Lower Extremity Somatosensory Function Throughout Concussion Recovery: A Prospective Cohort Study

Landon B. Lempke, Matthew C. Hoch, Jarrod A. Call, Julianne D. Schmidt, Robert C. Lynall

Research output: Contribution to journalArticlepeer-review


Objective: Balance impairments may suggest somatosensory disruption beyond concussion clinical recovery, but somatosensory subsystems have never been directly assessed. Our objective was to examine somatosensory function between individuals with a concussion and healthy matched-controls at acute (<7 days) and asymptomatic (<72 hours of being symptom-free) time points. Setting: Laboratory. Participants: Participants with a concussion and matched controls (n = 24; 58% male, age: 19.3 ± 1.1 years, mass: 70.3 ± 16.4 kg, height: 177.3 ± 12.7 cm). Design: Prospective cohort. Main Measures: Somatosensory assessments on the dominant limb at both time points included: (1) plantar touch sensation threshold via Semmes-Weinstein monofilaments, (2) plantar pressure pain threshold via algometry, and (3) knee absolute passive joint repositioning (PJR) error via Biodex across 3 arcs (105°-75°, 30°-60°, 90°-45° knee-flexion). We used mixed-model analyses of variance, post hoc Tukey honestly significant difference t tests with mean difference, 95% CI, and Hedges' g effect sizes to examine outcomes. Results: Touch sensation had a group effect with the concussion cohort needing 0.95 grams of force (gf) more relative to controls (95% CI: 0.03 to 1.87; P =.043). No touch sensation interaction was present, but medium and large effects were observed for greater gf needed among the concussed cohort at the acute (1.11 gf; 95% CI: 0.17 to 2.05; g = 0.96) and asymptomatic time points (0.79 gf; 95% CI:-0.15 to 1.73; g = 0.73). No plantar pressure pain threshold effects were observed (P ≥.311), with negligible pressure difference magnitudes at the acute (0.26 pound force [lbf]/cm2; 95% CI:-1.54 to 2.06; g = 0.13) and medium magnitudes at the asymptomatic time points (0.99 lbf/cm2; 95% CI:-0.81 to 2.80; g = 0.42) for the concussed cohort needing more pressure to detect pain. The 30° to 60° PJR had a time effect, with asymptomatic time point having 3.12° better accuracy (95% CI: 1.23° to 5.02; P =.002). The concussed cohort had small-to-medium magnitude differences relative to controls at the acute time point for PJR during 105° to 75° (0.89°; g = 0.30) and 90° to 45° (0.62°; g = 0.17), but not 30° to 60° (-1.75°; g =-0.40). Conclusions: Individuals with a concussion exhibited large effects for diminished plantar touch sensation and small to medium effects for inhibited plantar pressure pain sensation compared with controls, which may indicate altered somatosensory function. Negligible PJR differences suggest knee joint position sense is not altered post-concussion. Pre-and postconcussion examination is warranted to understand causal somatosensory mechanisms.

Original languageEnglish
Pages (from-to)E156-E166
JournalJournal of Head Trauma Rehabilitation
Issue number2
StatePublished - Mar 1 2023

Bibliographical note

Funding Information:
This research was supported in part by the National Athletic Trainers' Association (NATA) Doctoral Student Grant from the NATA Research & Education Foundation, and the Southeast Athletic Trainers' Association (SEATA) Professional Grant from the SEATA Research and Education Committee.

Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.


  • balance
  • mild traumatic brain injury
  • proprioception
  • return to play
  • sensorimotor

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation
  • Clinical Neurology


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