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Tracking postural stability of young concussion patients using dual-task interference. J Sci
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Contents lists available at ScienceDirect
Journal of Science and Medicine in Sport
j our nal homepage: www. el sevi er . com/ l ocat e/ j sams
Original research
Tracking postural stability of young concussion patients using
dual-task interference
Jason C. Dorman
a,
, Verle D. Valentine
b,c
, Thayne A. Munce
a,c
, B. Joel Tjarks
c
,
Paul A. Thompson
c,d
, Michael F. Bergeron
a,c
a
National Institute for Athletic Health & Performance, Sanford USD Medical Center, United States
b
Sanford Orthopedics & Sports Medicine, Sanford USD Medical Center, United States
c
Sanford School of Medicine, University of South Dakota, United States
d
Methodology and Data Analysis Center, Sanford Research, United States
a r t i c l e i n f o
Article history:
Received 22 May 2013
Received in revised form
26 November 2013
Accepted 28 November 2013
Available online xxx
Keywords:
Balance
Brain injury
Clinical assessment
Cognitive function
Injury management
a b s t r a c t
Objectives: This study examined the diagnostic benet of using dual-task interference balance testing in
young concussion patients and the longitudinal changes in postural stability that occur relative to other
standard clinical assessments of concussion injury.
Design: Longitudinal, casecontrol.
Methods: Eighteen patients (16.6 (1.6) y) diagnosed with a concussion provided 22 separate ratings to
characterize the severity of their current concussion-related symptoms and were evaluated for postural
stability at each of four clinical visits. Twenty-six injury-free adolescents (17 (2.8) y) performed balance
testing on two occasions, separated by 1 week.
Results: There was a progressive decrease in self-reported symptoms from visit 1 to visit 4
(P <0.00010.001). A similar improvement occurred in postural stability, indicated by 95% ellipse area
and velocity. However, the differences in ellipse area and velocity were signicant only between visit 1
and the rest of the visits as a whole (P < 0.00010.05). There was a signicant difference between con-
cussion patients and healthy, injury-free participants in ellipse area and velocity during visit 1. A group
difference was also observed in ellipse area on visit 2, but only during the two balance tests that involved
a concomitant secondary cognitive task.
Conclusions: Improvements in postural stability coincide with reductions in reported symptoms, though
apparent recovery of these selected measures of postural stability seemingly occurs sooner. Because of
the distinguishing time course of recovery indicated by dual-task interference balance testing, this type of
balance testing assessment may be particularly valuable in evaluating integrated functional impairment
and recovery in young concussion patients.
2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
1. Introduction
The signs andsymptoms of a concussionare critical tothe evalu-
ation and treatment of mild traumatic brain injury. Symptoms can
be subtle, may not appear immediately, and can last for varying
periods (hours, days, or weeks). Medical personnel are dependent
upon patients self-appraisal and reporting of concussion symp-
toms during a clinical evaluation; however, self-reporting might
not always be reliable.
13
In sports, this may be due to an ath-
letes desire to play outweighing the value of an honest response,
being conditioned to downplay pain and injury to coaches,

Corresponding author.
E-mail addresses: jason.dorman@sanfordhealth.org,
jachdo@hotmail.com(J.C. Dorman).
teammates and opponents, or thinking that the symptoms are
not due to head trauma and a resulting concussion.
1
Alter-
natively, patients are asked to subjectively rate their current
post-concussion symptoms at that particular moment in time in
circumstances that may not prompt symptoms. This can lessen
accurate characterization of symptoms that the patient is cur-
rently experiencing. Self-reported symptom scales can indeed aid
in detection of concussions and assist clinicians in determining
whena patient canreturnto play andresume other activities. How-
ever, clinicians should also appreciate that these scales have not
gone through comprehensive scientic scrutiny and validation.
4
Accordingly, there is a recognized need for more objective mea-
sures that can independently determine and clarify concussion
recovery. There would be even greater utility if more sensitive
and objective measures indicated incomplete concussion recovery
beyond resolution of standard signs and symptoms. If validated,
1440-2440/$ see front matter 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jsams.2013.11.010
Please cite this article in press as: Dorman JC, et al. Tracking postural stability of young concussion patients using dual-task interference. J Sci
Med Sport (2013), http://dx.doi.org/10.1016/j.jsams.2013.11.010
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2 J.C. Dorman et al. / Journal of Science and Medicine in Sport xxx (2013) xxxxxx
such new diagnostic tools could prompt and support continued
accommodation and potential activity restrictions, while more
assuredly averting premature full return.
With a concussion, there is often a temporary reduction in
postural stability that is particularly evident when an affected indi-
vidual is evaluatedclose totime of injury.
5
Postural stability may be
further challenged and a balance decit revealed with a dual-task
scenario (i.e., simultaneous cognitive and balance demands).
5
In
this study, we examined the diagnostic utility of using dual-task
cognitive interference balance testing (BT) in young concussion
patients. We alsoinvestigatedthelongitudinal changes intheseand
other balance measures relative to standard clinical assessments
and indicators of concussion injury. Accordingly, we hypothesized
that a sequential analysis of postural stability using these selected
BT protocols would provide a discrete, independent indicator of
concussionstatus andrecovery, as indicatedbya parallel resolution
of concussion symptoms. Secondly, we expected that the dual-
task BT incorporating a concomitant cognitive challenge would
be a more discriminating indicator of a postural stability decit
and progressive concussion recovery than BT without a cognitive
interference.
Because BT with an added cognitive task is a relatively new
assessment in concussion care, optimal protocols and reference
standards have not yet been established. Accordingly, this research
helps to establish the validity of this method, while offering
clinicians another objective tool to assist in the evaluation and
management of this increasingly prevalent condition.
2. Methods
Eighteen patients (10 male, 8 female; 16.6 (1.6) y) diagnosed
with a concussion (INJ) by a board-certied sports medicine physi-
cian were recruited through a local sports medicine clinic (Sanford
Orthopedics & Sports Medicine Clinic; Sioux Falls, SD, USA) to par-
ticipate in this study. Twenty-six injury-free adolescents (14 male,
12 female; 17.2 (2.8) y) were recruited from local sport teams as
healthy, normative (NORM) participants. Prior to being involved
in the study, participants 18y and older provided informed con-
sent, while all younger participants provided assent with parents
providing informed consent. The study was approved by an ethics
committee (Sanford Health Institutional ReviewBoard) designated
for all human investigations and the ethical guidelines for recruit-
ment, informed consent and conduct of the study were closely
followed by the investigators.
An INJ patient was eligible to participate in the study if his/her
initial examination in our clinic was within 10 days of a suspected
head injury and the resulting clinical condition was determined to
be a concussion by a sports medicine physician trained in diagnos-
ingandtreatingconcussions. Onlypatients whohadbeenevaluated
and performed concussion-related testing at least four times in
the clinic over the course of their recovery period were included
in these analyses. It should be noted that these inclusion criteria
resulted in the selection of a unique cohort of concussion patients,
as they had unresolved concussion symptoms over an extended
period of time. The amount of time between each of the four clini-
cal visits (V14) varied frompatient-to-patient, and was based on
the recommendation from the examining physician (average was
15 days between V1 and V2; 24 days between V2 and V3; and 29
days between V3 and V4). The concussion evaluation procedure
includedassessments of self-reportedsymptomscores andbalance
tests for postural stability at concomitant time points.
Potential NORM participants were excluded if they had a con-
cussion in the past year and/or had any vision, vestibular or other
known condition that could have negatively affected postural sta-
bility. Each NORMparticipant was evaluated two times, separated
by approximately one week. The NORMgroup was included in this
investigation to establish reference values for the selected balance
protocol and outcome measures in age-matched, healthy individ-
uals, as well as to establish the reliability and consistency of the
outcome measures across repeated measurements. Only two vis-
its were deemed necessary to determine reliability of the balance
protocol. Moreover, no further changes were anticipated over time
in the NORMgroup that would have necessitated additional visits.
BT for postural stability was performed on a strain gauge force
platform(AMTI Newton, MA). Each subject stood on the force plat-
form, without shoes on, facing forward, with his/her feet shoulder
width apart and hands on hips, while attempting to be as steady
as possible under four conditions: (1) eyes open (O), (2) eyes open
with a cognitive task (reciting months of the year backwards; OT),
(3) eyes closed (C) and (4) eyes closed with the same cognitive task
(CT). All tests wereperformedinthesameorder oneachsubsequent
visit in order to consistently assess clinical progress. For each test
condition, participants center of pressure (COP) positional changes
were tracked for a period of 20s with a sampling rate of 100Hz
and recorded using an integrated computer and diagnostic soft-
ware (BioAnalysis). Two commonly used COP testing variables, 95%
ellipse area (EA) and velocity (V) were used as markers of postural
stability for each study participant.
During each INJ patients four clinical visits, a certied athletic
trainer asked the patient to characterize the severity of his/her
current concussion-related symptoms using a post-concussion
symptom scale (PCSS). Responses for rating each of the 22 symp-
toms were based on a 7-point Likert-type scale (0 =no symptom;
6 =severe symptom). Symptoms were grouped into four clusters:
physical-, cognitive-, emotional- and sleep-related. The NORMpar-
ticipants were not asked to provide any symptomratings.
Datawereexaminedandscreenedfor extrema(noneconsidered
unusual were found). A power analysis (subject sample size) was
not performed because the study, done in conjunction with clini-
cal assessment andtreatment, was exploratory innature. Summary
statistics for EA, V, and PCSS were computed. The data were struc-
tured as a 4-factor design, including Participants (INJ or NORM),
Visual Condition (Eyes Open or Closed), Cognitive Task (No Task or
Task), andTime(V14for INJ; V1andV2for NORM). TheVisual Con-
ditionandCognitiveTaskfactors werecombinedtoprovidethe4BT
levels (O, OT, C and CT). Primary statistical analysis was performed
using PROC MIXEDin SAS V9.3, with an AR(1) model for the covari-
ance matrix. As the most important lines of inquiry were between
specic combinations and comparisons of design cells within the
four-factor design, planned contrasts were used to properly test
these specic questions. The overall 4-factor design (main effects
andinteractions) was not examinedper se for several reasons. First,
visits are not entirely comparable between INJ and NORM, as the
two groups have different numbers of andtime betweenvisits. Sec-
ondly, total symptoms scores were collectedonlyinINJ. Toexamine
the change in balance measures (EA and V) for each condition over
all visits and in symptoms over all INJ visits, mixed-model repeated
measures were used. For these analyses, unstructured covariance
matrices were used to impose a no-covariance structure. V1 was
comparedagainst theremainingthreevisits, V2against theremain-
ing two and V3 against V4, in order to detect a break in the slope
of means. All data for EA, V and PCSS are expressed as mean (SD).
Statistical signicance for all analyses was set at P<0.05.
3. Results
There was a progressive decrease in PCSS scores fromV1 to V4
(Fig. 1). Compared to V1, scores for V2, V3, and V4 were collec-
tively lower (P<0.0001), as was the case for V3 and V4 compared
to V2 (P<0.0001). Symptom scores for V4 were also lower than
Please cite this article in press as: Dorman JC, et al. Tracking postural stability of young concussion patients using dual-task interference. J Sci
Med Sport (2013), http://dx.doi.org/10.1016/j.jsams.2013.11.010
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1
s
t
2
n
d
3
r
d
4
t
h
0
10
20
30
40
50
60
70
Visit
P
C
S
S

t
o
t
a
l

s
c
o
r
e
****
***
****
Fig. 1. Temporal changes in post-concussion symptom scale (PCSS) scores during
each clinical visit (V1V4). V1 was compared against the remaining three visits, V2
against the remaining two and V3 against V4, in order to detect a break in the
slope of means. P values are as follows: ***<0.001; ****<0.0001.
reported during V3 (P<0.001). A similar progression was evident
in EA (especially during the dual-task cognitive interference chal-
lenge condition) andless sowithVduring the four visits (Fig. 2); but
a signicant difference was only found between V1 and the later
visits as a whole in almost all cases. A difference in EA approached
statistical signicance in the OT and CT test conditions when com-
paring V2 and the last two visits combined (OT EA: P=0.06; CT EA:
P=0.08).
While INJ were observed on four visits, NORM subjects were
observed just twice. Comparisons and interactions between the
two groups were performed on V1 and V2 for each group. Restric-
tion to these two visits resulted in a complete factorial design,
with Visit (V1, V2), Group (INJ, NORM) and the interaction. The
F values and signicance for each of the four balance test con-
ditions for V1 and V2 in the INJ and non-injured NORM groups
are shown in Table 1. During V1 there was a signicant difference
between the INJ and NORMgroups in all tests and measured vari-
ables (P=<0.00010.0161). A signicant difference was observed
in V2 EA between the INJ and NORM groups only with the OT
(P=0.0129) and CT (P=0.0066) conditions.
4. Discussion
Supporting our hypothesis, changes inpostural stability, as indi-
cated by EA, generally paralleled concomitant temporal changes in
symptom scores in these concussion patients who were initially
seenwithintherst tendays post-concussion. This was particularly
evident when EA was measured during the dual-task interference
conditions. However, most BT specic measures of EA and V seem-
ingly recovered or leveled off earlier than concussion symptoms.
Notably, the OT and CT conditions also uniquely revealed postural
stability differences between INJ and NORM.
Balance in healthy individuals is maintained by the proper inte-
gration and interpretation of the bodys visual, vestibular, and
somatosensory cues. Following brain trauma, there is often a loss
of balance or ability to fully control postural stability. The areas of
the brain responsible for postural control (cerebellum), cognitive
tasks (frontal lobe) and complex functions (parietal lobe) may be
damagedandnormal functiondisrupted,
6
whichis oftencharacter-
ized in concussed athletes by impaired postural stability (balance)
and a reduction in cognitive function.
79
Most subjective eld tests
are not sensitive enough to accurately discriminate subtle postural
stability decits (indicated by excessive COP excursions) and pro-
gressive recovery over time. Position statements by the National
Athletic Trainers Association and other recognized organizations
recommend utilizing the Balance Error Scoring System(BESS) test
for evaluating balance decits following a suspected sport-related
concussion.
1012
The BESS scoring systemis largely based on sub-
jective observations made by an examiner. Also, the use of a foam
pad (unstable surface) during the BESS test may be problematic
whenusedby a novice patient (because of unfamiliarity withmain-
taining balance on a foampad, prompting non-concussion-related
instability). Combined with the inuence of a large learning effect,
this inconsistency and variation potentially lessen the precision in
interpreting a patients BT performance when using a foam pad.
There is also inconsistency with test-retest reliability and measur-
able variance in baseline and concussion-related postural stability
changes. According to Bell et al., the BESS is valid to detect balance
decits where large differences exist (concussionor fatigue). It may
not be valid when differences are more subtle.
13
Medical profes-
sionals may be able to better determine subtle concussion-related
postural stability changes and more precisely track the progres-
sion of concussion recovery throughout the healing process using
an instrumented force platformespecially for patients who are suf-
fering fromunresolved symptoms.
Others have stated that standard balance tests may not be sen-
sitive enough to detect long-term decits.
14,15
Whereas V had
little-to-no progressive change after the rst visit (V1), there was a
more prominent subsequent change in EA that closely approached
statistical signicance in the OT and CT test conditions when com-
paring V2 to the remaining two visits. This apparent yet unresolved
aspect of a concussion-related decit in postural stability at V2 is
reinforced by the signicant difference that was observed in V2 EA
between the INJ and NORMgroups with the OT and CT conditions.
The average elapsed time from concussion to the second clinical
visit was 23 days. This extended residual decit is notably in con-
trast to other studies reporting balance decits usually resolving
within 35 days of a concussion.
16,17
Studies examining dual-task testing paradigms with healthy
individuals have suggested such protocols may be benecial
in evaluating concussed patients.
18,19
Moreover, athletic success
often requires effective, simultaneous integration of cognitive
awareness and dynamic balance. When an athlete suffers a head
trauma and consequent concussion, the specic areas of the brain
that normally contribute to performing these functions may have
been altered, therefore, making these tasks more difcult. Many
current diagnostic tools examine cognitive and balance tasks inde-
pendently of each other. This increases the possibility of not fully
appreciating a more integrated functional decit, perhaps lead-
ing to a misdiagnosed concussion status. BT can be more effective
using specic sensory and cognitive tasks that challenge postu-
ral control. For example, attempting to maintain balance with the
eyes closed or while performing a cognitive task creates either a
sensory-limited (closed eyes) or dual-task (dual-attention) situa-
tion. Without a visual anchor to help maintain balance, closed eyes
could encourage greater postural destabilization. A similar effect
can be achieved with a cognitive challenge. Combining visual and
cognitive challenges, while attempting to maintain balance, cre-
ates a sensory-limited dual-task environment that challenges and
reduces postural control to a greater extent and potentially pro-
vides a more revealing measure of integrated functional decits.
In our dual-task interference BT protocol, we implemented a sim-
ple bipedal static balance test as the concurrent postural stability
task (with COP excursion as the primary outcome measure), so
that there would not likely be a preferential (intentional) or forced
focus on postural stability (which would likely be the case with a
more challenging balance demand) when the patients were asked
to recite the months backwards. That is, we anticipated that this
Please cite this article in press as: Dorman JC, et al. Tracking postural stability of young concussion patients using dual-task interference. J Sci
Med Sport (2013), http://dx.doi.org/10.1016/j.jsams.2013.11.010
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10
20
30
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50
Visit
9
5
%

E
l
l
i
p
s
e

A
r
e
a

(
c
m
2
)
*
Eyes open (O)
1
s
t
2
n
d

3
r
d

4
t
h
0
2
4
6
8
Visit
V
e
l
o
c
i
t
y

(
c
m
/
s
e
c
)
*
Eyes open (O)
1
s
t
2
n
d

3
r
d

4
t
h
0
10
20
30
40
50
Visit
9
5
%

E
l
l
i
p
s
e

A
r
e
a

(
c
m
2
)
Eyes open w/ cognitive task (OT)
1
s
t
2
n
d

3
r
d

4
t
h
0
2
4
6
8
Visit
**
V
e
l
o
c
i
t
y

(
c
m
/
s
e
c
)
Eyes open w/ cognitive task (OT)
1
s
t
2
n
d

3
r
d

4
t
h
0
10
20
30
40
50
Visit
9
5
%

E
l
l
i
p
s
e

A
r
e
a

(
c
m
2
)
***
Eyes closed (C)
1
s
t
2
n
d

3
r
d

4
t
h
0
2
4
6
8
Visit
V
e
l
o
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i
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(
c
m
/
s
e
c
)
****
Eyes closed (C)
1
s
t
2
n
d

3
r
d

4
t
h
0
10
20
30
40
50
Visit
****
9
5
%

E
l
l
i
p
s
e

A
r
e
a

(
c
m
2
)
Eyes closed w/ cognitive task (CT)
1
s
t
2
n
d

3
r
d

4
t
h
0
2
4
6
8
Visit
****
V
e
l
o
c
i
t
y

(
c
m
/
s
e
c
)
Eyes closed w/ cognitive task (CT)
Fig. 2. Temporal changes in 95% ellipse area and velocity of center of pressure excursions during each clinical visit (V1V4). V1 was compared against the remaining three
visits, V2 against the remaining two and V3 against V4, in order to detect a break in the slope of means. P values are as follows: *<0.05; **<0.01; ***<0.001; ****<0.0001.
cognitive task would reveal the concussion patients ability to
process these two tasks simultaneously without requiring a dis-
proportionate allocation of attention to simple standing postural
stability.
Postural instability is also observed with Parkinsons disease.
Parkinsons disease patients have particular difculty maintaining
postural control while performing a secondary cognitive task.
20,21
In contrast, postural control has been shown to improve or be
maintained in healthy control participants while performing an
accompanying cognitive task.
18,19,22
While dual-task BT and pos-
tural stability decits have been demonstrated in Parkinsons
patients
23
and in brain injured adults,
5
each patient was assessed
only at a single time point. Whether dual-task interference during a
static balancetest occurs andremains adiscriminatingdeterminant
Please cite this article in press as: Dorman JC, et al. Tracking postural stability of young concussion patients using dual-task interference. J Sci
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Table 1
Comparison between the concussion patients (INJ) and healthy, normative subjects (NORM) on V1 and V2.
Balance condition Comparison Ellipse area Velocity
F P value F P value
Eyes open (O) Visit 1 (V1): INJ vs NORM 5.88 0.0161
*
8.03 0.0050
*
Visit 2 (V2): INJ vs NORM 0.19 0.6599 0.13 0.7187
Eyes open w/cognitive task (OT) V1: INJ vs NORM 7.44 0.0069
*
13.60 0.0003
*
V2: INJ vs NORM 6.28 0.0129
*
2.11 0.1475
Eyes closed (C) V1: INJ vs NORM 21.86 <.0001
*
16.85 <.0001
*
V2: INJ vs NORM 1.60 0.2072 0.23 0.6315
Eyes closed w/cognitive task (CT) V1: INJ vs NORM 47.46 <.0001
*
33.01 <.0001
*
V2: INJ vs NORM 7.51 0.0066
*
0.97 0.3248
NORM=healthy, normative participant; INJ =injured (concussion) patient.
*
Signicant difference between INJ and NORM.
of concussion resolve in patients over the course of their recovery
period has not been previously determined. Moreover, research to
date has only analyzed the short-term effects of concussions on
postural stability. This may have beenguidedby a seemingly preva-
lent perspective that postural stability decits usually resolve very
promptly.
16,17,24
Thedegreeof difcultyof thecognitivetask(recitingthemonths
backwards) may not have been uniformfor all individuals because
of the age range of the patients and inherent differences in men-
tal acuity. However, we utilized this particular cognitive task to
simply cause a secondary interference that was not overtly chal-
lenging (requiring a very high level of concentrated focus) among
a diverse group of individuals. No evaluation was made of whether
the task was successful or not. Moreover, more complex tasks
have demonstrated inconsistent interference in those with a brain
injury.
5
However, further exploration and consideration may be
warranted to determine a more discriminating cognitive challenge
that can be better standardized and is less affected by maturation
or learning.
The subjectivity of the PCSS ratings may permit an athlete
to intentionally mislead the examiner in order to return-to-play
more quickly or unintentionally because of the athletes inabil-
ity to accurately characterize symptoms. This may be further
encouraged by the conditioning of athletes to generally downplay
injuries or thinking that their symptoms are not related to brain
injury. Objective postural stability data should be combined with
other standard measures used in the diagnosis and management
of concussion (e.g. neurocognitive testing or reaction time). This
allows the clinician to reinforce and validate the reported PCSS
scores or more carefully examine patients who may have indicated
no symptoms or other more obvious signs related to ongo-
ing concussion-related physiological dysfunction and functional
decits.
A limitation of this study is that INJ and NORM participants
performed each of the four different postural stability tests only
one time during each visit. There also may have been a small
learning effect especially from V1 to V2. However, the same
potential learning effect would be similar in both groups. Also,
individuals may have practiced reciting the months of years back-
wards after V1. An increase in familiarity and comfort with this
task could have diminished the cognitive load during the dual-
task interference BT. Notably, we appreciate that there may be
age- and sex-specic responses in these outcome measures, as,
for example, female athletes with concussion have been shown
to have some differences from male athletes in reported symp-
toms and neurocognitive performance.
25,26
Accordingly, these
ndings can be generalized only to the specic age range
dened here and that individual responses may vary, based on
sex.
5. Conclusion
As the serious nature and potential long-term effects of mild
traumatic braininjury are increasingly appreciatedandrecognized,
it is imperative that medical professionals continue to develop
and rene new tools for assisting in the diagnosis and manage-
ment of concussions. BT is a promising method for enhancing
objective concussion evaluation. However, optimal protocols and
reference standards have not yet been established. Accordingly,
this research helps to establish the utility of this novel approach to
evaluating and tracking postural stability decits using dual-task
interference BT, while offering clinicians another potential objec-
tive means to assist in concussion assessment. This is the rst time
that the parallel tracking of postural stability decits and symp-
toms in post-concussion patients over the course of treatment has
beenreported. Our ndings further indicate that dual-task interfer-
ence BT may uniquely assist healthcare providers in making more
objective and appropriate return-to-play and unrestricted physi-
cal/cognitive activity determinations, as well as return-to-school
decisions for the student athlete.
Practical implications

Dual-task interference BT is a potentially viable and sensi-

tive method of evaluating postural stability and determining
functional decit and recovery in young concussion patients;
however, further investigation is warranted to establish clinical
relevance and utility.

Improvements in postural stability generally coincide with

reductions in reported symptoms, reinforcing a clinical determi-
nationof concussionresolutionwhenconsideringbothmeasures.

Given that a simple interference task demonstrated an added

value compared to balance alone, further research is warranted
to examine more challenging dual-task scenarios to extend the
utility of this approach.
Disclosure
Nothing to declare.
Acknowledgments
No additional dedicated nancial assistance was received for
this project. The authors sincerely thank our research volunteers
and their parents for their participation in this study.
Please cite this article in press as: Dorman JC, et al. Tracking postural stability of young concussion patients using dual-task interference. J Sci
Med Sport (2013), http://dx.doi.org/10.1016/j.jsams.2013.11.010
ARTICLE IN PRESS
GModel
JSAMS-972; No. of Pages 6
6 J.C. Dorman et al. / Journal of Science and Medicine in Sport xxx (2013) xxxxxx
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