# Balance Impairments in Adolescents Post‐Sports Concussion during Single and Dual Tasks

## TL;DR

Adolescents with sports concussion show greater balance impairments during specific tasks and surfaces compared to healthy peers.

## Contribution

Identifies antero-posterior RMS sway as a sensitive indicator of concussion-related balance deficits.

## Key findings

- Adolescents with concussion had greater antero-posterior root-mean-square sway than healthy peers.
- Sway increased on compliant surfaces and during perceptual inhibition tasks across all participants.
- Normalized sway path length decreased during dual-task conditions, suggesting automatic stabilization or compensation.

## Abstract

This study aimed to explore changes in sway during single tasks and dual tasks in adolescents with and without sport concussion (SC).

A cross‐sectional study of 57 adolescents with an SC and 67 healthy participants was compared on static balance during single‐ and dual‐task conditions on hard and compliant surfaces. Postural sway was assessed using a force platform (with and without a foam pad) during three cognitive conditions.

Individuals with SC had greater sway compared with healthy participants (p < 0.05). There were no significant interactions of groups and the task conditions. Across both groups, higher sway was observed in the compliant surface condition compared with the hard surface condition (p < 0.001). Greater sway was measured in the single task compared with the dual‐task conditions (p < 0.05), and the perceptual inhibition task generated greater sway than the spatial discrimination task (p < 0.05).

Several factors were associated with increased sway, including compliant surface, dual task, and perceptual inhibition tasks. However, the root‐mean‐square in the anteroposterior direction was the only measure that showed a difference between the two groups, while only the normalized path length sway measures illustrated the difference between the dual‐ and single‐task conditions.

This study examined postural sway in 124 adolescents (57 with sports concussion, 67 healthy) during static balance tasks on hard and compliant surfaces under three conditions: no cognitive task, spatial discrimination, and perceptual inhibition. Adolescents with concussion exhibited significantly greater antero‐posterior root‐mean‐square (RMS) sway than healthy peers. Across all participants, sway increased on compliant surfaces and during perceptual inhibition tasks. Notably, normalized sway path length (NSPL) was reduced during dual‐task conditions compared to single‐task trials, possibly reflecting automatic stabilization or conscious compensation. These findings highlight that concussion‐related postural control deficits may be direction‐specific and task‐dependent. RMS sway in the antero‐posterior direction emerged as the most sensitive indicator of concussion‐related balance impairments. Clinically, incorporating dual‐task balance assessments and attention‐demanding tasks can enhance the detection of lingering deficits post‐concussion and support informed return‐to‐play decisions.