1. Postural and Cognitive Changes Observed During Re-Baseline Assessments
B.J. Mizeski1, M.E. Mormile1, B. Szekely1, K. Grimes1, B.A. Munkasy1, N.G. Murray1.
1School of Health and Kinesiology, Georgia Southern University, Statesboro, GA.

2. Introduction
Concussion : “complex pathophysiological process affecting the brain by traumatic biomechanical forces”1
Mechanisms: Direct blow to head, neck, or any part of the body that causes a force to travel to the head

3. Epidemiology 57,000,000 people hospitalized2
1.6 – 3.8 million concussions occur annually2
2.5 concussions for every 1000 athlete exposures (NCAA)3
55% of NCAA concussions occur in football3

4. Signs & Symptoms Brief loss of consciousness Lightheadedness
Blurred vison
Difficulty concentrating
Fatigue
Headache3
86% of cases
Dizziness3
67% of cases
Confusion3
59% of cases
Balance disturbances4
30% of cases

5. Balance
Process of maintaining a position within the body’s base of support5
Balance disturbance is characterized as the inability to stand with an upright posture without deviating outside the limits of the base of support.
Greater risk for additional injury

6. Baseline Evaluation Initial assessment Provides vital information
Should include Neurocognitive and Postural Assessments6

7. Diagnosis Multi-faceted approach to evaluation is most commonly used10
Evaluate different pathways responsible for executive and motor function
Majority of athletic trainers use at-least 3 concussion assessments to evaluate concussions7
Standardized Assessment of Concussion (SAC)
Balance Error Scoring System (BESS)
Immediate Post Concussion Assessment and Cognitive Testing (IMPACT)
Application of these assessments rely on comparing scores to baseline evaluations

8. Return to Participation (RTP)
Athlete should not participate in physical or extensive mental activity6
Recommended athletes return to or perform better on baseline assessments before starting a return to participation protocol6
Protocol should be progressive starting with light aerobic activity culminating with full return to unrestricted activity8

9. Re-Baseline Evaluation
Recommended all athletes who sustain a concussion are administered re-baseline assessments6
Initial baseline assessments may be influenced by a number of factors9-11
Performance improvements
Practice effects
Testing setting
Fatigue
Limited literature exists – Lynall et. al 20159

10. Purpose
Assess changes following full recovery from concussion on two standard clinical measures of concussion, the BESS and the SAC
Deficits will be present following re-baseline exams
in athletes who had experienced a concussion during the previous athletic season.

11. Methods 2 Testing time points Pre & Post included SAC & BESS
Preseason (PRE)
Initial Assessment
Post Season (POST)
Re-Baseline
Pre & Post included SAC & BESS
34 Division I Athletes & Cheerleaders over 2 athletic years
13 male, 21 female
Diagnosed concussion, confirmed by team physician, & returned to play

12. Participants
Football 8
Cheer 7
Women’s Soccer 3
Men’s Soccer
Women’s Basketball
Men’s Basketball
Women’s Track & Field
Women’s Volleyball 1
Women’s Swim & Dive

13. Standardized Assessment of Concussion
Cognitive assessment
30/30 max score

14. Balance Error Scoring System
6 Trials
3 stances
Stable & Unstable
Airex Pad
20 seconds each
Composite score
60/60 max

15. Analysis Independent samples t - test SPSS – Version 23 p=0.05
Variables
Dependent
Independent
Time
Sac
BESS
Independent samples t - test
SPSS – Version 23
p=0.05
(Except this presentation)a

16. Results
p = 0.353
p =0.728

17. Discussion
Participants
Subjective
Sensitivity

18. Conclusions
Effects of a single known concussion during an athletic season does not appear to influence clinical assessments
Further research should include more sensitive and objective assessments to determine potential differences

19. References
McCrory P, Meeuwisse WH, Aubry M, et al. Consensus statement on concussion in sport: The 4th international conference on concussion in sport, Zurich, November J Athl Train. 2013;48(4): p.
Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: A brief overview. J Head Trauma Rehabil. 2006;21(5): p.
Guskiewicz KM, Weaver NL, Padua DA, Jr GW. Epidemiology of concussion in collegiate and high school football players. Am J Sports Med. 2000;28(5): p.
Murray N, Salvatore A, Powell D, Reed-Jones R. Reliability and validity evidence of multiple balance assessments in athletes with a concussion. J Athl Train. 2014;49(4):
Guskiewicz KM. Balance assessment in the management of sport-related concussion. Clin Sports Med. 2011;30:
Broglio SP, Cantu RC, Gioia GA, et al. National athletic trainers' association position statement: Management of sport concussion. J Athl Train. 2014;49(2): p. doi: /
Kelly KC, Jordan EM, Joyner AB, Burdette GT, Buckley TA. National collegiate athletic association division I athletic trainers' concussion-management practice patterns. J Athl Train. 2014;49(5):
Leitch H, Ayers E, Andrews A. LITERATURE REVIEW: A review of concussion management in the young adult; the importance of baseline testing and caregiver education. J Natl Med Assoc. 2015;107:60-65
Lynall RC, Schmidt JD, Mihalik JP, Guskiewicz KM. The clinical utility of a concussion rebaseline protocol after concussion recovery. Clin J Sport Med
Burk JM, Munkasy BA, Joyner AB, Buckley TA. Balance error scoring system performance changes after a competitive athletic season. Clin J Sport Med. 2013;23(4):
Valovich TC, Perrin DH, Gansneder BM. Repeat administration elicits a practice effect with the balance error scoring system but not with the standardized assessment of concussion in high school athletes. J Athl Train. 2003;38(1):51