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Ulman S, Erdman AL, Loewen A, Worrall HM, Tulchin-Francis K, Jones JC, Chung JS, Ellis HB, Cullum CM, Miller SM. Improvement in balance from diagnosis to return-to-play initiation following a sport-related concussion: BESS scores vs center-of-pressure measures. Brain Inj 2022; 36:921-930. [PMID: 35957571 DOI: 10.1080/02699052.2022.2109736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Accurate assessment of balance recovery throughout treatment of a sport-related concussion is imperative. This study examined differences in balance from diagnosis to return-to-play initiation in adolescent patients post-concussion. Second, this study investigated the extent to which the Balance Error Scoring System (BESS) correlated with center-of-pressure (COP) measures. METHODS Forty participants performed the BESS while standing on a force platform such that COP data were obtained simultaneously. Spatial and velocity COP-based measures were computed for the double-stance conditions. RESULTS BESS scores and COP-based measures indicated improved balance performance between visits. Specifically, 62.5/65.0% of participants exhibited improved firm/foam BESS final scores, respectively, and 56.4-71.8% exhibited improved COP-based measures. However, once normative ranges were referenced to identify maintained performance, the percentage of participants who substantially improved differed from initial findings (BESS: 2.5/7.5%, COP: 48.7-69.2%). Additionally, positive correlations between balance measures were primarily found at diagnosis (r=0.33-0.53), while only three correlations were maintained at return-to-play initiation (r=0.34-0.39). CONCLUSIONS BESS scores successfully identified poor balance performance at diagnosis when symptoms were most pronounced, but failed to accurately depict performance once balance impairment, indicated by COP-based measures, became less apparent. Further work is needed to implement more advanced balance assessments into clinical environments.
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Affiliation(s)
- Sophia Ulman
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ashley L Erdman
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA
| | - Alex Loewen
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA
| | - Hannah M Worrall
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA
| | - Kirsten Tulchin-Francis
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jacob C Jones
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jane S Chung
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Henry B Ellis
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - C Munro Cullum
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shane M Miller
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Matthews M, Johnston W, Bleakley CM, Davies RJ, Rankin AT, Webb M, Caulfield BC, Archbold H. Concussion History and Balance Performance in Adolescent Rugby Union Players. Am J Sports Med 2021; 49:1348-1354. [PMID: 33729858 PMCID: PMC8020306 DOI: 10.1177/0363546521998709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sports-related concussion is a worldwide problem. There is a concern that an initial concussion can cause prolonged subclinical disturbances to sensorimotor function that increase the risk of subsequent injury. The primary aim of this study was to examine whether a history of sports-related concussion has effects on static and dynamic balance performance in adolescent rugby players. HYPOTHESIS Dynamic balance would be worse in players with a history of concussion compared with those with no history of concussion. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Male adolescent rugby players aged 14 to 18 years from 5 schools were recruited before the start of the 2018-2019 playing season. Participants completed questionnaires and physical tests, including dynamic Y balance and single-leg static balance (eyes closed) tests, while performing single and dual tasks. Dynamic balance was assessed using inertial sensor instrumentation. Dependent variables were normalized reach distance and the sample entropy (SEn) of the 3 axes (x, y, and z). RESULTS Of the 195 participants, 100 reported a history of concussion. Those with a history of concussion demonstrated higher SEn in all directions, with highest values during anterior (standardized mean difference [SMD], 0.4; 95% CI, 0.0-0.7; P = .027) and posteromedial (SMD, 0.5; 95% CI, 0.2-0.9; P = .004) reach directions compared with those with no history. There was no difference between groups (concussion history vs control) in traditional Y balance reach distances in the anterior or posteromedial directions or single-leg static balance during both single- (P = .47) and dual-task (P = .67) conditions. CONCLUSION Adolescent rugby union athletes with a history of concussion had poorer dynamic balance during performance tasks compared with healthy controls. Static single-leg balance tests, either single or dual task, may not be sensitive enough to detect sensorimotor deficits in those with a history of concussion.
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Affiliation(s)
- Mark Matthews
- Sports and Exercise Science Research
Institute, Ulster University, Belfast, UK,Mark Matthews, PhD, Sport
and Exercise Science Research Institute, Ulster University, Belfast, BT370QB, UK
() (Twitter: @Mark_MatthewsNZ)
| | - William Johnston
- School of Public Health, Physiotherapy
and Sports Science, University College Dublin, Dublin, Ireland,Insight Centre for Data Analytics,
University College Dublin, Dublin, Ireland
| | | | | | | | | | - Brian C. Caulfield
- School of Public Health, Physiotherapy
and Sports Science, University College Dublin, Dublin, Ireland,Insight Centre for Data Analytics,
University College Dublin, Dublin, Ireland
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Johnston W, Davenport J, Connelly R, Caulfield B. Quantifying Y Balance Test performance with multiple and single inertial sensors. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:4243-4247. [PMID: 33018933 DOI: 10.1109/embc44109.2020.9176416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A growing body of evidence has highlighted that inertial sensor data can increase the sensitivity and clinical utility of the Y Balance Test, a commonly used clinical dynamic balance assessment. While early work has demonstrated the value of a single lumbar worn inertial sensor in quantifying dynamic balance control, no research has investigated if alternative (shank) or combined (lumbar and shank) sensor mounting locations may improve the assessments discriminant capabilities. Determining the optimal sensor set-up is crucial to ensuring minimal cost and maximal utility for clinical users The aim of this cross-sectional study was to investigate if single or multiple inertial sensors, mounted on the lumbar spine and/or shank could differentiate young (18-40 years [n = 41]) and middle-aged (40-65 years [n = 42]) adults, based on dynamic balance performance. Random-forest classification highlighted that a single lumbar sensor could classify age-related differences in performance with an accuracy of 79% (sensitivity = 81%; specificity = 78%). The amalgamation of shank and lumbar data did not significantly improve the classification performance (accuracy = 73-77%; sensitivity = 71-76%; specificity = 73-78%). Jerk magnitude root-mean-square consistently demonstrated predictor importance across the three reach directions: posteromedial (rank 1), anterior (rank 3) and posterolateral (rank 6).
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Johnston W, Heiderscheit B, Sanfilippo J, Brooks MA, Caulfield B. Athletes with a concussion history in the last two years have impairments in dynamic balance performance. Scand J Med Sci Sports 2020; 30:1497-1505. [PMID: 32311175 DOI: 10.1111/sms.13691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/05/2020] [Accepted: 04/09/2020] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to determine if National Collegiate Athletics Association Division 1 American Football and Ice Hockey athletes with a history of concussion have impaired dynamic balance control when compared to healthy control athletes. This cross-sectional observational study recruited 146 athletes; 90 control athletes and 56 athletes with a history of concussion. Athletes were tested during a pre-season evaluation using the inertial-sensor instrumented Y Balance Test. Independent variables were normalized reach distance, gyroscope magnitude sample entropy, and jerk magnitude root mean square. Kruskal-Wallis H test and Dunn-Bonferroni analysis demonstrated that individuals with a concussion history within the last 2 years have statistically significantly lower jerk magnitude root mean square in the posteromedial (Z = 23.22, P = .015) and posterolateral (Z = 24.64, P = .010) reach directions, when compared to the control group. There was no significant difference between those who sustained a concussion longer than two years ago and the control group for the posteromedial (Z = -1.25; P = .889) and posterolateral (Z = 6.44; P = .469) directions. These findings show that athletes with a concussion history within the last two years possess dynamic balance deficits, when compared to healthy control athletes. Conversely, athletes whose injury occurred greater than 2 years ago possessed comparable performance to the healthy controls. This suggests that sensorimotor control deficits may persist beyond clinical recovery, for up to 2 years. Therefore, clinicians should integrate balance training interventions into the return-to-play process to accelerate sensorimotor recovery and mitigate the risk of future injury.
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Affiliation(s)
- William Johnston
- Insight Centre for Data Analytics, University College Dublin, Belfield, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Ireland
| | - Bryan Heiderscheit
- Department of Orthopaedics and Rehabilitation, University of Wisconsin, Madison, WI, USA.,Badger Athletic Performance, University of Wisconsin, Madison, WI, USA
| | | | - M Alison Brooks
- Department of Orthopaedics and Rehabilitation, University of Wisconsin, Madison, WI, USA.,Badger Athletic Performance, University of Wisconsin, Madison, WI, USA
| | - Brian Caulfield
- Insight Centre for Data Analytics, University College Dublin, Belfield, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Ireland
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