title: Recovery of postural control after cerebral concussion: new insights using approximate entropy.
abstract: BACKGROUND
  The return-to-play decision after sport-related cerebral concussion depends in part on knowing when an athlete has fully recovered postural control after injury.
  
  
  OBJECTIVE
  To describe the postconcussion recovery of postural control using approximate entropy (ApEn), a regularity statistic from nonlinear dynamics.
  
  
  METHODS
  Retrospective case series analysis.
  
  
  METHODS
  Sports medicine research laboratory.
  
  
  METHODS
  Collegiate athletes from whom center-of-pressure and symptom data were collected at preseason, less than 48 hours after injury, and 48 to 96 hours after injury.
  
  
  METHODS
  Approximate entropy values reflecting the amount of randomness contained in center-of-pressure oscillations were calculated for anterior-posterior (AP) and medial-lateral (ML) time series. Equilibrium scores reflecting the amplitude of center-of-pressure AP oscillations were used to indicate postural stability. The number and severity of symptoms were described.
  
  
  RESULTS
  Compared with the healthy preseason state, ApEn values for the AP and ML time series generally declined immediately after injury in both steady and unsteady injured athletes. At 48 to 96 hours after injury, ApEn values for the ML time series remained significantly depressed (mean difference compared with preseason = -0.268, standard error = 0.072), even among athletes whose initial postural instability had resolved. We found few significant relationships between changes in ApEn values and changes in symptoms before and after injury.
  
  
  CONCLUSIONS
  The effects of cerebral concussion on postural control appear to persist for longer than 3 to 4 days, even among athletes with no signs of unsteadiness. Our results may reflect changes in neurophysiologic or mechanical constraints on postural control. Approximate entropy provides a theoretically distinct, valuable measurement alternative that may prove useful for reducing uncertainty in the return-to-play decision.
authors.affiliation: Department of Physical Therapy and Occupational Therapy, Duke University Medical Center, Durham, NC, USA. Jim.Cavanaugh@duke.edu
authors.forename: James T
authors.initials: JT
authors.lastname: Cavanaugh
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Guskiewicz
authors.forename: Carol
authors.initials: C
authors.lastname: Giuliani
authors.forename: Stephen
authors.initials: S
authors.lastname: Marshall
authors.forename: Vicki S
authors.initials: VS
authors.lastname: Mercer
authors.forename: Nicholas
authors.initials: N
authors.lastname: Stergiou