A longitudinal examination of postural impairments in children with mild traumatic brain injury: Implications for acute testing

Objective: To examine how postural control changes following pediatric mild traumatic brain injury. Setting: Urban pediatric emergency department. Participants: Children 11 to 16 years old who presented within 6 hours of sustaining mild traumatic brain injury. Design: Prospective observational cohort followed for 1 month. Main Measures: Total center of pressure path velocity and path velocity within distinct frequency bands, ranging from moderate to ultralow, were recorded by the Nintendo Wii Balance Board during a 2-legged stance. Measurements were recorded in 2 separate tests with eyes open and closed. The scores of the 2 tests were compared, and a Romberg quotient was computed. Results: Eleven children were followed for 1 month postinjury. The ultralow frequency, which reflects slow postural movements associated with exploring stability boundaries, was lower (p = .02) during the eyes closed stance acutely following injury. The Romberg quotient for this frequency was also significantly lower acutely following injury (p = .007) than at 1 month. Conclusion: Following mild traumatic brain injury, children acutely demonstrate significantly more rigid sway patterns with eyes closed than with eyes open, which were highlighted by the Romberg quotient. The Romberg quotient could allow for accurate identification and tracking of postural instability without requiring knowledge of preinjury balance ability.