1
|
Tuncer D, Gurses HN. The Effects of Core Stabilization Exercises on Respiratory Muscle Strength, Respiratory Functions, and Postural Control in Children With Hearing Loss: A Randomized Controlled Trial. Ear Hear 2024; 45:306-315. [PMID: 37784232 DOI: 10.1097/aud.0000000000001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
OBJECTIVES To evaluate the effects of core stabilization training on respiratory muscle strength, respiratory functions, and postural control in children with hearing loss. DESIGN We conducted a randomized controlled trial at Bezmialem Vakif University, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation. Thirty children with hearing loss who were diagnosed with prelingual sensorineural hearing loss were randomly allocated to the study (n = 15, 12.20 ± 1.69 years) and control (n = 15, 11.87 ± 2.20 years) groups. Core stabilization training protocol was performed by the study group for 8 weeks, 5 days/week, whereas the control group received no training. The primary outcome measure was respiratory muscle strength. The secondary outcome measures were: spirometry, postural control tests on Biodex Balance System, and Balance Error Scoring System (BESS). Exercise adherence was recorded via a diary for home sessions. Outcomes were assessed at baseline and the end of the 8 weeks. RESULTS In the study group, a significant improvement was observed in force vital capacity, peak expiratory flow of the spirometry test, maximum inspiratory pressure/expiratory pressure (MEP) of the respiratory muscle strength test; postural stability test except "anterior/posterior stability index", limits of stability test except "backward" and "forward/right", all parameters of the Modified Clinical Test for Sensory Interaction and Balance (mCTSIB) test except "eyes closed firm surface" of the Biodex Balance System, and total score of BESS. Group × time interaction was found in MEP, "overall" stability index in postural stability test, "overall," "left," and "backward left" of limits of stability test, all parameters of the mCTSIB, and BESS total. CONCLUSIONS Core stabilization exercises were effective in improving respiratory muscle strength, spirometry, and postural control in children with hearing loss.
Collapse
Affiliation(s)
- Deniz Tuncer
- Cardiopulmonary Physiotherapy Rehabilitation Department, Institute of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey
| | - Hulya Nilgun Gurses
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
2
|
Schönberg NKT, Poppel J, Howell D, Wagner J, Höfinger M, Fabri N, Bonke EM, Rojczyk P, Hösl M, Kiwull L, Schröder SA, Blaschek A, Vill K, Koerte IK, Huppert D, Heinen F, Bonfert MV. Instrumented Balance Error Scoring System in Children and Adolescents-A Cross Sectional Study. Diagnostics (Basel) 2024; 14:513. [PMID: 38472985 DOI: 10.3390/diagnostics14050513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/14/2024] Open
Abstract
Background: The Balance Error Scoring System (BESS) is a commonly used method for clinically evaluating balance after traumatic brain injury. The utilization of force plates, characterized by their cost-effectiveness and portability, facilitates the integration of instrumentation into the BESS protocol. Despite the enhanced precision associated with instrumented measures, there remains a need to determine the clinical significance and feasibility of such measures within pediatric cohorts. Objective: To report a comprehensive set of posturographic measures obtained during instrumented BESS and to examine the concurrent validity, reliability, and feasibility of instrumented BESS in the pediatric point of care setting. Methods: Thirty-seven participants (18 female; aged 13.32 ± 3.31 years) performed BESS while standing on a force plate to simultaneously compute stabilometric measures (instrumented BESS). Ellipse area (EA), path length (PL), and sway velocity (VM) were obtained for each of the six BESS positions and compared with the respective BESS scores. Additionally, the effects of sex and age were explored. A second BESS repetition was performed to evaluate the test-retest reliability. Feedback questionnaires were handed out after testing to evaluate the feasibility of the proposed protocol. Results: The BESS total score was 20.81 ± 6.28. While there was no statistically significant age or sex dependency in the BESS results, instrumented posturography demonstrated an age dependency in EA, VM, and PL. The one-leg stance on a soft surface resulted in the highest BESS score (8.38 ± 1.76), EA (218.78 cm2 ± 168.65), PL (4386.91 mm ± 1859.00), and VM (21.93 mm/s ± 9.29). The Spearman's coefficient displayed moderate to high correlations between the EA (rs = 0.429-0.770, p = 0.001-0.009), PL (rs = 0.451-0.809, p = 0.001-0.006), and VM (rs = 0.451-0.809, p = 0.001-0.006) when compared with the BESS scores for all testing positions, except for the one-leg stance on a soft surface. The BESS total score significantly correlated during the first and second repetition (rs = 0.734, p ≤ 0.001), as did errors during the different testing positions (rs = 0.489-0.799, p ≤ 0.001-0.002), except during the two-legged stance on a soft surface. VM and PL correlated significantly in all testing positions (rs = 0.465-0.675, p ≤ 0.001-0.004; (rs = 0.465-0.675, p ≤ 0.001-0.004), as did EA for all positions except for the two-legged stance on a soft surface (rs = 0.392-0.581, p ≤ 0.001-0.016). A total of 92% of participants stated that the instructions for the testing procedure were very well-explained, while 78% of participants enjoyed the balance testing, and 61% of participants could not decide whether the testing was easy or hard to perform. Conclusions: Instrumented posturography may complement clinical assessment in investigating postural control in children and adolescents. While the BESS score only allows for the consideration of a total score approximating postural control, instrumented posturography offers several parameters representing the responsiveness and magnitude of body sway as well as a more differentiated analysis of movement trajectory. Concise instrumented posturography protocols should be developed to augment neuropediatric assessments in cases where a deficiency in postural control is suspected, potentially stemming from disruptions in the processing of visual, proprioceptive, and/or vestibular information.
Collapse
Affiliation(s)
- Nils K T Schönberg
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Julius Poppel
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - David Howell
- Department of Orthopedics, University of Colorado School of Medicine, Colorado Children's Hospital, Sports Medicine Center, Aurora, CO 80045, USA
| | - Johanna Wagner
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Michael Höfinger
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Nicole Fabri
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Elena M Bonke
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Philine Rojczyk
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Matthias Hösl
- Gait and Motion Analysis Laboratory, Schoen Clinic Vogtareuth, 83569 Vogtareuth, Germany
| | - Lorenz Kiwull
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
- Clinic for Child Neurology and Social Pediatrics, Kinderzentrum Maulbronn gGmbH, 75433 Maulbronn, Germany
| | - Sebastian A Schröder
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Clinic for Child Neurology and Social Pediatrics, Kinderzentrum Maulbronn gGmbH, 75433 Maulbronn, Germany
| | - Astrid Blaschek
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Katharina Vill
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Florian Heinen
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Michaela V Bonfert
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| |
Collapse
|
3
|
Mangum LC, Skibski A, Devorski L, Slater L. Balance Error Scoring System Performance Differences in Figure Skaters Based on Discipline. Int J Sports Phys Ther 2023; 18:898-904. [PMID: 37547844 PMCID: PMC10399104 DOI: 10.26603/001c.81598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/07/2023] [Indexed: 08/08/2023] Open
Abstract
Background Balance and postural stability are required of figure skaters throughout on-ice performance. Spinning, jumping, and landing each rely on this skill set to maintain control while skaters manage changing demands for each skating discipline. Hypothesis/Purpose The aim of this study was to compare balance error scoring system (BESS) performance in figure skaters between disciplines and determine if age was related to BESS performance. Study Design Cross-sectional study. Methods Three hundred and fifty-eight figure skaters (age: 15.4±3.3 years, 213 females, 145 males) of multiple disciplines completed the BESS during the United States Figure Skating's Standardized Testing of Athleticism to Recognize Skaters (S.T.A.R.S.) combine. Errors during each condition of the BESS were recorded by trained evaluators. A 3x6 ANOVA was used to determine BESS differences based on skating discipline. Spearman's rho (ρ) correlation coefficients were calculated for relationships between BESS errors and age. Results Ice dancers had more errors than singles and pairs for bipedal foam (p<0.001) but had fewer errors than single skaters for single leg foam (p=0.002). Tandem on a firm surface also showed an increase in errors for ice dancers and pairs skaters compared to singles (p<0.001). There were significant weak negative relationships noted between age and bipedal foam and single leg firm conditions (ρ=-0.14, -0.23, p<0.05). Conclusion Figure skaters of different disciplines have varying levels of static postural stability. Assessing postural stability in figure skaters can provide insight to improve performance and may identify skaters at risk of injury. Level of Evidence 3©The Author(s).
Collapse
Affiliation(s)
- L Colby Mangum
- Kinesiology and Rehabilitation Sciences University of Central Florida
| | - Andrew Skibski
- Kinesiology and Rehabilitation Sciences University of Central Florida
| | - Luk Devorski
- Kinesiology and Rehabilitation Sciences University of Central Florida
| | - Lindsay Slater
- Physical Therapy University of Illinois at Chicago
- Athlete High Performance United States Figure Skating
| |
Collapse
|
4
|
Echemendia RJ, Burma JS, Bruce JM, Davis GA, Giza CC, Guskiewicz KM, Naidu D, Black AM, Broglio S, Kemp S, Patricios JS, Putukian M, Zemek R, Arango-Lasprilla JC, Bailey CM, Brett BL, Didehbani N, Gioia G, Herring SA, Howell D, Master CL, Valovich McLeod TC, Meehan WP, Premji Z, Salmon D, van Ierssel J, Bhathela N, Makdissi M, Walton SR, Kissick J, Pardini J, Schneider KJ. Acute evaluation of sport-related concussion and implications for the Sport Concussion Assessment Tool (SCAT6) for adults, adolescents and children: a systematic review. Br J Sports Med 2023; 57:722-735. [PMID: 37316213 DOI: 10.1136/bjsports-2022-106661] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To systematically review the scientific literature regarding the acute assessment of sport-related concussion (SRC) and provide recommendations for improving the Sport Concussion Assessment Tool (SCAT6). DATA SOURCES Systematic searches of seven databases from 2001 to 2022 using key words and controlled vocabulary relevant to concussion, sports, SCAT, and acute evaluation. ELIGIBILITY CRITERIA (1) Original research articles, cohort studies, case-control studies, and case series with a sample of >10; (2) ≥80% SRC; and (3) studies using a screening tool/technology to assess SRC acutely (<7 days), and/or studies containing psychometric/normative data for common tools used to assess SRC. DATA EXTRACTION Separate reviews were conducted involving six subdomains: Cognition, Balance/Postural Stability, Oculomotor/Cervical/Vestibular, Emerging Technologies, and Neurological Examination/Autonomic Dysfunction. Paediatric/Child studies were included in each subdomain. Risk of Bias and study quality were rated by coauthors using a modified SIGN (Scottish Intercollegiate Guidelines Network) tool. RESULTS Out of 12 192 articles screened, 612 were included (189 normative data and 423 SRC assessment studies). Of these, 183 focused on cognition, 126 balance/postural stability, 76 oculomotor/cervical/vestibular, 142 emerging technologies, 13 neurological examination/autonomic dysfunction, and 23 paediatric/child SCAT. The SCAT discriminates between concussed and non-concussed athletes within 72 hours of injury with diminishing utility up to 7 days post injury. Ceiling effects were apparent on the 5-word list learning and concentration subtests. More challenging tests, including the 10-word list, were recommended. Test-retest data revealed limitations in temporal stability. Studies primarily originated in North America with scant data on children. CONCLUSION Support exists for using the SCAT within the acute phase of injury. Maximal utility occurs within the first 72 hours and then diminishes up to 7 days after injury. The SCAT has limited utility as a return to play tool beyond 7 days. Empirical data are limited in pre-adolescents, women, sport type, geographical and culturally diverse populations and para athletes. PROSPERO REGISTRATION NUMBER CRD42020154787.
Collapse
Affiliation(s)
- Ruben J Echemendia
- Concussion Care Clinic, University Orthopedics, State College, Pennsylvania, USA
- University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jared M Bruce
- Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dhiren Naidu
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Simon Kemp
- Sports Medicine, Rugby Football Union, London, UK
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | | | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Christopher M Bailey
- Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Benjamin L Brett
- Neurosurgery/ Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Gerry Gioia
- Depts of Pediatrics and Psychiatry & Behavioral Sciences, Children's National Health System, Washington, District of Columbia, USA
| | - Stanley A Herring
- Department of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - David Howell
- Orthopedics, Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Tamara C Valovich McLeod
- Department of Athletic Training and School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
| | - William P Meehan
- Sports Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
- Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | | | | | - Neil Bhathela
- UCLA Health Steve Tisch BrainSPORT Program, Los Angeles, California, USA
| | - 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
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, School of Medicine, Richmond, Virginia, USA
| | - James Kissick
- Dept of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie Pardini
- Departments of Internal Medicine and Neurology, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
5
|
Psychometric properties of functional postural control tests in children: A systematic review. Ann Phys Rehabil Med 2023; 66:101729. [PMID: 36669385 DOI: 10.1016/j.rehab.2022.101729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/10/2022] [Accepted: 11/04/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Postural control deficits are one of the most common impairments treated in pediatric physiotherapeutic practice. Adequate evaluation of these deficits is imperative to identify postural control deficits, plan treatment and assess efficacy. Currently, there is no gold standard evaluation for postural control deficits. However, the number of studies investigating the psychometric properties of functional pediatric postural control tests has increased significantly. OBJECTIVE To facilitate the selection of an appropriate pediatric functional postural control test in research and clinical practice. METHODS Systematic review following the PRISMA guidelines. PubMed, Web of Science and Scopus were systematically searched (last update: June 2022; PROSPERO: CRD42021246995). Studies were selected using the PICOs-method (pediatric populations (P), functional assessment tools for postural control (I) and psychometric properties (O). The risk of bias was rated with the COSMIN checklist and the level of evidence was determined with GRADE. For each test, the postural control systems were mapped, and the psychometric properties were extracted. RESULTS Seventy studies investigating 26 different postural control tests were included. Most children were healthy or had cerebral palsy. Overall, the evidence for all measurement properties was low to very low. Most tests (95%) showed good reliability (ICC>0.70), but inconsistent validity results. Structural validity, internal consistency and responsiveness were only available for 3 tests. Only the Kids-BESTest and FAB covered all postural control systems. CONCLUSION Currently, 2 functional tests encompass the entire construct of postural control. Although reliability is overall good, validity results depend on task, age and pathology. Future research should focus on test batteries and should particularly explore structural validity and responsiveness in different populations with methodologically strong study designs.
Collapse
|
6
|
Footwear Type and Testing Environment Do Not Affect Baseline Modified Balance Error Scoring System Performance Among Middle School Athletes. J Sport Rehabil 2023; 32:9-13. [PMID: 35894918 DOI: 10.1123/jsr.2021-0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 01/03/2023]
Abstract
CONTEXT Limited evidence exists to demonstrate the effect of extrinsic factors, such as footwear worn or the testing environment, on performance of the modified balance error scoring system (mBESS) in the middle school age (10-14 y) population. Therefore, the purpose of our study was to investigate the effect of footwear types and testing environments on performance of the mBESS by middle school athletes. DESIGN Cross-sectional. METHODS In total, 2667 middle school athletes (55.9% boys and 44.1% girls; age = 12.3 [0.94] y) were administered the mBESS while wearing their self-selected footwear (barefoot, cleats, or shoes) either indoors (basketball court) or outdoors (football field or track). The number of errors committed (range = 0-10) during the double-leg, single-leg, and tandem stances of the mBESS were summed to calculate a total score (range = 0-30). Kruskal-Wallis tests were used to assess for differences among the footwear groups for each mBESS stance and the total score. Mann-Whitney U tests with calculated nonparametric effect sizes (r) were used to assess for differences between the footwear groups and testing environments when appropriate. RESULTS There were significant differences for the number of committed errors among the footwear groups in the single-leg (P < .001) and tandem (P < .001) stances of the mBESS and mBESS total scores (P < .001). Significantly fewer errors (better) were committed while wearing shoes compared with other footwear in the single-leg and tandem stances of the mBESS (Ps ≤ .032, r = .07-.13). Participants assessed indoors committed significantly fewer errors than those assessed outdoors in each stance of the mBESS (Ps ≤ .022, r = .04-.14). Lower (better) mBESS total scores were observed for participants while wearing shoes (Ps ≤ .002, r = .10-.15) or assessed indoors (P = .001, r = .14). CONCLUSIONS Although our data suggest that the type of footwear worn and the testing environment have a significant effect on mBESS scores of middle school athletes, the magnitudes of these differences are negligible.
Collapse
|
7
|
Tuncer D, Gurses HN, Senaran H, Uzer G, Tuncay I. Evaluation of postural control in children with increased femoral anteversion. Gait Posture 2022; 95:109-114. [PMID: 35472734 DOI: 10.1016/j.gaitpost.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/25/2022] [Accepted: 04/14/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Femoral anteversion is defined as the angular difference between the axis of the femoral neck and the transcondylar axis of the knee and the most common cause of an in-toe gait in children. RESEARCH QUESTION Does increased femoral anteversion (IFA) adversely affect postural stability and balance in healthy children? METHODS Sixteen children with IFA aged 10-15 years and an age-matched control group of 16 children who were growing typically were included. Postural stability (PS), limits of stability (LoS), and the modified clinical test of sensory integration of balance (mCTSIB) were used to evaluate postural control by "Biodex Balance System® (BBS)" and Balance Error Scoring System (BESS), which is a visual observation of instability in 3 stance positions under 6 different conditions, were performed for all cases. SPSS v.20 program was used for data analysis. Independent Samples T-test or Mann Whitney U test were used for between-group comparisons depending on the distribution properties of the data. The significance level was set at p < 0.05. RESULTS A significant difference was found between the groups for overall and anterior/posterior stability index in PS (p < 0.05), all parameters of LoS (p < 0.05) and mCTSIB (p < 0.05). Also there was a significant difference between the BESS firm surface (p = 0.007), BESS foam surface (p < 0.001), and total surface scores (p < 0.001). SIGNIFICANCE The results indicate that the children with IFA were significantly more unstable in all parameters of BBS and BESS when compared to their healthy peers. This shows that postural stability and balance are impaired in healthy children with IFA. To the extent of our knowledge, this study is the first to examine the postural control problems associated with IFA in healthy children.
Collapse
Affiliation(s)
- Deniz Tuncer
- Bezmialem Vakif University, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Merkez Mahallesi, Silahtarağa Caddesi, No: 189, Eyupsultan, Istanbul 34050, Turkey.
| | - Hulya Nilgun Gurses
- Bezmialem Vakif University, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Merkez Mahallesi, Silahtarağa Caddesi, No: 189, Eyupsultan, Istanbul 34050, Turkey; Bezmialem Vakif University, Faculty of Health Sciences Department of Cardiopulmonary Physiotherapy and Rehabilitation, Merkez Mahallesi, Silahtarağa Caddesi, No:189, Eyupsultan, Istanbul 34050, Turkey.
| | - Hakan Senaran
- Bezmialem Vakif University, Faculty of Medicine, Department of Orthopedics and Traumatology, Adnan Menderes Bulvarı, Vatan Caddesi, Fatih, Istanbul 34093, Turkey.
| | - Gokcer Uzer
- Bezmialem Vakif University, Faculty of Medicine, Department of Orthopedics and Traumatology, Adnan Menderes Bulvarı, Vatan Caddesi, Fatih, Istanbul 34093, Turkey.
| | - Ibrahim Tuncay
- Bezmialem Vakif University, Faculty of Medicine, Department of Orthopedics and Traumatology, Adnan Menderes Bulvarı, Vatan Caddesi, Fatih, Istanbul 34093, Turkey.
| |
Collapse
|
8
|
Contributions of PCSS, BESS, Tandem Gait, and Romberg Test for Identifying Balance Deficits in Pediatric Concussions. J Head Trauma Rehabil 2021; 37:E129-E134. [PMID: 34145162 DOI: 10.1097/htr.0000000000000702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Balance deficits are common after concussions in pediatric patients. This study evaluates 3 clinical tools for identifying postconcussion balance deficits in a pediatric population: (1) Post-Concussion Symptom Scale (PCSS); (2) Balance Error Scoring System (BESS); and (3) physical examination measures of balance: tandem gait (TG) and Romberg test. SETTING Data were collected in a tertiary care outpatient pediatric sports medicine clinic. PARTICIPANTS English-speaking patients aged 8 to 17 years who presented to a tertiary care hospital-based pediatric sports medicine clinic and diagnosed with concussion between August 2014 and February 2018 were invited to participate. A total of 614 patients were screened and/or approached during the inclusion period and 500 were enrolled. Of those enrolled, 423 patients had complete data collected and analyzed. DESIGN This is a cross-sectional, observational data set from a longitudinal, prospective study. MAIN MEASURES Data extracted from patients' electronic medical records included physical examination, PCSS, and BESS scores from their initial visit. Descriptive statistics were calculated for the outcome measures. A logistic regression was performed to evaluate significant contributors to abnormal BESS score (≥25). RESULTS There were 423 patients (56.7% female; 14.7 ± 2.01 years old) included in the study. Overall, we identified 336 patients (79.4%) with balance difficulties. Of the 336 with balance difficulties, 284 (84.5%) reported "balance problems" and/or "dizziness" on PCSS, 153 (45.5%) had abnormal BESS scores (≥25), and 100 (29.8%) had an abnormality on either TG or Romberg test. CONCLUSION Balance difficulties were identified in close to 80% of children with concussions. Using PCSS and BESS along with physical examination measures, TG and Romberg test, identified more patients with balance deficits than using TG and Romberg test alone.
Collapse
|
9
|
Kuo KT, Hunter BC, Obayashi M, Lider J, Teramoto M, Cortez M, Hansen C. Novice vs expert inter-rater reliability of the balance error scoring system in children between the ages of 5 and 14. Gait Posture 2021; 86:13-16. [PMID: 33668005 DOI: 10.1016/j.gaitpost.2021.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 01/22/2021] [Accepted: 02/23/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Balance Error Scoring System (BESS) is a tool to measure balance, however, no studies have shown its reliability between novice and expert raters. RESEARCH QUESTION What is the inter-rater reliability of BESS measurements when performed by novice raters compared to experts, and does completion of a focused, online training module increase the inter-rater reliability among novice raters? METHODS In this reliability study, 5 novice volunteers were asked to independently rate BESS tests from 50 random prerecorded BESS videos of normal healthy subjects aged 5-14. Novice raters regraded the same 50 videos after receiving a formal training. The novices' scores before and after the formal training were compared to one another and then the scores were compared to 4 expert scores. Intraclass correlation (ICC) with 95 % confidence intervals or percent agreements were calculated and compared across groups. RESULTS For the total BESS score, novice raters showed good reliability (ICC 0.845) which did not change with a formal training (ICC 0.846). Expert raters showed excellent reliability (ICC 0.929). Poor to moderate reliability was noted in the foam stance-single leg in the untrained novice and trained novice group (ICCs 0.452 and 0.64 L respectively). SIGNIFICANCE BESS testing by novice raters with only written instruction and no formal training yields good inter-rater reliability. In contrast, BESS testing by expert raters yields excellent reliability. A focused training for novice raters conferred a small improvement in the reliability of the scoring of the single leg stance on foam condition but not a significant difference to the overall BESS score. While novices demonstrated promising reliability for overall BESS scores, optimizing clinical research using the BESS with expert raters show the highest reliability.
Collapse
Affiliation(s)
- Keith T Kuo
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, USA.
| | | | - Mizuho Obayashi
- Johns Hopkins University Krieger School of Arts & Science, Baltimore, MD, USA
| | - Joshua Lider
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Masaru Teramoto
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Melissa Cortez
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Colby Hansen
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
10
|
Differences in inhibitory control and motor fitness in children practicing open and closed skill sports. Sci Rep 2021; 11:4033. [PMID: 33597630 PMCID: PMC7889632 DOI: 10.1038/s41598-021-82698-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/13/2021] [Indexed: 01/19/2023] Open
Abstract
The aim of the present study was to investigate the differences between types of sport (i.e., closed vs. open skills sport) on inhibitory control and motor fitness in children. Forty-nine children were allocated into three groups based on their sports participation, which comprised an open skill sport group, a closed skill sport group, and a sedentary group. Participants were tested on cognitive performance (inhibitory control by the Flanker task) and motor fitness (reaction time, speed, agility, power, balance). Open skill sport group appeared to display higher inhibitory control (response time and accuracy of incongruent condition of the Flanker task) and motor fitness performance (reaction time, speed, agility, power) than sedentary group, whereas its superiority over closed skill sport group was found only in speed and agility. Moreover, closed skill sport group had only a better reaction time than sedentary group. Our data supports the framework according to which cognitive demands in complex motor actions may contribute to explain the beneficial effects of exercise on inhibitory control. This might suggest that the complexity of the environment (typical in open skill sports) in which sport training is performed plays a key role for both cognitive and motor development in children.
Collapse
|
11
|
Relationship between Cognitive Functions and Sport-Specific Physical Performance in Youth Volleyball Players. Brain Sci 2021; 11:brainsci11020227. [PMID: 33673260 PMCID: PMC7917811 DOI: 10.3390/brainsci11020227] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/20/2021] [Accepted: 02/06/2021] [Indexed: 01/27/2023] Open
Abstract
The aim of this study was to investigate the relationship between basic cognitive functions and sport-specific physical performance in young volleyball players. Forty-three female volleyball players (age 11.2 ± 0.8 years) were tested for cognitive performance by measuring simple reaction time (clinical reaction time), executive control (Flanker task), and perceptual speed (visual search task). Moreover, a set of tests was used to assess physical abilities as volleyball-specific skills (accuracy of setting, passing, and serving) and motor skills (change of direction, vertical jump, and balance). A cumulated value for both cognitive and sport-specific physical performance tests was computed by adding up each test’s domain outcomes. Pearson’s r correlation analysis showed a large positive correlation (r = 0.45, d-value = 1.01) of the cumulated score summarizing cognitive functions with the cumulated score summarizing sport-specific physical performance. Moreover, small-to-medium correlations (d-value from 0.63 to 0.73) were found between cognitive and motor skills. Given the cumulative scores, these results suggest that volleyball athletes with superior basic cognitive functions present better sport-specific physical performance. Our findings encourage to extend the knowledge of the associations between cognitive and motor skills within a sports performance context.
Collapse
|
12
|
Normative Data for the Balance Error Scoring System in Iranian Adults. J Sport Rehabil 2020; 30:408-413. [PMID: 32732449 DOI: 10.1123/jsr.2019-0482] [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] [Received: 11/10/2019] [Revised: 04/30/2020] [Accepted: 05/22/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT The Balance Error Scoring System (BESS), originally designed to diagnose and assess athletes with concussion syndrome, is now widely used to evaluate postural stability. To interpret balance status, a normative database can be a reliable source. However, different anthropometric characteristics and sociocultural backgrounds across populations hinder the application of previously developed databases in different populations. OBJECTIVE The present study was designed to develop a normative data set for the general population of healthy Iranian adults according to their age groups and to study the correlation between BESS scores and the participants' sex, height, weight, and body mass index. DESIGN A cross-sectional study. PARTICIPANTS A total of 1051 community-dwelling adults aged 20-69 years not suffering from balance disorders, dizziness, or other neurological or musculoskeletal diseases were recruited and stratified into 5 different age groups by decade. MAIN OUTCOME MEASURES The BESS tests were composed of single-leg, double-leg, and tandem stances, each on a rigid surface and a foam pad. The individuals maintained each position for 20 seconds with eyes closed. The assessor recorded the total number of errors as the individuals' BESS score (range: 0-60). RESULTS Significant but weak correlations were found between BESS score and height (r = -.13, P < .001) and between BESS score and body mass index (r = .11, P < .001), and the difference between sexes in BESS score was statistically significant in the 50- to 59-year-old (P = .021) and 60- to 69-year-old (P < .001) groups. The BESS scores were significantly different between all age groups (P < .05), except between the 20- to 29-year-old and 30- to 39-year-old groups (P = 1.000) and between the 40- to 49-year-old and 50- to 59-year-old groups (P = .086). CONCLUSIONS This study provided a normative database for different age groups of asymptomatic Iranian adults. The BESS score had weak correlations with height and body mass index and no correlation with weight, and significant differences were found between sexes in 50- to 69-year-old individuals. This study emphasizes the importance of obtaining specific normative data for different populations.
Collapse
|
13
|
Sweeney EA, Wilson JC, Potter MN, Dahab KS, Denay KL, Howell DR. Symptom profiles and postural control after concussion in female artistic athletes. Brain Inj 2020; 34:928-933. [DOI: 10.1080/02699052.2020.1763464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Emily A. Sweeney
- Department of Orthopedics, University of Colorado School of Medicine , Aurora, CO, USA
- Sports Medicine Center, Children’s Hospital Colorado , Aurora, CO, USA
| | - Julie C. Wilson
- Department of Orthopedics, University of Colorado School of Medicine , Aurora, CO, USA
- Sports Medicine Center, Children’s Hospital Colorado , Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine , Aurora, CO, USA
| | - Morgan N. Potter
- Department of Physical Therapy, University of Delaware , Newark, DE, USA
| | - Katherine S. Dahab
- Department of Orthopedics, University of Colorado School of Medicine , Aurora, CO, USA
- Sports Medicine Center, Children’s Hospital Colorado , Aurora, CO, USA
| | - Keri L. Denay
- Department of Family Medicine, University of Michigan Medical School , Ann Arbor, MI, USA
| | - David R. Howell
- Department of Orthopedics, University of Colorado School of Medicine , Aurora, CO, USA
- Sports Medicine Center, Children’s Hospital Colorado , Aurora, CO, USA
| |
Collapse
|
14
|
Abstract
PURPOSE A case study of a 12-year-old boy with Irlen syndrome illustrates the overlapping symptoms of Irlen syndrome and vestibular-related dizziness. SUMMARY OF KEY POINTS Individuals with Irlen syndrome have eyestrain and headache, and often report visual perceptual distortions of blurring, doubling, and movement of print on the page. These symptoms can be relieved with the use of individually prescribed tinted lenses or overlays. Visually induced dizziness, also known as visual vertigo, is characterized by dizziness and/or unsteadiness that is triggered by complex, distorted, large field/moving visual stimuli. Visually induced dizziness can be effectively treated with progressive, controlled exposure to optokinetic visual stimuli. The child with Irlen syndrome had impaired balance, impaired gaze stability, and symptoms of visual vertigo. His complaint of visually induced dizziness resolved following vestibular rehabilitation. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE When an individual with Irlen syndrome complains of dizziness, ruling out a concomitant diagnosis of a central and/or peripheral vestibular disorder is warranted. WHAT THIS ADDS TO THE EVIDENCE The visual symptoms associated with Irlen syndrome can overlap with those of visually induced dizziness. This case report is the first to describe overlapping visual and vestibular complaints of dizziness in an individual with Irlen syndrome.
Collapse
|
15
|
Abstract
OBJECTIVE To examine and describe normative values for an objective, mobile measure of postural stability commonly used in concussion assessments, SWAY Balance (SWAY Medical, Tulsa, Oklahoma). DESIGN Retrospective analysis of baseline balance assessments in a healthy pediatric population. SETTING Baseline assessments completed by certified athletic trainers at an outpatient concussion center or sports medicine offices in Philadelphia, PA and surrounding suburban Pennsylvania and New Jersey or during an athletic trainer's baseline assessment of collegiate athletes at a National Collegiate Athletic Association (NCAA) Division-II University in Fort Lauderdale, FL. PARTICIPANTS Test results of a sample of 466 athletes aged 5 to 18 years were included. INTERVENTIONS The SWAY Balance test was administered using a mobile device on all participants as part of a standard preseason, baseline evaluation, following the standard evaluation protocol. MAIN OUTCOME MEASURES Baseline SWAY Balance mobile assessment balance and reaction time scores, age and sex effects, were examined. RESULTS Normative scores are described, with results stratified into 4 age groups (5-9, 10-12, 13-17, and 18 years old). Balance scores, overall and within each individual stance score, improved with the age of the participants. Sex effects on balance were only seen in single-leg stances, with females outperforming males. Reaction time was found to be faster in males and improved with age, peaking at 13 to 17 years old and slowing in 18-year-olds. CONCLUSIONS Normative, age-specific SWAY Balance test results provided are of clinical use as references in the concussion assessments of pediatric athletes.
Collapse
|
16
|
Moeskops S, Oliver JL, Read PJ, Cronin JB, Myer GD, Lloyd RS. The Physiological Demands of Youth Artistic Gymnastics: Applications to Strength and Conditioning. Strength Cond J 2019. [DOI: 10.1519/ssc.0000000000000404] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
17
|
Houston MN, Peck KY, Malvasi SR, Roach SP, Svoboda SJ, Cameron KL. Reference values for the Balance Error Scoring System as measured by the Tekscan MobileMat™ in a physically active population. Brain Inj 2018; 33:299-304. [PMID: 30501390 DOI: 10.1080/02699052.2018.1552021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The Balance Error Scoring System (BESS) is commonly used to measure postural stability; however, it has demonstrated inconsistent reliability values when administered by humans. The Tekscan MobileMat™ was developed to automate the assessment of BESS errors and eliminate rater subjectivity. The objective of this study was to report reference values for the BESS, as measured by the MobileMat™, and examine the effect of sex, concussion history, and competitive sport level on BESS performance. METHODS Four hundred and forty participants performed the BESS on the MobileMat™. Participants were asked to maintain each stance with their eyes closed for 20 s. The MobileMat™ was used to quantify the number of errors. RESULTS Concussion history (p = 0.279-0.979) and competitive sport level (p = 0.422-0.979) did not affect BESS performance. Males performed significantly better than females for the single-limb foam stance (p = 0.032). No sex differences were detected for the other BESS stances or BESS total score (p = 0.067-0.744). CONCLUSIONS Previously reported reference values in collegiate athletes and adolescents were slightly higher thus highlighting the value in establishing population norms and in developing new technologies to objectively quantify BESS performance. Furthermore, sex, concussion history, and competitive sport level do not appear to influence BESS performance as measured by the MobileMat™.
Collapse
Affiliation(s)
- Megan N Houston
- a John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopaedic Surgery , Keller Army Community Hospital , West Point , NY , USA
| | - Karen Y Peck
- a John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopaedic Surgery , Keller Army Community Hospital , West Point , NY , USA
| | - Steven R Malvasi
- a John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopaedic Surgery , Keller Army Community Hospital , West Point , NY , USA
| | - Sean P Roach
- a John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopaedic Surgery , Keller Army Community Hospital , West Point , NY , USA
| | - Steven J Svoboda
- b Department of Orthopaedic Surgery , Lafayette Centre Orthopaedics and Sports Medicine, MedStar Georgetown University Hospital , Washington , DC , USA
| | - Kenneth L Cameron
- a John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopaedic Surgery , Keller Army Community Hospital , West Point , NY , USA
| |
Collapse
|
18
|
Halstead ME, Walter KD, Moffatt K, LaBella CR, Brooks MA, Canty G, Diamond AB, Hennrikus W, Logan K, Nemeth BA, Pengel KB, Peterson AR, Stricker PR. Sport-Related Concussion in Children and Adolescents. Pediatrics 2018; 142:peds.2018-3074. [PMID: 30420472 DOI: 10.1542/peds.2018-3074] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Sport-related concussion is an important topic in nearly all sports and at all levels of sport for children and adolescents. Concussion knowledge and approaches to management have progressed since the American Academy of Pediatrics published its first clinical report on the subject in 2010. Concussion's definition, signs, and symptoms must be understood to diagnose it and rule out more severe intracranial injury. Pediatric health care providers should have a good understanding of diagnostic evaluation and initial management strategies. Effective management can aid recovery and potentially reduce the risk of long-term symptoms and complications. Because concussion symptoms often interfere with school, social life, family relationships, and athletics, a concussion may affect the emotional well-being of the injured athlete. Because every concussion has its own unique spectrum and severity of symptoms, individualized management is appropriate. The reduction, not necessarily elimination, of physical and cognitive activity is the mainstay of treatment. A full return to activity and/or sport is accomplished by using a stepwise program while evaluating for a return of symptoms. An understanding of prolonged symptoms and complications will help the pediatric health care provider know when to refer to a specialist. Additional research is needed in nearly all aspects of concussion in the young athlete. This report provides education on the current state of sport-related concussion knowledge, diagnosis, and management in children and adolescents.
Collapse
Affiliation(s)
| | - Kevin D. Walter
- Department of Orthopaedic Surgery, Pediatric Sports Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Kody Moffatt
- Creighton University School of Medicine, Omaha, Nebraska
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Rehabilitation of an Adolescent Equestrian Athlete With a History of Multiple Concussions: A Case Report Describing an Adapted Return-to-Sport Protocol. J Orthop Sports Phys Ther 2018; 48:934-942. [PMID: 30053793 PMCID: PMC6671687 DOI: 10.2519/jospt.2018.8214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Equestrian riding is a sport with a high risk of concussion. Currently, the literature guiding rehabilitation for concussions in equestrian athletes is limited, especially for directing return to sport. CASE DESCRIPTION In this case report, a 14-year-old female equestrian athlete presented to physical therapy following her third concussion in 3 years. Her primary complaints were headaches, dizziness, difficulty concentrating, light sensitivity, and neck pain. On examination, the patient demonstrated reproduction of symptoms during testing of the vestibular-ocular reflex, showed a 3-line symptomatic loss on the dynamic visual acuity test, and had impairments in the joint position error test (1/5 correct on the left, 4/5 correct on the right) and a Balance Error Scoring System (BESS) score of 38/60 errors. A return-to-riding protocol was adapted from general return-to-sport guidelines and tailored to meet the unique demands of the patient's equestrian sport. The protocol included phased progression through no activity, light aerobic activity, moderate aerobic activity, sport-specific nonjumping skills, sport-specific jumping skills, full practice, and return to competition. During the protocol, the patient participated in 8 physical therapy sessions over 4 weeks for vestibular training, aerobic conditioning, and cervical and core exercises, as well as equestrian exercises at her stables. OUTCOMES At the final evaluation, the patient reported no symptoms at rest, with exercise, or when testing vestibular-ocular reflex. Improvements were noted in the dynamic visual acuity test, joint position error, and BESS, with changes in the BESS exceeding minimal detectable change. The patient completed the full return-to-riding protocol in 8 weeks and was able to return to equestrian competition without complaints. DISCUSSION This case report describes the physical therapy management of an adapted return-to-sport protocol for an equestrian athlete with a history of multiple sport-related concussions. LEVEL OF EVIDENCE Therapy, level 5. J Orthop Sports Phys Ther 2018;48(12):934-942. Epub 27 Jul 2018. doi:10.2519/jospt.2018.8214.
Collapse
|
20
|
Ozinga SJ, Linder SM, Koop MM, Dey T, Figler R, Russman AN, So R, Rosenthal AH, Cruickshank J, Alberts JL. Normative Performance on the Balance Error Scoring System by Youth, High School, and Collegiate Athletes. J Athl Train 2018; 53:636-645. [PMID: 30109948 DOI: 10.4085/1062-6050-129-17] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
CONTEXT Annually, more than 1 million youth athletes in the United States receive or are suspected of receiving a concussion. The Balance Error Scoring System (BESS) is the most commonly used clinical balance evaluation designed to provide a better understanding of the motor-control processes of individuals with concussion. Despite the widespread use of the BESS, a fundamental gap exists in applying this tool to young athletes, as normative values are lacking for this population. OBJECTIVE To determine age- and sex-specific normative values for the BESS in youth, high school, and collegiate athletes. DESIGN Cross-sectional study. SETTING Local youth sport organizations, high schools, and colleges. PATIENTS OR OTHER PARTICIPANTS Student-athletes (N = 6762) completed preseason baseline concussion testing as part of a comprehensive concussion-management program. Groups were youth males aged 5 to 13 years (n = 360), high school males aged 14 to 18 years (n = 3743), collegiate males aged 19 to 23 years (n = 497), youth females aged 5 to 13 years (n = 246), high school females aged 14 to 18 years (n = 1673), and collegiate females aged 19 to 23 years (n = 243). MAIN OUTCOME MEASURE(S) Errors according to the BESS specifications. RESULTS Performance on the BESS was worse ( P < .01) in youth athletes than in high school and collegiate athletes. In the youth and high school cohorts, females exhibited better scores than males ( P < .05). Sex was not a factor for collegiate athletes. Data from the youth cohort were further subdivided into 4-year bins to evaluate potential motor-development differences. The error count was highest for 5- to 9-year-old males and decreased with age. CONCLUSIONS Performance on the BESS depended on sex and age, particularly in youth athletes. These sex- and age-specific normative values provide a reference to facilitate and unify clinical decision making across multiple providers caring for youth athletes with concussions.
Collapse
Affiliation(s)
| | - Susan M Linder
- Department of Biomedical Engineering.,The Concussion Center
| | | | | | - Richard Figler
- The Concussion Center.,Orthopedic and Rheumatologic Institute
| | | | - Richard So
- The Pediatric Institute, Cleveland Clinic, OH
| | | | | | - Jay L Alberts
- Department of Biomedical Engineering.,The Concussion Center
| |
Collapse
|
21
|
Returning Adolescents to Driving after Sports-Related Concussions: What Influences Physician Decision-Making. J Pediatr 2018; 194:177-181. [PMID: 29198541 DOI: 10.1016/j.jpeds.2017.10.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/07/2017] [Accepted: 10/12/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine which data collected on an initial patient clinic visit for a sports-related concussion (SRC) might influence physicians to clear an adolescent to return to drive (RTD) after injury. STUDY DESIGN Retrospective cohort study of 189 adolescents with a SRC referred to a hospital-based concussion clinic between June 1, 2015, and May 31, 2016. Subjects were ≥16 years with a valid driver's license (median age = 16, IQR [16, 17]). Concussion evaluations included Post-Concussion Symptom Scale, modified Balance Error Scoring System, and postinjury computerized neurocognitive testing (CNT). Clearance for RTD was the main outcome. Statistical comparisons were conducted with Mann-Whitney U and χ2 tests and logistic regression. RESULTS In multivariable analysis, odds of being fully cleared to drive were 5.9-fold greater among patients who were administered CNT. Stated symptoms of "headache" and "sensitivity to light" were statistically significantly associated with RTD clearance. For a subset of 113 individuals undergoing CNT, each additional 10-millisecond decrease in simple reaction time was associated with 9% greater odds of being cleared to drive. Each additional 10-millisecond decrease in choice reaction time was associated with 4% greater odds of being cleared to drive. CONCLUSIONS CNT and associated reaction time measures may facilitate a physician's objective decision-making. Making a RTD determination for adolescents recovering from an SRC should be a core component of a physician's assessment.
Collapse
|
22
|
Cushman D, Hendrick J, Teramoto M, Fogg B, Bradley S, Hansen C. Reliability of the balance error scoring system in a population with protracted recovery from mild traumatic brain injury. Brain Inj 2018; 32:569-574. [DOI: 10.1080/02699052.2018.1432891] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Daniel Cushman
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - John Hendrick
- Department of Emergency Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Masaru Teramoto
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Benjamin Fogg
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Sean Bradley
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Colby Hansen
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
23
|
Martínez-Lemos RI, Ayán-Pérez C, Bouzas-Rico S. Test-retest reliability of the Wii Balance Board for assessing standing balance in young people with intellectual disability. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2017; 65:231-238. [PMID: 34141343 PMCID: PMC8115488 DOI: 10.1080/20473869.2017.1403065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objectives: The main objective was to identify the test-retest reliability of the Wii Balance Board (WBB) for assessing standing balance when administered to a population of people with intellectual disability (ID). A secondary objective was to provide information regarding the reliability of the WBB, taking into account the severity of cognitive impairment. Methods: The WBB was administered two times to a group of 50 people (mean age: 20.44 ± 5.73 years) with mild (n=32), moderate (n=6), or severe ID (n=12) within a 15-day period. The relative reliability of the WBB for the 'standing balance with open eyes' test was analyzed by means of intraclass correlation coefficients (ICCs). The standard error measurement and the minimum detectable change were used to identify absolute reliability. Results: For the whole sample, the WBB showed a fair (ICC=0.71), poor (ICC=0.66), and excellent (ICC=0.99) relative reliability for assessing weight-bearing asymmetry, center of pressure, path length, and sway area, respectively. In people with moderate/severe ID, statistically significant differences between the WBB test and retest scores were found. The absolute reliability of the WBB was considered poor. Conclusion: The WBB showed accurate adequate test-retest reliability for assessing standing balance in young people with ID. When using this device with people with moderate/severe ID, it is advisable to perform several testing trials, in order to avoid a possible learning effect. Standard error of measurement and minimal detectable change were high, indicating that this device might not be sensitive enough to properly identify static balance changes in this population.
Collapse
Affiliation(s)
| | - Cárlos Ayán-Pérez
- Faculty of Education and Sport Sciences, Campus A Xunqueira, Pontevedra, Spain
| | - Sara Bouzas-Rico
- Faculty of Education and Sport Sciences, Campus A Xunqueira, Pontevedra, Spain
| |
Collapse
|
24
|
Simon M, Maerlender A, Metzger K, Decoster L, Hollingworth A, Valovich McLeod T. Reliability and Concurrent Validity of Select C3 Logix Test Components. Dev Neuropsychol 2017; 42:446-459. [PMID: 29068702 DOI: 10.1080/87565641.2017.1383994] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We sought to investigate the one-week and within-session reliability of the instrumented balance error scoring system test and the concurrent validity/one-week reliability of two neurocognitive assessments available through C3 Logix. (n = 37) Participants completed two balance error scoring system tests separated by the Trails A, Trails B, and Symbol Digit Modality test available through C3 Logix, and with paper and pencil. We found that the instrumented balance error scoring system test demonstrated strong one-week reliability and that neuropsychological tests available through C3 Logix show acceptable concurrent validity with standard (comparable) paper and pencil measures.
Collapse
Affiliation(s)
- Madeline Simon
- a New Hampshire Musculoskeletal Institute , Manchester , New Hampshire
| | - Arthur Maerlender
- b Center for Brain, Biology and Behavior, University of Nebraska - Lincoln , Lincoln , Nebraska
| | - Katelyn Metzger
- a New Hampshire Musculoskeletal Institute , Manchester , New Hampshire
| | - Laura Decoster
- a New Hampshire Musculoskeletal Institute , Manchester , New Hampshire
| | - Amy Hollingworth
- a New Hampshire Musculoskeletal Institute , Manchester , New Hampshire
| | - Tamara Valovich McLeod
- c Athletic Training Programs and School of Osteopathic Medicine , A.T. Still University , Mesa , Arizona
| |
Collapse
|
25
|
Abstract
OBJECTIVE Pediatric concussion is an extensive public health concern with a complex clinical presentation. Balance assessment has been well-studied in the adult population, but has been limited in children. We aimed to assess the reliability and minimum detectable change (MDC) of the Balance Error Scoring System (BESS) in healthy children. DESIGN This prospective observational study included 373 healthy children aged 5 to 14. Interrater reliability was assessed by having 4 assessors review videos of 50 random subjects distributed evenly by age and sex across the entire cohort. Intrarater reliability was performed by having assessors review videos of other assessors' live evaluations. Test-retest reliability was obtained by comparing BESS scores as recorded live at the 2 separate time points by the same rater. SETTING Local elementary and junior high schools. PARTICIPANTS Three hundred and seventy three healthy children between the ages of 5 and 14. INTERVENTIONS The BESS was performed on all children. MAIN OUTCOME MEASURES Intraclass Correlation Coefficients (ICCs) and MDC Scores. RESULTS The overall interrater ICC was determined to be 0.93 [95% confidence interval (CI), 0.79-0.97] and intrarater ICC was 0.96 (95% CI, 0.95-0.97) with individual intrarater ICCs ranging between 0.69 and 0.99. The test-retest reliability was 0.90 (95% CI, 0.88-0.92). The MDCs were 9.6, 4.6, and 7.3 points at the 95% CIs for interrater, intrarater, and test-retest comparisons, respectively. No learning effect was seen. CONCLUSIONS The BESS demonstrates excellent reliability in the pediatric population without evidence of a learning effect.
Collapse
|
26
|
Radhakrishnan R, Garakani A, Gross LS, Goin MK, Pine J, Slaby AE, Sumner CR, Baron DA. Neuropsychiatric aspects of concussion. Lancet Psychiatry 2016; 3:1166-1175. [PMID: 27889010 DOI: 10.1016/s2215-0366(16)30266-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/13/2016] [Accepted: 08/15/2016] [Indexed: 10/20/2022]
Abstract
Over the past decade, concussion has become the most widely discussed injury in contact sports. However, concussions also occur in several other settings, such as non-contact sports, elderly individuals, young children, military personnel, and victims of domestic violence. Concussion is frequently undiagnosed as a cause of psychiatric morbidity, especially when the patient has no history of loss of consciousness or direct head trauma. Almost all of the extant literature focuses on traumatic brain injury and assumes that concussion is merely a mild form of traumatic brain injury, which has resulted in a lack of understanding about what concussion is, and how to diagnose, monitor, and treat its varied neuropsychiatric symptoms. In this Review, we address key issues so that the psychiatric clinician can better understand and treat patients with a clinical phenotype that might be the direct result of, or be exacerbated by, concussion. Future research needs to focus on prospective clinical trials in all affected patient populations (ie, those affected by concussion and those affected by various degrees of traumatic brain injury), the identification of reliable biomarkers that can be used to assist with diagnosis and treatment response, and the development of effective treatment interventions. Clearly differentiating concussion from traumatic brain injury is essential to achieve reliable and clinically relevant outcomes.
Collapse
Affiliation(s)
- Rajiv Radhakrishnan
- Yale University School of Medicine, New Haven, CT, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA
| | - Amir Garakani
- Yale University School of Medicine, New Haven, CT, USA; Silver Hill Hospital, New Canaan, CT, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA
| | - Lawrence S Gross
- University of Southern California, Los Angeles, CA, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA
| | - Marcia K Goin
- University of Southern California, Los Angeles, CA, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA
| | - Janet Pine
- University of Southern California, Los Angeles, CA, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA
| | - Andrew E Slaby
- New York University, New York, NY, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA
| | - Calvin R Sumner
- Pearson North America, Boston, MA, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA
| | - David A Baron
- University of Southern California, Los Angeles, CA, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA.
| |
Collapse
|