University of Buffalo researchers find thirty-second single-leg stand task differentiates concussion patients from never-concussed controls

By Conor Gormally. This article was initially published in our Concussion Update newsletter; please consider subscribing.

A study by Ghazala T. Saleem et al. examined the efficacy of the Physical and Neurological Examination of Subtle Signs (PANESS) to identify subtle postural control deficits after concussion. They found that the thirty-second single-leg stance identified impaired postural control in children after concussion.

Their research, published in Human Kinetics Journals, evaluated 60 participants: “(1) 18 youth symptomatic from concussion when evaluated 4 days to 2 weeks postinjury, ages 13–17 years; (2) 15 youth assessed 3 days to 6 weeks after medical clearance postconcussion, ages 10–17 years; and (3) 27 age- and sex-matched never-concussed controls, ages 13–17 years.”

The researchers highlight the PANESS as a brief and cost-effective measure (it requires only paper, pencil, and a stopwatch), differentiating it from measures like the Balance Error Scoring System and the Sensory Organization Test, “limited either by their decreased sensitivity to subtle deficits, increased cost and major space requirements, or their use of only static (measuring postural control at rest) tasks.” 

After their analysis, Saleem et al. found that only the single-leg stand test (where participants stand on one leg for 30 seconds on both their dominant and non-dominant legs) differentiated controls from both symptomatic and medically-cleared concussion patients to a statistically significant degree.

While the two gait tasks of walking with weight on the toes and the sides of feet “trended towards significance,” they found no significant effect from any of the other tests. While the single-leg stand test differentiated patients with concussion history from never-concussed controls, they found no difference between symptomatic and medically cleared patients. This inability could be due to previous research findings that subtle postural control deficits may persist well beyond symptom resolution and may factor into previously concussed athletes’ increased risk of musculoskeletal injuries after return to sport.