{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:58:57Z","timestamp":1760057937695,"version":"build-2065373602"},"reference-count":79,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T00:00:00Z","timestamp":1740700800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Funding Program for Research and Teaching (F\u00f6FoLe\u2013F\u00f6rderprogramm f\u00fcr Forschung und Lehre) LMU University Hospital, Ludwig-Maximilians-University Munich"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Mild traumatic brain injury (mTBI) in the pediatric population is a significant public health concern, often associated with persistent post-concussion symptoms, including postural instability. Current tools for assessing postural control, such as the Balance Error Scoring System (BESS), lack integration with objective metrics. Incorporating force plate sensors into BESS assessments may enhance diagnostic accuracy and support return-to-play or sports decisions. This study evaluates postural performance in children with mTBI compared to controls using an instrumented BESS and examines recovery trajectories after mTBI. Methods: This prospective, longitudinal study included 31 children with mTBI (12.01 \u00b1 3.28 years, 20 females) and 31 controls (12.31 \u00b1 3.27 years, 18 females). Postural control was assessed using an instrumented BESS protocol during standing on a ground reaction force plate at three timepoints: within 72 h post injury (T1), at two weeks (T2), and three months after trauma (T3). Posturographic parameters derived from the displacement of the center of pressure included the ellipse area, path length, and mean velocity in the anterior\u2013posterior and medio\u2013lateral directions. Symptom burden was monitored using the Post-Concussion Symptom Inventory (PCSI). Results: The BESS total scores did not differ significantly between the groups at any timepoint. A significant reduction in BESS errors over time was observed exclusively in the two-legged stance on a soft surface (p = 0.047). The instrumented BESS revealed higher body swaying in the mTBI group compared to controls, particularly under demanding conditions. Significant between-group differences were most frequently observed in single-leg soft surface (38% of comparisons) and two-legged soft surface stances (29%). In those cases, path length and mean velocity differed between groups, respectively. Ellipse area did not show significant differences across conditions. Conclusions: An instrumented BESS has the potential to enhance the detection of subtle postural deficits in pediatric mTBI patients. Specifically, more demanding conditions with altered sensory-proprioceptive input and path length as an outcome measure should be focused on. This study underscores the need for tailored and age-appropriate objective and quantitative balance assessments to improve diagnostic precision in pediatric mTBI populations.<\/jats:p>","DOI":"10.3390\/jcm14051666","type":"journal-article","created":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T04:10:42Z","timestamp":1740975042000},"page":"1666","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Balance Performance After Mild Traumatic Brain Injury in Children and Adolescents: Instrumented BESS in the Acute Situation and Over Time"],"prefix":"10.3390","volume":"14","author":[{"given":"Nils K. T.","family":"Sch\u00f6nberg","sequence":"first","affiliation":[{"name":"Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, LMU Munich, Dr. von Hauner Children\u2019s Hospital, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, LMU Munich, Dr. von Hauner Children\u2019s Hospital, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Korbinian","family":"Heinrich","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, LMU Munich, Dr. von Hauner Children\u2019s Hospital, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ida","family":"Kandler","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, LMU Munich, Dr. von Hauner Children\u2019s Hospital, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Graf","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, LMU Munich, Dr. von Hauner Children\u2019s Hospital, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rieke","family":"B\u00f6ddeker","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, LMU Munich, Dr. von Hauner Children\u2019s Hospital, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lea","family":"Zinke","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, LMU Munich, Dr. von Hauner Children\u2019s Hospital, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Fabri","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, LMU Munich, Dr. von Hauner Children\u2019s Hospital, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Wilke","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, LMU Munich, Dr. von Hauner Children\u2019s Hospital, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care and Emergency Medicine, Dr. von Hauner Children\u2019s Hospital, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6664-2012","authenticated-orcid":false,"given":"A. Sebastian","family":"Schr\u00f6der","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, LMU Munich, Dr. von Hauner Children\u2019s Hospital, 80336 Munich, Germany"},{"name":"Center for Child Neurology and Social Pediatrics, Child Centre Maulbronn, 75433 Maulbronn, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne-Sophie","family":"Holler","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Dr. von Hauner Children\u2019s Hospital, Ludwig-Maximilians-University (LMU), 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Fr\u00f6ba-Pohl","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Dr. von Hauner Children\u2019s Hospital, Ludwig-Maximilians-University (LMU), 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2790-4395","authenticated-orcid":false,"given":"Oliver","family":"Muensterer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Dr. von Hauner Children\u2019s Hospital, Ludwig-Maximilians-University (LMU), 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doreen","family":"Huppert","sequence":"additional","affiliation":[{"name":"German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University (LMU), LMU Hospital, 80539 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"H\u00f6sl","sequence":"additional","affiliation":[{"name":"Gait and Motion Analysis Laboratory, Sch\u00f6n Klinik Vogtareuth, 83569 Vogtareuth, Germany"},{"name":"Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3872-6136","authenticated-orcid":false,"given":"Florian","family":"Heinen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, LMU Munich, Dr. von Hauner Children\u2019s Hospital, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0995-9050","authenticated-orcid":false,"given":"Michaela V.","family":"Bonfert","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, LMU Munich, Dr. von Hauner Children\u2019s Hospital, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.wneu.2016.03.045","article-title":"Epidemiology of Global Pediatric Traumatic Brain Injury: Qualitative Review","volume":"91","author":"Dewan","year":"2016","journal-title":"World Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.neuchi.2020.02.002","article-title":"Definition and epidemiology of mild traumatic brain injury","volume":"67","author":"Cogne","year":"2021","journal-title":"Neurochirurgie"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.spen.2019.03.017","article-title":"Concussion: A Global Perspective","volume":"30","author":"Hon","year":"2019","journal-title":"Semin. 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