It has been widely accepted that the assessment of balance after concussion plays a large role in determining deficit. Qualitative balance assessments have been an established piece of the post-injury assessment as a clinical behavioral marker of concussion for many years. Recently more specific guidelines outlining the role of balance evaluation in concussion identification and management have been developed as part of concussion management tools. As part of the ongoing development of concussions protocols, quantitative assessment of balance function following concussion has also been identified to have an important role. Frequently imbalance and dizziness reported following concussion is assumed to be associated with post-concussion syndrome (PCS). While imbalance and dizziness are common complaints in PCS, they can also be a sign of additional underlying pathology. In cases of specific dizziness symptoms or limited balance recovery beyond the initial post-concussive period, a quantitative vestibular assessment may also be needed. Electronystagmography and videonystagmography (ENG/VNG), rotary chair testing (RCT), and vestibular evoked myogenic potentials (VEMPs) have all been identified as valid assessment tools for vestibular dysfunction following traumatic brain injury (TBI). The assessment of balance and dizziness following sports-related concussions is an integral piece of the puzzle for removal from play, assessment of severity, and management.
