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West SW, Shill IJ, Bailey S, Syrydiuk RA, Hayden KA, Palmer D, Black AM, Hagel BE, Stokes KA, Emery CA. Injury Rates, Mechanisms, Risk Factors and Prevention Strategies in Youth Rugby Union: What's All the Ruck-Us About? A Systematic Review and Meta-analysis. Sports Med 2023; 53:1375-1393. [PMID: 37191819 PMCID: PMC10290028 DOI: 10.1007/s40279-023-01826-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Rugby Union is a collision team sport played globally. Despite this, significant concerns have been raised regarding the sport's safety, particularly in youth players. Given this, a review of injury rates, risk factors and prevention strategies is required across different youth age groups as well as in males and females. OBJECTIVE The objective of this systematic review (SR) and meta-analysis was to investigate injury and concussion rates, risk factors and primary prevention strategies in youth rugby. METHODS To be included, studies were required to report either rates, risk factors or prevention strategies in youth rugby and to have a randomised controlled trial, quasi-experimental, cohort, case control, or ecological study design. Exclusion criteria included non-peer-reviewed grey literature, conference abstracts, case studies, previous systematic reviews and studies not written in English. Nine databases were searched. The full search strategy and list of sources are available and pre-registered on PROSPERO (Ref: CRD42020208343). Each study was assessed for risk of bias using the Downs and Black quality assessment tool. Meta-analyses were conducted using a DerSimonian Laird random effect model for each age group and sex. RESULTS Sixty-nine studies were included in this SR. The match injury rates (using a 24-h time-loss definition) were 40.2/1000 match hours (95% CI 13.9-66.5) in males and 69.0/1000 match hours (95% CI 46.8-91.2) in females. Concussion rates were 6.2/1000 player-hours (95% CI 5.0-7.4) for males and 33.9/1000 player-hours (95% CI: 24.1-43.7) for females. The most common injury site was lower extremity (males) and the head/neck (females). The most common injury type was ligament sprain (males) and concussion (females). The tackle was the most common event associated with injury in matches (55% male, 71% females). Median time loss was 21 days for males and 17 days for females. Twenty-three risk factors were reported. The risk factors with the strongest evidence were higher levels of play and increasing age. Primary injury prevention strategies were the focus of only eight studies and included law changes (n = 2), equipment (n = 4), education (n = 1) and training (n = 1). The prevention strategy with the most promising evidence was neuromuscular training. The primary limitations included a broad range of injury definitions (n = 9) and rate denominators (n = 11) used, as well as a limited number of studies which could be included in the meta-analysis for females (n = 2). CONCLUSION A focus on high-quality risk factor and primary prevention evaluation should be considered in future studies. Targeting primary prevention and stakeholder education remain key strategies in the prevention, recognition and management of injuries and concussions in youth rugby.
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Affiliation(s)
- Stephen W West
- Centre for Health, and Injury and Illness Prevention in Sport, University of Bath, Bath, UK.
- UK Collaborating Centre on Injury & Illness Prevention in Sport (UKCCIIS), Edinburgh & Bath, UK.
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada.
- O'Brien Institute of Public Health, University of Calgary, Calgary, Canada.
| | - Isla J Shill
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Stuart Bailey
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Reid A Syrydiuk
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor, USA
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Canada
| | - Debbie Palmer
- UK Collaborating Centre on Injury & Illness Prevention in Sport (UKCCIIS), Edinburgh & Bath, UK
- Edinburgh Sports Medicine Research Network, Institute for Sport, PE and Health Sciences, University of Edinburgh, Edinburgh, UK
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amanda M Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Brent E Hagel
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Keith A Stokes
- Centre for Health, and Injury and Illness Prevention in Sport, University of Bath, Bath, UK
- UK Collaborating Centre on Injury & Illness Prevention in Sport (UKCCIIS), Edinburgh & Bath, UK
- Rugby Football Union, Twickenham, London, UK
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Patricios JS, Schneider GM, van Ierssel J, Purcell LK, Davis GA, Echemendia RJ, Fremont P, Fuller GW, Herring SA, Harmon KG, Holte K, Loosemore M, Makdissi M, McCrea M, Meehan WP, O'Halloran P, Premji Z, Putukian M, Shill IJ, Turner M, Vaandering K, Webborn N, Yeates KO, Schneider KJ. Beyond acute concussion assessment to office management: a systematic review informing the development of a Sport Concussion Office Assessment Tool (SCOAT6) for adults and children. Br J Sports Med 2023; 57:737-748. [PMID: 37316204 DOI: 10.1136/bjsports-2023-106897] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To systematically review the scientific literature regarding the assessment of sport-related concussion (SRC) in the subacute phase (3-30 days) and provide recommendations for developing a Sport Concussion Office Assessment Tool (SCOAT6). DATA SOURCES MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, CINAHL, SPORTDiscus and Web of Science searched from 2001 to 2022. Data extracted included study design, population, definition of SRC diagnosis, outcome measure(s) and results. ELIGIBILITY CRITERIA (1) Original research, cohort studies, case-control studies, diagnostic accuracy and case series with samples >10; (2) SRC; (3) screening/technology that assessed SRC in the subacute period and (4) low risk of bias (ROB). ROB was performed using adapted Scottish Intercollegiate Guidelines Network criteria. Quality of evidence was evaluated using the Strength of Recommendation Taxonomy classification. RESULTS Of 9913 studies screened, 127 met inclusion, assessing 12 overlapping domains. Results were summarised narratively. Studies of acceptable (81) or high (2) quality were used to inform the SCOAT6, finding sufficient evidence for including the assessment of autonomic function, dual gait, vestibular ocular motor screening (VOMS) and mental health screening. CONCLUSION Current SRC tools have limited utility beyond 72 hours. Incorporation of a multimodal clinical assessment in the subacute phase of SRC may include symptom evaluation, orthostatic hypotension screen, verbal neurocognitive tests, cervical spine evaluation, neurological screen, Modified Balance Error Scoring System, single/dual task tandem gait, modified VOMS and provocative exercise tests. Screens for sleep disturbance, anxiety and depression are recommended. Studies to evaluate the psychometric properties, clinical feasibility in different environments and time frames are needed. PROSPERO REGISTRATION NUMBER CRD42020154787.
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Affiliation(s)
- Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Geoff M Schneider
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Laura K Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Ruben J Echemendia
- Psychology, University of Missouri, Kansas City, Missouri, USA
- University Orthopedics Concussion Care Clinic, State College Area School District, State College, Pennsylvania, USA
| | - Pierre Fremont
- Rehabilitation, Laval University, Quebec, Quebec, Canada
| | - Gordon Ward Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stanley A Herring
- Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | | | - Mike Loosemore
- Institute for Sport Exercise and Health, University Collage Hospital London, London, UK
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William P Meehan
- Sports Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
- Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Patrick O'Halloran
- Neurotrauma and Ophthalmology Research Group, University of Birmingham, Birmingham, UK
- Health Education England West Midlands, Edgbaston, UK
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | | | - Isla Jordan Shill
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
| | - Michael Turner
- International Concussion and Head Injury Research Foundation, London, UK
- University College London, London, UK
| | - Kenzie Vaandering
- University of Calgary Faculty of Kinesiology, Calgary, Alberta, Canada
| | - Nick Webborn
- Medical Committee, International Paralympic Committee, Bonn, Germany
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Huang Z, Xiao X. Characteristics of the postural stability of the lower limb in different visual states of undergraduate students with moderate myopia. Front Physiol 2023; 13:1092710. [PMID: 36685196 PMCID: PMC9846033 DOI: 10.3389/fphys.2022.1092710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023] Open
Abstract
Objective: To explore the characteristics of lower limb postural stability in undergraduates with moderate myopia in three different visual states. Methods: Twenty male undergraduate students were recruited to complete respectively the static and dynamic postural stability tests under eyes-closed, myopia (taking off their glasses immediately) and corrected vision conditions. A three-dimensional force platform (Bertec, United States) was used to test static postural stability, which calculated the total path length of the Center of Pressure (COP), path length in the antero-posterior (A/P) and medio-lateral (M/L) directions, COP area, SampleEntropy (SampEn), and low-, medium-, and high-frequency spectrum energies. Dynamic postural stability was tested using the Y-balance test, and the Y-balance test scores were calculated. The Vicon three-dimensional motion capture system (Oxford, United Kingdom) measured the maximum flexion angles of the ankle, knee, and hip joints. The electromyography (EMG) root mean square (RMS) and integral EMG (iEMG) of the tibialis anterior and lateral gastrocnemius of the lower extremity were simultaneously measured using wireless surface electromyography (Noraxon, United States). Results: The SampEn-A/P and SampEn-M/L of corrected vision state higher than myopia and eyes-closed states, and myopia state larger than eyes-closed state (χ2 = 51.631, p < .001). The original and standard scores of the anterior, postero-medial and comprehensive values of the three visual states had significant differences (F = 32.125, p < .001). The original and standard values of postero-lateral corrected vision and myopia were larger than those of eyes-closed states (F = 37.972, p < .001). The maximum flexion angles of the ankle and knee joints were in the following order: corrected vision, myopia and eyes-closed (F = 10.93, p < .001). The iEMG and RMS had significant differences in the three different states (χ2 = 12.700, p < .001) in the all directions of YBT. Conclusion: Compared with corrected vision, the stability of static posture in the state of myopia was decreased, and the postural regularity was more regular. The dynamic postural stability in the state of myopia was also lower than that corrected vision, and the activation and work of ankle muscles were also increased.
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Howell DR, Hunt DL, Oldham JR, Aaron SE, Meehan WP, Tan CO. Postconcussion Exercise Volume Associations With Depression, Anxiety, and Dizziness Symptoms, and Postural Stability: Preliminary Findings. J Head Trauma Rehabil 2022; 37:249-257. [PMID: 34320557 PMCID: PMC8789955 DOI: 10.1097/htr.0000000000000718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the association between postconcussion exercise volume and changes in depression, anxiety, dizziness, and postural stability. DESIGN Secondary analysis of a single-site prospective clinical trial. SETTING Cerebrovascular research laboratory. PARTICIPANTS Participants completed questionnaires and underwent tests of gait and balance within 2 weeks of a concussion (mean = 11 ± 3 days postconcussion) and approximately 1 month later (mean = 41 ± 7 days postconcussion). Exercise volume was tracked by weekly exercise logs. INTERVENTIONS On the basis of a previous work classifying exercise volume following concussion, we grouped participants according to self-reported exercise volume between visits as high exercise volume (≥150 min/wk) or low exercise volume (<150 min/wk). MAIN OUTCOME MEASURES Participants completed assessments evaluating anxiety and depression (Hospital Anxiety and Depression Scale), dizziness (Dizziness Handicap Inventory), and postural stability (tandem gait and modified Balance Error Scoring System). RESULTS Thirty-eight participants completed the study, of which 22 were in the high exercise volume group (mean = 71 ± 40 min/wk; 16.8 ± 2.1 years; 59% female) and 16 were in the low exercise volume group (mean = 379 ± 187 min/wk; 17.5 ± 2.1 years; 31% female). Although depression symptoms were not significantly different initially (mean difference = 1.5; 95% CI, -0.68 to 3.68; P = .24), the high exercise volume group had significantly lower depression symptom scores at follow-up (mean difference = 3.0; 95% CI, 1.40 to 4.47; P < .001). Anxiety symptoms (mean difference = 2.8; 95% CI, 0.3 to 5.4; P = 0.03), dizziness symptoms (mean difference = 10.9; 95% CI, 0.2 to 21.5; P = .047), single-task tandem gait (mean difference = 3.1 seconds; 95% CI, 0.2 to 6.0; P = .04), and dual-task tandem gait (mean difference = 4.2 seconds; 95% CI, 0.2 to 8.2; P = .04) were significantly better among the high exercise volume group. CONCLUSION Greater exercise volumes were associated with lower depression, anxiety, and dizziness symptoms, and faster tandem gait performance. These preliminary findings suggest a potentially beneficial role for exercise within several different domains commonly affected by concussion.
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Affiliation(s)
- David R Howell
- Children's Hospital Colorado and Department of Orthopedics, University of Colorado School of Medicine, Aurora (Dr Howell); Boston Children's Hospital, Boston, Massachusetts (Ms Hunt and Drs Oldham and Meehan); and Spaulding Rehabilitation Hospital, Cambridge, Massachusetts (Drs Aaron and Tan)
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Assessment of Dynamic Balancing Performance of Synchronized Ice Skaters With Sudden Provocation Test via Principal Component Analysis. JOURNAL OF MOTOR LEARNING AND DEVELOPMENT 2022. [DOI: 10.1123/jmld.2021-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Balancing performance can be affected by regular and high-level athletic training, which has not been fully explored in synchronized ice skaters. This study aimed to analyze the dynamic balancing performance by assessing the principal and compensatory movements performed during the sudden provocation tests and evaluating the parameters that characterize the platform’s motion. Method: Twelve young female synchronized ice skaters and 12 female age-matched controls participated. Sudden provocation tests were completed three times in bipedal stance and in single-leg stances, and sport-specific fatigue session was inserted between the repetitions. Results: Significantly more time was necessary to recover balance for both groups after the fatiguing sessions (p < .05). Interestingly, skaters performed less effectively in the simplest condition (bipedal stance) than the control group (p < .05). The principal component analysis showed that the first principal movement was the same for both groups. The skater group used the upper body and arms more often to compensate, while the control group’s recovery strategy consisted mainly of abduction of the elevated leg. The damping ratio and the relative variance of the first principal movement showed a negative correlation (p < .05), suggesting that those with superior balancing effectiveness recruited more compensatory movements.
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Sweeny M, Habib Perez O, Inness EL, Danells C, Chandra T, Foster E, Comper P, Bayley M, Mochizuki G. The Toronto concussion study: a cross-sectional analysis of balance deficits following acute concussion in community-dwelling adults. Brain Inj 2021; 35:587-595. [PMID: 33734923 DOI: 10.1080/02699052.2021.1891288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To characterize balance deficits in community-dwelling adults following acute concussion.Design: Cross-sectional observational study.Methods: Individuals with acute concussion (n=100) and healthy controls (n=20) completed the BESS (Balance Error Scoring System) and quiet standing trials on forceplates with the eyes open, closed, or during a cognitive dual task. BESS score and centre-of-pressure root mean square and high-frequency power (0.4-3Hz) were used to characterize group differences. In a secondary analysis, participants were subdivided based on self-reported symptoms of balance problems and dizziness using the SCAT-3 (Sport Concussion Assessment Tool - Third Edition) Symptom Checklist.Results: In comparing individuals with concussion and controls, BESS score (16.0 ± 6.0 vs 12.6 ± 3.8; F(1,116) = 5.814, p = .017) and anteroposterior [F(1.78, 204.2) = 11.93, p < .001] and mediolateral [F(1, 114) = 10.05, p = .002] high-frequency power revealed significant group differences. Dividing individuals based on self-reported symptoms revealed significant differences in mediolateral high frequency power, such that participants reporting balance and dizziness problems as well as those participants not reporting balance or dizziness symptoms following concussion were less stable than controls.Conclusions: Deficits in clinical and posturographic measures of balance occur in community-dwelling adults with concussion. These measures do not align with self-reported balance symptoms. Future research and clinical practice aimed at careful selection of optimized balance assessment is recommended.
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Affiliation(s)
- Michelle Sweeny
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Olinda Habib Perez
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute,Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Cynthia Danells
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Tharshini Chandra
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada
| | - Evan Foster
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada
| | - Paul Comper
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute,Faculty of Medicine, University of Toronto, Toronto, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - George Mochizuki
- Toronto Rehabilitation Institute -University Centre, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute,Faculty of Medicine, University of Toronto, Toronto, Canada.,School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada
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Development of Machine Learning Algorithms for the Determination of the Centre of Mass. Symmetry (Basel) 2021. [DOI: 10.3390/sym13030401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The study of the human body and its movements is still a matter of great interest today. Most of these issues have as their fulcrum the study of the balance characteristics of the human body and the determination of its Centre of Mass. In sports, a lot of attention is paid to improving and analysing the athlete’s performance. Almost all the techniques for determining the Centre of Mass make use of special sensors, which allow determining the physical magnitudes related to the different movements made by athletes. In this paper, a markerless method for determining the Centre of Mass of a subject has been studied, comparing it with a direct widely validated equipment such as the Wii Balance Board, which allows determining the coordinates of the Centre of Pressure. The Motion Capture technique was applied with the OpenPose software, a Computer Vision method boosted with the use of Convolution Neural Networks. Ten quasi-static analyses have been carried out. The results have shown an error of the Centre of Mass position, compared to that obtained from the Wii Balance Board, which has been considered acceptable given the complexity of the analysis. Furthermore, this method, despite the traditional methods based on the use of balances, can be used also for prediction of the vertical position of the Centre of Mass.
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