The Relationship Between Postural Control, Kinesiophobia, and Exercise in Collegiate Athletes With and Without Concussion

Concussion is defined as a traumatic brain injury caused by biomechanical forces to the head, neck, or body. It is recommended to evaluate and manage concussion by using a multidimensional approach consisting of measures of neurocognitive function, postural control, and symptomology. Balance deficits are common after concussion. However, the measures that are currently used to assess balance are typically static, subjective, or not time efficient. It is therefore pertinent to explore a measure such as the Limits of Stability (LOS) test which is dynamic, objective, and time efficient. An emerging psychological deficit associated with concussion is kinesiophobia (i.e. fear of movement). Kinesiophobia has been shown to be associated with a variety of deficits after concussion, including recovery time. However, the measure and clinical cutoff score (>37) used to evaluate clinically relevant kinesiophobia, the Tampa Scale of Kinesiophobia, was originally developed in a population of older adults with low back pain and therefore may not be applicable to collegiate athletes. In addition, given that kinesiophobia has been shown to associate with recovery time, it is imperative to explore interventions that may reduce fear of movement after a diagnosed concussion. This is especially important given the new recommendations to shift away from a “rest is best” approach in managing the injury. Prescribed exercise has been shown to have significant positive effects on symptom reduction and recovery time following concussion, however the mechanism by which exercise influences recovery is relatively unknown.

The following series of studies explored the intersection between postural control, kinesiophobia, and exercise following concussion in collegiate athletes. First (Manuscript I), we explored the reliability and validity of the Limits of Stability assessment in both healthy and concussed collegiate athletes. The primary findings were that the LOS was reliable and valid in detecting concussion related postural control deficits. Next (Manuscript II), we derived a new cutoff score for the Tampa Scale of Kinesiophobia specifically for collegiate athletes with concussion. We then aimed to determine if those with high fear of movement demonstrated postural control differences compared to those with low fear of movement using the newly derived clinical cutoff score. The primary findings were that the original cutoff is valid for collegiate athletes with concussion and that kinesiophobia was associated with slower reaction times in concussed athletes. Lastly (Manuscript III), we aimed to create, describe, and test an ecologically valid approach to enhance concussion recovery by leveraging a novel exercise prescription to reduce kinesiophobia, depression, anxiety, symptoms, and recovery time following a diagnosed concussion. The primary findings were that prescribing aerobic exercise using rating of perceived exertion was feasible and that considering exercise intensity may play an important role in reducing kinesiophobia and other psychological outcomes without significantly increasing recovery time.