2017.03.002
Fino, P. C. (2016). A preliminary study of longitudinal differences in local dynamic stability between recently concussed and healthy athletes during single and dual-task gait. Journal of Biomechanics, 49(9), 1983–1988. https://doi.org/10.1016/j.jbiomech.2016.05.004
Fino, P. C., Nussbaum, M. A., & Brolinson, P. G. (2016). Locomotor deficits in recently concussed athletes and matched controls during single and dual-task turning gait: Preliminary results. Journal of NeuroEngineering and Rehabilitation, 13(1), 1–15. https://doi.org/10.1186/s12984-016-0177-y
Furman, G. R., Lin, C. C., Bellanca, J. L., Marchetti, G. F., Collins, M. W., & Whitney, S. L. (2013). Comparison of the balance accelerometer measure and balance error scoring system in adolescent concussions in sports. American Journal of Sports Medicine, 41(6), 1404–1410. https://doi.org/10.1177/0363546513484446
Galetta, K. M., Morganroth, J., Moehringer, N., Mueller, B., Hasanaj, L., Webb, N., … Balcer, L. J. (2015). Adding vision to concussion testing: A prospective study of sideline testing in youth and collegiate athletes. Journal of Neuro-Ophthalmology, 35(3), 235–241. https://doi.org/10.1097/WNO.0000000000000226
Hansen, C., Cushman, D., Anderson, N., Chen, W., Cheng, C., Hon, S. D., & Hung, M. (2016). A Normative Dataset of the Balance Error Scoring System in Children Aged between 5 and 14. Clinical Journal of Sport Medicine, 26(6), 497–501. https://doi.org/10.1097/JSM.0000000000000285
Hansen, C., Cushman, D., Chen, W., Bounsanga, J., & Hung, M. (2017). Reliability testing of the balance error scoring system in children between the ages of 5 and 14. Clinical Journal of Sport Medicine, 27(1), 64–68. https://doi.org/10.1097/JSM.0000000000000293
Heyer, G. L., Young, J. A., & Fischer, A. N. (2017). Lightheadedness After Concussion: Not All Dizziness is Vertigo. Clinical Journal of Sport Medicine, 0(0). https://doi.org/10.1097/JSM.0000000000000445
Howell, D. R., Beasley, M., Vopat, L., & Meehan, W. P. (2017). The Effect of Prior Concussion History on Dual-Task Gait following a Concussion. Journal of Neurotrauma, 34(4), 838–844. https://doi.org/10.1089/neu.2016.4609
Howell, D. R., Brilliant, A. N., Storey, E. P., Podolak, O. E., Meehan, W. P., & Master, C. L. (2018). Objective Eye Tracking Deficits Following Concussion for Youth Seen in a Sports Medicine Setting. Journal of Child Neurology, 33(12), 794–800. https://doi.org/10.1177/0883073818789320
Howell, D. R., Brilliant, A., Berkstresser, B., Wang, F., Fraser, J., & Meehan, W. P. (2017). The Association between Dual-Task Gait after Concussion and Prolonged Symptom Duration. Journal of Neurotrauma, 34(23), 3288–3294. https://doi.org/10.1089/neu.2017.5191
Howell, D. R., Hanson, E., Sugimoto, D., Stracciolini, A., & Meehan, W. P. (2017). Assessment of the Postural Stability of Female and Male Athletes. Clinical Journal of Sport Medicine, 27(5), 444–449. https://doi.org/10.1097/JSM.0000000000000374
Howell, D. R., Myer, G. D., Grooms, D., Diekfuss, J., Yuan, W., & Meehan, W. P. (2019). Examining Motor Tasks of Differing Complexity After Concussion in Adolescents. Archives of Physical Medicine and Rehabilitation, 100(4), 613–619. https://doi.org/10.1016/j.apmr.2018.07.441
Howell, D. R., O’Brien, M. J., Raghuram, A., Shah, A. S., & Meehan, W. P. (2017). Receded near point of convergence and gait are associated after concussion. British Journal of Sports Medicine, 51(11), A9.1-A9. https://doi.org/10.1136/bjsports-2016-097270.21
Howell, D. R., O’Brien, M. J., Raghuram, A., Shah, A. S., & Meehan, W. P. (2018). Near Point of Convergence and Gait Deficits in Adolescents after Sport-Related Concussion. Clinical Journal of Sport Medicine, 28(3), 262–267. https://doi.org/10.1097/JSM.0000000000000439
Howell, D. R., Osternig, L. R., & Chou, L. S. (2013). Dual-task effect on gait balance control in adolescents with concussion. Archives of Physical Medicine and Rehabilitation, 94(8), 1513–1520. https://doi.org/10.1016/j.apmr.2013.04.015
Howell, D. R., Osternig, L. R., & Chou, L. S. (2015). Adolescents demonstrate greater gait balance control deficits after concussion than young adults. American Journal of Sports Medicine, 43(3), 625–632. https://doi.org/10.1177/0363546514560994
Howell, D. R., Osternig, L. R., & Chou, L. S. (2015). Return to activity after concussion affects dual-task gait balance control recovery. Medicine and Science in Sports and Exercise, 47(4), 673–680. https://doi.org/10.1249/MSS.0000000000000462
Howell, D. R., Osternig, L. R., & Chou, L. S. (2016). Consistency and cost of dual-task gait balance measure in healthy adolescents and young adults. Gait and Posture, 49, 176–180. https://doi.org/10.1016/j.gaitpost.2016.07.008
Howell, D. R., Osternig, L. R., Christie, A. D., & Chou, L. S. (2016). Return to physical activity timing and dual-task gait stability are associated 2 months following concussion. Journal of Head Trauma Rehabilitation, 31(4), 262–268. https://doi.org/10.1097/HTR.0000000000000176
Howell, D. R., Osternig, L. R., Koester, M. C., & Chou, L.-S. (2014). The effect of cognitive task complexity on gait stability in adolescents following concussion. Experimental Brain Research, 232(6), 1773–1782. https://doi.org/10.1007/s00221-014-3869-1
Howell, D. R., Shore, B. J., Hanson, E., & Meehan, W. P. (2016). Evaluation of postural stability in youth athletes: the relationship between two rating systems. Physician and Sportsmedicine, 44(3), 304–310. https://doi.org/10.1080/00913847.2016.1197763
Howell, D. R., Stracciolini, A., Geminiani, E., & Meehan, W. P. (2017). Dual-task gait differences in female and male adolescents following sport-related concussion. Gait and Posture, 54(November 2016), 284–289. https://doi.org/10.1016/j.gaitpost.2017.03.034
Hugentobler, J. A., Gupta, R., Slater, R., Paterno, M. V., Riley, M. A., & Quatman-Yates, C. (2016). Influence of Age on Postconcussive Postural Control Measures and Future Implications for Assessment. Clinical Journal of Sport Medicine, 26(6), 510–517. https://doi.org/10.1097/JSM.0000000000000286
King, L. A., Horak, F. B., Mancini, M., Pierce, D., Priest, K. C., Chesnutt, J., … Chapman, J. C. (2014). Instrumenting the balance error scoring system for use with patients reporting persistent balance problems after mild traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 95(2), 353–359. https://doi.org/10.1016/j.apmr.2013.10.015
Königs, M., Weeda, W. D., Van Heurn, L. W. E., Vermeulen, R. J., Goslings, J. C., Luitse, J. S. K., … Oosterlaan, J. (2015). Impaired Visual Integration in Children with Traumatic Brain Injury: An Observational Study. PLoS ONE, 10(12), 1–15. https://doi.org/10.1371/journal.pone.0144395
Lynch, J. M., Anderson, M., Benton, B., & Green, S. S. (2015). The gaming of concussions: A unique intervention in postconcussion syndrome. Journal of Athletic Training, 50(3), 270–276. https://doi.org/10.4085/1062-6050-49.3.78
Master, C. L., Master, S. R., Wiebe, D. J., Storey, E. P., Lockyer, J. E., Podolak, O. E., & Grady, M. F. (2018). Vision and Vestibular System Dysfunction Predicts Prolonged Concussion Recovery in Children. Clinical Journal of Sport Medicine, 28(2), 139–145. https://doi.org/10.1097/JSM.0000000000000507
Master, C. L., Scheiman, M., Gallaway, M., Goodman, A., Robinson, R. L., Master, S. R., & Grady, M. F. (2016). Vision Diagnoses Are Common after Concussion in Adolescents. Clinical Pediatrics, 55(3), 260–267. https://doi.org/10.1177/0009922815594367
Mucha, A., Collins, M. W., Elbin, R. J., Furman, J. M., Troutman-Enseki, C., Dewolf, R. M., … Kontos, A. P. (2014). A brief vestibular/ocular motor screening (VOMS) assessment to evaluate concussions: Preliminary findings. American Journal of Sports Medicine, 42(10), 2479–2486. https://doi.org/10.1177/0363546514543775
Murray, N. G., Ambati, V. N. P., Contreras, M. M., Salvatore, A. P., & Reed-Jones, R. J. (2014). Assessment of oculomotor control and balance post-concussion: A preliminary study for a novel approach to concussion management. Brain Injury, 28(4), 496–503. https://doi.org/10.3109/02699052.2014.887144
Ozinga, S. J., Linder, S. M., Koop, M. M., Dey, T., Figler, R., Russman, A. N., … Alberts, J. L. (2018). Normative performance on the balance error scoring system by youth, high school, and collegiate athletes. Journal of Athletic Training, 53(7), 636–645. https://doi.org/10.4085/1062-6050-129-17
Pavlou, M., Whitney, S. L., Alkathiry, A. A., Huett, M., Luxon, L. M., Raglan, E., … Bamiou, D. E. (2017). Visually induced dizziness in children and validation of the Pediatric Visually Induced Dizziness Questionnaire. Frontiers in Neurology, 8(DEC), 1–9. https://doi.org/10.3389/fneur.2017.00656
Pearce, K. L., Sufrinko, A., Lau, B. C., Henry, L., Collins, M. W., & Kontos, A. P. (2015). Near point of convergence after a sport-related concussion: Measurement reliability and relationship to neurocognitive impairment and symptoms. American Journal of Sports Medicine, 43(12), 3055–3061. https://doi.org/10.1177/0363546515606430
Quatman-Yates, C. C., Bonnette, S., Hugentobler, J. A., Médé, B., Kiefer, A. W., Kurowski, B. G., & Riley, M. A. (2015). Postconcussion Postural Sway Variability Changes in Youth: The Benefit of Structural Variability Analyses. Pediatric Physical Therapy, 27(4), 316–327. https://doi.org/10.1097/PEP.0000000000000193
Quatman-Yates, C., Hugentobler, J., Ammon, R., Mwase, N., Kurowski, B., & Myer, G. D. (2014). The utility of the balance error scoring system for mild brain injury assessments in children and adolescents. Physician and Sportsmedicine, 42(3), 32–38. https://doi.org/10.3810/psm.2014.09.2073
Rhine, T. D., Byczkowski, T. L., Clark, R. A., & Babcock, L. (2016). Investigating the Feasibility and Utility of Bedside Balance Technology Acutely after Pediatric Concussion: A Pilot Study. Clinical Journal of Sport Medicine, 26(3), 221–225. https://doi.org/10.1097/JSM.0000000000000234
Rhine, T., Quatman-Yates, C., & Clark, R. A. (2017). A longitudinal examination of postural impairments in children with mild traumatic brain injury: Implications for acute testing. Journal of Head Trauma Rehabilitation, 32(2), E18–E23. https://doi.org/10.1097/HTR.0000000000000192
Rochefort, C., Walters-Stewart, C., Aglipay, M., Barrowman, N., Zemek, R., & Sveistrup, H. (2017). Balance markers in adolescents at 1 month postconcussion. Orthopaedic Journal of Sports Medicine, 5(3), 1–7. https://doi.org/10.1177/2325967117695507
Rochefort, C., Walters-Stewart, C., Aglipay, M., Barrowman, N., Zemek, R., & Sveistrup, H. (2017). Self-reported balance status is not a reliable indicator of balance performance in adolescents at one-month post-concussion. Journal of Science and Medicine in Sport, 20(11), 970–975. https://doi.org/10.1016/j.jsams.2017.04.008
Sambasivan, K., Grilli, L., & Gagnon, I. (2015). Balance and mobility in clinically recovered children and adolescents after a mild traumatic brain injury. Journal of Pediatric Rehabilitation Medicine, 8(4), 335–344. https://doi.org/10.3233/PRM-150351
Santo, A., Lynall, R. C., Guskiewicz, K. M., & Mihalik, J. P. (2017). Clinical utility of the sport concussion assessment tool 3 (SCAT3) tandem-gait test in high school athletes. Journal of Athletic Training, 52(12), 1096–1100. https://doi.org/10.4085/1062-6050-52.11.26
Scheiman, M. M., Talasan, H., Lynn Mitchell, G., & Alvarez, T. L. (2017). Objective Assessment of Vergence after Treatment of Concussion-Related CI: A Pilot Study. Optometry and Vision Science, 94(1), 74–88. https://doi.org/10.1097/OPX.0000000000000936
Schneider, K. J., Meeuwisse, W. H., Nettel-Aguirre, A., Barlow, K., Boyd, L., Kang, J., & Emery, C. A. (2014). Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. British Journal of Sports Medicine, 48(17), 1294–1298. https://doi.org/10.1136/bjsports-2013-093267
Sinopoli, K. J., Chen, J.-K., Wells, G., Fait, P., Ptito, A., Taha, T., & Keightley, M. (2014). Imaging “Brain Strain” in Youth Athletes with Mild Traumatic Brain Injury during Dual-Task Performance. Journal of Neurotrauma, 31(22), 1843–1859. https://doi.org/10.1089/neu.2014.3326
Storey, E. P., Master, S. R., Lockyer, J. E., Podolak, O. E., Grady, M. F., & Master, C. L. (2017). Near Point of Convergence after Concussion in Children. Optometry and Vision Science, 94(1), 96–100. https://doi.org/10.1097/OPX.0000000000000910
Storey, E. P., Wiebe, D. J., D’Alonzo, B. A., Nixon-Cave, K., Jackson-Coty, J., Goodman, A. M., … Master, C. L. (2018). Vestibular rehabilitation is associated with visuovestibular improvement in pediatric concussion. Journal of Neurologic Physical Therapy, 42(3), 134–141. https://doi.org/10.1097/NPT.0000000000000228
Sufrinko, A. M., Marchetti, G. F., Cohen, P. E., Elbin, R. J., Re, V., & Kontos, A. P. (2017). Using Acute Performance on a Comprehensive Neurocognitive, Vestibular, and Ocular Motor Assessment Battery to Predict Recovery Duration after Sport-Related Concussions. American Journal of Sports Medicine, 45(5), 1187–1194. https://doi.org/10.1177/0363546516685061
Sufrinko, A. M., Mucha, A., Covassin, T., Marchetti, G., Elbin, R. J., Collins, M. W., & Kontos, A. P. (2017). Sex differences in vestibular/ocular and neurocognitive outcomes after sport-related concussion. Clinical Journal of Sport Medicine, 27(2), 133–138. https://doi.org/10.1097/JSM.0000000000000324
Swanson, M. W., Weise, K. K., Dreer, L. E., Johnston, J., Davis, R. D., Ferguson, D., … Swanson, E. (2017). Academic Difficulty and Vision Symptoms in Children with Concussion. Optometry and Vision Science, 94(1), 60–67. https://doi.org/10.1097/OPX.0000000000000977
Vernau, B. T., Grady, M. F., Goodman, A., Wiebe, D. J., Basta, L., Park, Y., … Master, C. L. (2015). Oculomotor and neurocognitive assessment of youth ice hockey players: Baseline associations and observations after concussion. Developmental Neuropsychology, 40(1), 7–11. https://doi.org/10.1080/87565641.2014.971955
Zhou, G., & Brodsky, J. R. (2015). Objective vestibular testing of children with dizziness and balance complaints following sports-related concussions. Otolaryngology – Head and Neck Surgery (United States), 152(6), 1133–1139. https://doi.org/10.1177/0194599815576720
Additional references that helped to inform the domain recommendations:
Baugh, R.F., Bronston, L.J., Whitney, S.L., Haidari, J., Steiner, R.W.P., … Desmond, A.L. (2008). Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo. Otolaryngology-Head and Neck Surgery. 139(5_suppl),47-81. https://doi.org/10.1016/j.otohns.2008.08.022
Brodsky, J.R., Lipson, S., Wilber, J., Zhou, G. (2018). Benign Paroxysmal Positional Vertigo (BPPV) in Children and Adolescents: Clinical Features and Response to Therapy in 110 Pediatric Patients. Otology and Neurotology. 39(3),344-350. https://doi.org/10.1097/MAO.0000000000001673
Mcdonnell, M.N., Hillier, S.L. (2015). Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews. 2015(1),CD005397. https://doi.org/10.1002/14651858.CD005397.pub4
Murray, D.A., Meldrum, D., Lennon, O. (2017). Can vestibular rehabilitation exercises help patients with concussion? A systematic review of efficacy, prescription and progression patterns. British Journal of Sports Medicine. 51(5),442-451. https://doi.org/10.1136/bjsports-2016-096081
Reneker, J.C., Clay Moughiman, M., Cook, C.E. (2015). The diagnostic utility of clinical tests for differentiating between cervicogenic and other causes of dizziness after a sports-related concussion: An international Delphi study. Journal of Science and Medicine in Sport. 18(4),366-372. https://doi.org/10.1016/j.jsams.2014.05.002
Schneider KJ, WH. (2014). Vestibular disorders following concussion. In R. Echemendia & G. L. Iverson (Eds.), The Oxford Handbook of Sport-related Concussion. New York: Oxford University Press. Online Publication Date: December 2014. https://doi.org/10.1093/oxfordhb/9780199896585.013.14
Ventura, R.E., Balcer, L.J., Galetta, S.L. (2014). The neuro-ophthalmology of head trauma. The Lancet Neurology. 13(10),1006-1016. https://doi.org/10.1016/S1474-4422(14)70111-5
Wallace, B., Lifshitz, J. (2016). Traumatic brain injury and vestibulo-ocular function: current challenges and future prospects. Eye and Brain. Volume 8,153-164. https://doi.org/10.2147/eb.s82670
Research papers not associated with a current recommendation:
Linder, S. M., Ozinga, S. J., Koop, M. M., Dey, T., Figler, R., Cruickshank, J., & Alberts, J. L. (2018). Cleveland Clinic Postural Stability Index Norms for the Balance Error Scoring System. Medicine and Science in Sports and Exercise, 50(10), 1998–2006. https://doi.org/10.1249/MSS.0000000000001660
Last update: November 16, 2019