Sport-related Concussion Group Research Articles

A-48 Comparative Analysis of Adolescents With a Sport-Related Concussion Versus Non-Sport-Related Concussion During Initial Visit

Abstract [Outstanding Trainee Award Winner] Purpose To investigate differences in pre-injury risk factors and clinical outcomes in adolescents with a Sport-Related Concussion (SRC) versus non-Sport-Related Concussion (non-SRC). Methods Participants (n=136, aged 10-18) presented to a specialty concussion clinic 2-30 (M=9.25) days post-injury. They completed a clinical interview with a trained clinician and were administered the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Post-Concussion Symptom Scale (PCSS), Concussion Clinical Profile Screening (CP Screen), Vestibular/Ocular-Motor Screening (VOMS), Screen for Child Related Anxiety Disorders - Child Version (SCARED-C), and the Generalized Anxiety Disorder Assessment (GAD-7). Data analyses utilized independent sample t-tests, chi-square tests, and descriptive statistics to compare clinical outcomes of both groups during initial visit. Alpha was set to p<.05 for all analyses. Results Adolescents with non-SRC took longer to seek specialty concussion care, were majority female, and were older than the SRC group. Non-SRC participants also reported a higher rate of migraine, depression, and anxiety history (i.e., SCARED-C Panic Disorder, SCARED-C Generalized Anxiety Disorder, and SCARED-C Anxiety Disorder). Additionally, non-SRC participants reported more symptoms on the PCSS Total score, and on most VOMS items, including Smooth Pursuits, Horizontal and Vertical Saccades, Horizontal and Vertical Vestibular-Ocular Reflex, Visual Motion Sensitivity, as well as VOMS Total. Non-SRC group also reported higher post-injury anxiety scores (i.e., GAD-7). All findings were below the p-value of .05. Conclusions The study findings suggest that mechanism of injury and individual risk factors play a significant role in determining the clinical presentation of a concussion in an SRC and non-SRC adolescent population.

The acute, systemic effects of aerobic exercise in recently concussed adolescent student-athletes: preliminary findings.

Examine the acute effects (pre-, during, post-intervention) of two different intensities of aerobic exercise or rest on autonomic, oculomotor, and vestibular function and symptom burden in patients with a recent sport-related concussion (SRC) and compare their responses to sex-matched, age-stratified, non-concussed (HEALTHY) student-athletes. Student-athletes between the ages of 13 and 18 that presented to the sports medicine clinic within Day 3-7 post-SRC and from local schools were recruited for a randomized controlled trial (RCT). The participants were administered the Vestibular/Ocular Motor Screening (VOMS), King-Devick (K-D), and Post-Concussion Symptom Scale (PCSS) before and after the intervention. Heart rate variability (HRV) and mean arterial pressure (MAP) were collected before, during, and after the intervention. The intervention was either a single, 20-min session of treadmill walking at 40% (40HR) or 60% of age-predicted max heart rate (60HR), or seated, rest (NOEX). 30 participants completed the intervention with the SRC group treated 4.5 ± 1.3days post-injury. Pre-exercise HRV and MAP were significantly different (p's < 0.001) during treatment but returned to pre-exercise values within 5min of recovery in both the SRC and HEALTHY groups. Both the SRC and HEALTHY groups exhibited similar reductions pre- to post-intervention for symptom severity and count (p's < 0.05), three VOMS items (p's < 0.05) but not K-D time. To date, this is the first adolescent RCT to report the acute, systemic effects of aerobic exercise on recently concussed adolescent athletes. The interventions appeared safe in SRC participants, were well-tolerated, and provided brief therapeutic benefit. Clinicaltrials.gov Identifier NCT03575455.

Utility of a Postural Stability/Perceptual Inhibition Dual Task for Identifying Concussion in Adolescents.

Research in the area of dual-task paradigms to assess sport-related concussion (SRC) status is growing, but additional assessment of this paradigm in adolescents is warranted. This case-control study compared 49 adolescent athletes aged 12-20 years with diagnosed SRC to 49 age- and sex-matched controls on visual-spatial discrimination and perceptual inhibition (PIT) reaction time tasks performed while balancing on floor/foam pad conditions. The SRC group completed measures at a single time point between 1 and 10 days postinjury. Primary outcomes were dual-task reaction time, accuracy, and sway. General linear models evaluated differences between groups (P < .05). Logistic regression identified predictors of concussion from outcomes. Area under the curve evaluated discriminative ability of identifying SRC. Results supported significantly higher anterior-posterior (AP) sway values in concussed participants for visual-spatial discrimination and PIT when balancing on the floor (P = .03) and foam pad (P = .03), as well as mediolateral sway values on the floor during visual-spatial discrimination (P = .01). Logistic regression analysis (R2 = .15; P = .001) of all dual-task outcomes identified AP postural sway during the PIT foam dual task as the only significant predictor of concussed status (ß = -2.4; P = .004). Total symptoms (area under the curve = 0.87; P < .001) and AP postural sway on foam (area under the curve = 0.70; P = .001) differentiated concussed from controls. The AP postural sway on foam during a postural stability/PIT dual task can identify concussion in adolescents between 1 and 10 days from injury.

Movement Patterns During a Jump-Landing Task in Athletes After Sport-Related Concussion and Healthy Control Individuals.

A relationship between a history of sport-related concussion (SRC) and lower extremity injury has been well established in the literature. To determine if biomechanical differences existed during a double-limb jump landing between athletes who had been released to return to play after SRC and healthy matched control individuals. Cross-sectional study. Health system-based outpatient sports medicine center. A total of 21 participants with SRC (age = 15.38 ± 1.77 years, height = 169.23 ± 8.59 cm, mass = 63.43 ± 7.39 kg, time since release to return to sport after SRC = 16.33 ± 12.7 days) were compared with 21 age-, sex-, and activity-matched healthy participants serving as controls (age = 15.36 ± 1.73 years, height = 169.92 ± 11.1 cm, mass = 65.62 ± 12.08 kg). Biomechanical performance during the double-limb jump landing was assessed using a motion-capture system and force plates. The average of 3 consecutive trials was used to calculate lower extremity joint kinetics and kinematics. The variables of interest were internal knee-extension moment, internal varus moment, and total sagittal-plane knee displacement for the dominant and nondominant limbs. Independent t tests were performed to examine the differences between SRC and control groups for the variables of interest. No differences existed between groups for the descriptive data. The SRC group demonstrated greater internal knee-extension moments in the dominant (-0.028 ± 0.009 Nm/kg, P = .003) and nondominant (-0.018 ± 0.007, P = .02) limbs. The SRC group also exhibited greater internal varus moments in the dominant (0.012 ± 0.004 Nm/kg, P = .005) and nondominant (0.010 ± 0.003, P = .005) limbs. For sagittal-plane knee displacement, the SRC group displayed less knee-flexion displacement in the dominant (-12.56 ± 4.67°, P = .01) but not the nondominant (-8.30 ± 4.91°, P = .10) limb. Athletes who had been released for return to sport after SRC landed with greater knee valgus than healthy matched control participants.

Compromised Resting Cerebral Metabolism After Sport-Related Concussion: A Calibrated MRI Study

Use calibrated MRI to model baseline cerebrovascular physiology parameters and investigate whether changes in resting cerebral blood flow (CBF0) following sport-related concussion (SRC) are concordant with changes in resting and dynamic cerebral physiologic markers, within two weeks of the injury. Altered CBF0 in the acute phase post-concussion may contribute to neurobehavioral deficiencies, often reported weeks after the injury. However, in addition to changes in CBF0, little is known about other physiologic mechanisms that may be disturbed within the cerebrovasculature. The aim of this study was to assess whether changes in baseline perfusion following SRC were co-localized with changes in cerebral metabolic demand. Forty-two subjects (15 SRC patients 8.0 ± 4.6 days post-injury and 27 age-matched healthy control athletes) were studied cross-sectionally. CBF0, cerebrovascular reactivity (CVR), resting oxygen extraction (OEF0) and cerebral metabolic rate of oxygen consumption (CMRO2|0) were measured using a combination of hypercapnic and hyperoxic breathing protocols, and the biophysical model developed in calibrated MRI. Blood Oxygenation Level Dependent and Arterial Spin Labelling data were acquired simultaneously using a dual-echo arterial spin labelling sequence. SRC patients showed significant decreases in CBF0 spread across the grey-matter (p < 0.05, corrected), and these differences were also confounded by the effects of baseline end-tidal CO2 (p < 0.0001). Lower perfusion was co-localized with reductions in regional CMRO2|0 (p = 0.006) post-SRC, despite finding no group-differences in OEF0 (p = 0.800). Higher CVR within voxels showing differences in CBF0 was also observed in the SRC group (p = 0.001), compared to controls. Reductions in metabolic demand despite no significant changes in OEF0 suggests that hypoperfusion post-SRC may reflect compromised metabolic function after the injury. These results provide novel insight about the possible pathophysiologic mechanisms underlying concussion that may affect the clinical recovery of athletes after sport-related head injuries.

Differences in Adolescent Symptom Reporting Following Motor Vehicle Accident Versus Sport-Related Concussion.

To characterize potential differences in youth concussion sustained in motor vehicle accident (MVA) versus sport-related concussion (SRC), hypothesizing that youth who sustain concussion in a MVA would endorse higher initial and persistent symptom scores compared to those with SRC, despite similar injury severity levels. Participants age 12-18 who sustained a concussion (i.e., Glasgow Coma Scale=13-15) in a MVA (n=35) were matched with SRC participants (n=35) by sex, age, and days since injury. ANCOVA comparing initial postconcussion total symptom scores between the MVA and SRC groups were performed. Chi-square analysis with injury group by recovery time was used to determine whether youth who sustained concussion from MVA were more likely to endorse symptoms persisting >30days at 3months postinjury, and ANCOVA compared 3-month total symptom scores. On average, the MVA group reported significantly higher initial postconcussion and more frequent persistent symptom scores compared to the SRC group. This is the first known study to examine context of injury in youth concussion while matching for injury severity, age, sex, and days since injury. Findings suggest the context of injury is an important clinical variable related to initial reporting of symptoms and endorsement of symptoms lasting more than 30days. Tailored interventions that consider the context of injury may facilitate symptom resolution.

Sensitivity and Specificity of On-Field Visible Signs of Concussion in the National Football League.

On-field visible signs (VS) are used to help identify sport-related concussion (SRC) in the National Football League (NFL). However, the predictive utility of a VS checklist for SRC is unknown. To report the frequency, sensitivity, specificity, and predictive value of VS in a cohort of NFL athletes. On-field VS ratings from 2 experts who independently reviewed video footage of a cohort of 251 injury plays that resulted in an SRC diagnosis (n=211) and no diagnosis (n=40) from the 2017 NFL season were examined. The frequency, sensitivity, specificity, and a receiver operating characteristic (ROC) curve with area under the curve (AUC) were calculated for each VS. Slow to get up (65.9%) and motor incoordination (28.4%) were the most frequent VS in concussed athletes, and slow to get up (60.0%) was the most common VS among nonconcussed athletes. The most sensitive VS was slow to get up (66%); the most specific signs in concussed NFL athletes were blank/vacant look and impact seizure (both 100%). Approximately 26% of concussed NFL players did not exhibit a VS, and the overall sensitivity and specificity for the VS checklist to detect SRC were 73% and 65%, respectively. The VS checklist demonstrated "poor" ability to discriminate between SRC and non-SRC groups (AUC=0.66). In the NFL, the diagnosis of concussion cannot be made from on-field VS alone. The VS checklist is one part of the comprehensive sideline/acute evaluation of concussion, and the diagnosis remains a multimodal clinical decision.

Commentary: Sensitivity and Specificity of On-Field Visible Signs of Concussion in the National Football League.

Davis, Gavin A MBBS, FRACS (Neurosurgery); Makdissi, Michael MBBS, PhD, FACSEP Author Information

Sport-related Concussions Have A More Conservative Stepping Pattern During Instrumented Tandem Gait Performance

Tandem gait has emerged as a dynamic and clinically viable test of dynamic motor control following sport-related concussion (SRC). A myriad of tools are available to objectively assess gait kinematics. One piece of equipment, the Tekscan Strideway, uses individual load cells on a series of connected force platform tiles to quantify gait. No data exists that examines the performance of SRC using this device. PURPOSE: The purpose of this study was to evaluate the differences in center of pressure (CoP) performance during single-task (ST) and dual-task (DT) tandem gait within 24-48 hours post-SRC. METHODS: 18 Division I [SRC (age: 19 ± 1.00 yr. Male=7, Female=11)] and 18 nearly matched controls [CON (age: 19.88 ± 1.05 yr. Male=7, Female=11)] completed the vestibular ocular motor screening test (VOMS) and 3 trials of ST and 1 trial of DT (serial 7s) using the Tekscan Strideway (30Hz, Boston, MA). The raw CoP trajectory for the best tandem gait trial of each condition (fastest overall) was exported and further analyzed using a custom MATLAB code. All turns during the tandem gait trials were removed and each straight path walking was composed together. The raw CoP data in the AP and ML directions were smoothed using empirical mode decomposition and then excursion and velocity data were calculated. T-tests compared the time to complete ST and DT while two multivariate ANOVAs compared CoP in the AP and ML directions. RESULTS: SRC took significantly longer to complete the ST trial (p=.006; SRC=14.2±4.4s, CON=10.8±2.1s) but not the DT trial (p=.279). The SRC group had a larger VOMS near-point convergence (NPC) (p=.007; SRC=9.5±5.5cm, CON=5.2±2.9cm) and a higher VOMS change score (p<.001; SRC=19.7±6.4, CON=0±0). A significant omnibus effect was noted in AP direction (p=.015) but not in the ML direction (p=.996) for the tandem gait CoP data. Follow-up comparisons noted that in the AP direction during ST, SRC had slower CoP excursion (p=.003; SRC=1.6±0.2cm, CON=1.9±0.4cm) and lower CoP velocity (p=.004; SRC=54.2±7.7cm/s, CON=66.1±14.2cm/s) but no differences during DT. CONCLUSIONS: These results suggest that during instrumented ST tandem gait, SRC have a more conservative and slower heel-to-toe stepping pattern.

A-43 Post-Traumatic Stress Symptoms in Sport-Related Concussion and Orthopedic Injury: An Initial Comparison

Abstract Objective Few studies have compared psychological responses to injury following sport-related concussion versus injury in general. The aim of this pilot investigation was to explore whether trauma-related stress symptoms differ between adolescents with sport-related concussion (SRC) vs. orthopedic injury (OI). Method Participants age 12-18 with SRC (n=48) or OI (n=12) presented to specialty clinics in the North Texas Concussion Registry (ConTex) within 21 days of injury (M= 6.7). Total scores from the PTSD Checklist for DSM-5 (PCL-5) were calculated (range=0-80). Independent t-test compared PCL-5 symptom scores between SRC and OI, and post-hoc analyses examined frequency of symptoms reported within each group. Results There was no significant difference between mean PCL-5 scores in SRC and OI groups, and both obtained scores above the typical cutoff for PTSD, defined as scores &amp;gt;30 (range= 0-46; SRC=10%, OI=16%). Most commonly reported symptoms for both SRC and OI were sleep problems, feeling jumpy, and being “super alert.” SRC subjects were more likely to report difficulty concentrating (SRC=42%; OI=16%), while OI subjects were more likely to report feeling distant from other people (OI=50%; SRC=20%). Conclusions While total post-traumatic stress symptoms may not differ between SRC and OI groups, there may be differences in individual trauma-related symptoms based upon the nature of injury. Both injury groups may be susceptible to sleep difficulties and hypervigilance, yet SRC individuals may experience more cognitive complaints, while OI may report more feelings of isolation. Furture studies will need to use the PCL-5 with larger sample sizes and recovery indices to provide a more detailed comparison of the injury groups.

Compromised resting cerebral metabolism after sport-related concussion: A calibrated MRI study

Altered resting cerebral blood flow (CBF0) in the acute phase post-concussion may contribute to neurobehavioral deficiencies, often reported weeks after the injury. However, in addition to changes in CBF0, little is known about other physiological mechanisms that may be disturbed within the cerebrovasculature. The aim of this study was to assess whether changes in baseline perfusion following sport-related concussion (SRC) were co-localized with changes in cerebral metabolic demand. Forty-two subjects (15 SRC patients 8.0 ± 4.6days post-injury and 27 age-matched healthy control athletes) were studied cross-sectionally. CBF0, cerebrovascular reactivity (CVR), resting oxygen extraction (OEF0) and cerebral metabolic rate of oxygen consumption (CMRO2|0) were measured using a combination of hypercapnic and hyperoxic breathing protocols, and the biophysical model developed in calibrated MRI. Blood oxygenation level dependent and perfusion data were acquired simultaneously using a dual-echo arterial spin labelling sequence. SRC patients showed significant decreases in CBF0 spread across the grey-matter (P < 0.05, corrected), and these differences were also confounded by the effects of baseline end-tidal CO2 (P < 0.0001). Lower perfusion was co-localized with reductions in regional CMRO2|0 (P = 0.006) post-SRC, despite finding no group-differences in OEF0 (P = 0.800). Higher CVR within voxels showing differences in CBF was also observed in the SRC group (P = 0.001), compared to controls. Reductions in metabolic demand despite no significant changes in OEF0 suggests that hypoperfusion post-SRC may reflect compromised metabolic function after the injury. These results provide novel insight about the possible pathophysiological mechanisms underlying concussion that may affect the clinical recovery of athletes after sport-related head injuries.

Baseline Postural Control and Lower Extremity Injury Incidence Among Those With a History of Concussion.

Lower extremity musculoskeletal (LEMSK) injury may be more prevalent among those with a history of sport-related concussion (SRC). To investigate the relationship between baseline postural control metrics and the LEMSK injury incidence in National Collegiate Athletic Association Division I student-athletes with a history of SRC. National Collegiate Athletic Association Division I athletes. Cohort study. Of 84 total athletes (62 males), 42 had been previously diagnosed with an SRC, and 42 were matched controls based on age, sex, height, weight, and sport. During the preseason baseline evaluation, all participants performed 3 trials of eyes-open and eyes-closed upright quiet stance on a force platform. Medical charts were assessed for all the LEMSK injuries that occurred from preseason baseline to 1 year later. Center-of-pressure data in the anteroposterior and mediolateral directions were filtered before we calculated root mean square and mean excursion velocity; the complexity index was calculated from the unfiltered data. Factorial analysis-of-variance models were used to examine differences between groups and across conditions for root mean square; mean excursion velocity, complexity index, and tests of association to examine between-groups LEMSK differences; and logistic regression models to predict LEMSK. Concussion history and injury incidence were related in the SRC group (P = .043). The complexity index of the SRC group was lower with eyes closed (14.08 ± 0.63 versus 15.93 ± 0.52) and eyes open (10.25 ± 0.52 vs 11.80 ± 0.57) in the mediolateral direction than for the control participants (P < .05). Eyes-open root mean square in the mediolateral direction was greater for the SRC group (5.00 ± 0.28 mm) than the control group (4.10 ± 0.22 mm). Logistic regression models significantly predicted LEMSK only in control participants. These findings may suggest that LEMSK after SRC cannot be predicted from postural-control metrics at baseline.

Executive Dysfunction after a Sport-Related Concussion Is Independent of Task-Based Symptom Burden.

A sport-related concussion (SRC) results in short- and long-term deficits in oculomotor control; however, it is unclear whether this change reflects executive dysfunction and/or a performance decrement caused by an increase in task-based symptom burden. Here, individuals with a SRC - and age- and sex-matched controls - completed an antisaccade task (i.e., saccade mirror-symmetrical to a target) during the early (initial assessment ≤12 days) and later (follow-up assessment <30 days) stages of recovery. Antisaccades were used because they require top-down executive control and exhibit performance decrements following an SRC. Reaction time (RT) and directional errors were included with pupillometry, because pupil size in the antisaccade task has been shown to provide a neural proxy for executive control. In addition, the Sport-Concussion Assessment Tool (SCAT-5) symptom checklist was completed prior to and after each oculomotor assessment to identify a possible task-based increase in symptomology. The SRC group yielded longer initial assessment RTs, more directional errors, and larger task-evoked pupil dilations (TEPD) than the control group. At the follow-up assessment, RTs for the SRC and control group did not reliably differ; however, the former demonstrated more directional errors and larger TEPDs. SCAT-5 symptom severity scores did not vary from the pre- to post-oculomotor evaluation for either initial or follow-up assessments. Accordingly, an SRC imparts a persistent executive dysfunction to oculomotor planning independent of a task-based increase in symptom burden. These findings evince that antisaccades serve as an effective tool to identify subtle executive deficits during the early and later stages of SRC recovery.

Smooth Pursuit and Saccades after Sport-Related Concussion.

Smooth pursuit eye movements (SPEMs) and saccadic eye movements are both commonly impaired following sport-related concussion (SRC). Typical oculomotor assessments measure individual eye movements in a series of restrictive tests designed to isolate features such as response times. These measures lack ecological validity for athletes because athletes are adept at simple tasks designed for the general population. Yet, because eye movement metrics are sensitive and well-characterized neuroanatomically, it would be valuable to test whether athletes exhibit abnormal eye movements with more challenging tasks. To address this gap in knowledge, we collected eye-tracking data during a sport-like task to gain insight on gaze behavior during active self-motion. SPEMs and saccadic eye movements were recorded during a sport-like visual task within 24-48 h following SRC. Thirty-six Division I student-athletes were divided into SRC and control (CON) groups. All participants completed two blocks of the Wii Fit© soccer heading game (WF) while wearing a monocular infrared eye tracker. Eye movement classification systems quantified saccadic amplitude (SA), velocity (SV), and count (SC); as well as SPEM velocity (SPV) and amplitude (SPA). Separate Mann-Whitney U tests evaluated SPA and SC and found no significant effects (SPA, p = 0.11; SC, p = 0.10). A multi-variate analysis of variance (MANOVA) for remaining variables revealed SPV was significantly greater in CON (p < 0.05), but the SRC group had greater SA and SV (p < 0.05). These findings suggest that during a sport-like task, to maintain foveation SRC subjects used larger amplitude, faster saccades, but exhibited slower SPEMs. Measuring oculomotor function during ecologically valid, sport-like tasks may serve as a concussion biomarker and provide insights into eye movement control after SRC.

Multimodal Assessment of Sport-Related Concussion.

The purpose of this study was to determine which assessments best identify athletes with sport-related concussion (SRC) from healthy controls in the acute/early subacute phase (within 10 days of SRC) of injury. Prospective, cohort study. Specialty concussion clinic. Sixty-four athletes with SRC (52% male) and 59 matched (age and sex), healthy controls (56% male) aged 12 to 20 years (Mean [M] = 15.07, Standard Deviation [SD] = 2.23). Participants completed symptom, cognitive, vestibular/oculomotor, near point of convergence (NPC), and balance assessments. Univariate analyses were conducted to compare athletes with SRC to healthy controls across all assessments. Assessments that significantly differed between the SRC group and healthy controls were used as predictors in an enter method logistic regression (LR) model and subsequent forward stepwise LR. Results of LR analyses indicated that symptom inventory and symptom provocation on vestibular/oculomotor assessments significantly predicted athletes with SRC versus controls. The forward stepwise LR accurately classified 84.6% of the overall sample (78.3% of athletes with SRC and 91.2% of controls were accurately predicted) and accounted for 60.5% of the variance in predicting athletes with SRC versus controls. Total symptom inventory score (P = 0.003) and vestibular/oculomotor symptom provocation (P < 0.01) were the most sensitive and specific measures in a comprehensive, multimodal assessment for distinguishing athletes with SRC from healthy controls within 10 days of injury. Elements within a multimodal evaluation that are the most robust at discriminating athletes with SRC from healthy controls in the acute/early subacute phase of injury include symptom report and provocation of symptoms on vestibular/oculomotor assessment. These assessments should be considered in conjunction with other objective assessments (ie, NPC measurement and cognitive testing) as part of a comprehensive evaluation of SRC.

Effect of Training Level on a Visuomotor Balance Task in Youth with Previous Sport-Related Concussion.

INTRODUCTION: The demands of sport require the integration of cognition and sensory inputs to produce more complex, goal-directed movement. Howell and colleagues (1) revealed that the differences in balance control between athletes with or without previous concussion were greater in youth compared young adults during dual-task gait. PURPOSE: 1) To determine if a novel visuomotor dynamic balance task can objectively identify differences between youth hockey players with/without sport-related concussion (SRC); and 2) If there are balance control differences between players who participate in minor hockey and private hockey academy training. METHODS: Youth hockey players (N=47; age=12-17 years), who reported previous SRC (n=17) and CONTROL (n=30). Group 1 was from a minor hockey team (SRC1=4; CONTROL1=12) and group 2 a private hockey academy (SRC2=13, CONTROL2=18). Participants stood in single support on a Nintendo Wii Balance board sampled at 100Hz and performed a lower limb reaching task with their non-stance foot. Five FitLights were arranged on the floor anteriorly at +60°, +30°, and 0° and were used as Go(GREEN)/No-Go(RED) stimuli. Balance control was assessed using RMS velocity of COP (vCOP) in anterior-posterior (A/P) and medial-lateral (M/L) planes. RESULTS: There were significant differences for both A/P vCOP (SRC= 8.04cm/s; CONTROL= 11.04cm/s, p <.05) and M/L vCOP (SRC= 6.27cm/s; CONTROL= 7.72cm/s, p <.05), as the SRC group performed the task slower than CONTROL There were no significant differences between SRC1 and SRC2 in vCOP A/P (p=0.50) or M/L (p=0.26) likewise for CONTROL1 and CONTROL2 vCOP A/P (p=0.88) and M/L (p=0.97). CONCLUSION: The assessment of a visuomotor dynamic balance task can objectively identify youth athletes with previous history of SRC regardless of training levels. Incorporating cognitive-motor tasks may help to improve balance control deficits in youth post-SRC and ensure true readiness for return-to-sport. 1. Howell DR, Osternig LR, Chou LS. Adolescents demonstrate greater gait balance control deficits after concussion than young adults. The American journal of sports medicine. 2015 Mar;43(3):625-32.