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Crowell MS, Thomasma E, Florkiewicz E, Brindle R, Roach M, Goss D, Pitt W. Validity and Responsiveness of a Modified Balance Error Scoring System Assessment Using a Mobile Device Application in Patients Recovering from Ankle Sprain. Int J Sports Phys Ther 2024; 19:440-450. [PMID: 38576835 PMCID: PMC10987306 DOI: 10.26603/001c.94608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/28/2024] [Indexed: 04/06/2024] Open
Abstract
Background Static balance is often impaired in patients after ankle sprains. The ability to identify static balance impairments is dependent on an effective balance assessment tool. The Sway Balance Mobile Application (SWAY App) (Sway Medical, Tulsa, OK) uses a smart phone or tablet to assess postural sway during a modified Balance Error Scoring System (mBESS) assessment and shows promise as an accessible method to quantify changes in static balance after injury. Purpose The primary purposes of this study were to determine the ability to differentiate between those with ankle sprain versus controls (construct validity) and ability to detect change over time (responsiveness) of a mBESS assessment using a mobile device application to evaluate static balance after an acute ankle sprain. Study Design Case-control study. Methods Twenty-two military academy Cadets with an acute ankle sprain and 20 healthy Cadets were enrolled in the study. All participants completed an assessment measuring self-reported function, ankle dorsiflexion range of motion (via the weightbearing lunge), dynamic balance, and static balance. Static balance measured with the mBESS using the SWAY App was validated against laboratory-based measures. Cadets with ankle sprains completed their assessment twice: once within two weeks of injury (baseline) and again after four weeks of rehabilitation that included balance training. Independent and paired t-tests were utilized to analyze differences over time and between groups. Effect sizes were calculated and relationships explored using Pearson's correlation coefficients. Results The mBESS scores measured by the SWAY App were lower in participants with acute ankle sprains than healthy Cadets (t = 3.15, p = 0.004). Injured participants improved their mBESS score measured by SWAY at four weeks following their initial assessments (t = 3.31, p = 0.004; Baseline: 74.2 +/- 16.1, 4-weeks: 82.7 +/- 9.5). The mBESS measured by the SWAY App demonstrated moderate to good correlation with a laboratory measure of static balance (r = -0.59, p \< 0.001). Conclusion The mBESS assessed with a mobile device application is a valid and responsive clinical tool for evaluating static balance. The tool demonstrated construct (known groups) validity detecting balance differences between a healthy and injured group, concurrent validity demonstrating moderate to good correlation with established laboratory measures, and responsiveness to changes in static balance in military Cadets during recovery from an acute ankle sprain. Level of Evidence Level 3.
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Affiliation(s)
- Michael S Crowell
- University of Scranton
- Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship
| | | | - Erin Florkiewicz
- Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship
| | | | - Megan Roach
- DoD-VA Extremity Trauma & Amputation Center of Excellence Womack Army Medical Center
| | | | - Will Pitt
- Army-Baylor Doctoral Program in Physical Therapy
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Dummar MK, Crowell MS, Pitt W, Yu AM, McHenry P, Benedict T, Morris J, Miller EM. The Convergent Validity of the SWAY Balance Application to Assess Postural Stability in Military Cadets Recovering from Concussion. Int J Sports Phys Ther 2024; 19:166-175. [PMID: 38313668 PMCID: PMC10837821 DOI: 10.26603/001c.92234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/04/2023] [Indexed: 02/06/2024] Open
Abstract
Background Concussions are often accompanied by balance disturbances. Clinically accurate evaluation systems are often expensive, large, and inaccessible to most clinicians. The Sway Balance Mobile Application (SWAY) is an accessible method to quantify balance changes. Purpose To determine the known groups and convergent validity of the SWAY to assess balance after a concussion. Study Design Case-Control Study. Methods Twenty participants with acute concussion and twenty controls were recruited. At initial, one-week, and final return to activity (RTA) evaluations, all participants completed the Sports Concussion Assessment Tool (SCAT-5), and balance control measured by SWAY mBESS and NeuroCom Balance Master Sensory Organization Test (SOT). Mixed model ANOVAs were used to detect differences in SWAY mBESS and NeuroCom SOT scores with time (initial, one-week, final RTA) as the within-subjects factor and group (concussed, healthy) as the between-subjects factor. Spearman's Rho correlations explored the associations between NeuroCom SOT scores, SWAY scores, SCAT-5 symptom scores, and time in days to final RTA. Results The sampled population was predominantly male and age (20 ± 1), and BMI differences were insignificant between groups. The SWAY did not detect differences between healthy and concussed participants and did not detect change over time [F(2,40) = .114, p = 0.89; F(2,40)= .276, p =0.60]. When assessing the relationship between the SWAY and the SOT, no correlation was found at any time point (r = -0.317 to -0.062, p > 0.05). Time to RTA demonstrated a moderate correlation with both SCAT-5 symptom severity score (r = .693, p < 0.01) and SCAT-5 total symptom score (r = .611, p < 0.01) at the one-week follow-up. Conclusion The SWAY mBESS does not appear to be a valid balance assessment for the concussed patient. The SWAY mBESS in patients with concussion failed to demonstrate convergent validity and did not demonstrate an ability to validate known groups. When assessing the time to final RTA, the one-week post-initial assessment SCAT-5 symptom severity and total scores may help determine the length of recovery in this population. Level of Evidence Level 3.
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Affiliation(s)
- Max K Dummar
- Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship Baylor University
| | - Michael S Crowell
- Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, Baylor University
- Doctor of Physical Therapy Program University of Scranton
| | - Will Pitt
- Army - Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston Baylor University
| | - Ai Mei Yu
- Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship Baylor University
| | - Paige McHenry
- Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship Baylor University
| | - Timothy Benedict
- Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship Baylor University
| | - Jamie Morris
- Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship Baylor University
| | - Erin M Miller
- Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship Baylor University
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Koshino Y, Akimoto M, Kawahara D, Watanabe K, Ishida T, Samukawa M, Kasahara S, Tohyama H. Inertial Sensor-Based Assessment of Static Balance in Athletes with Chronic Ankle Instability. J Sports Sci Med 2023; 22:36-43. [PMID: 36876176 PMCID: PMC9982532 DOI: 10.52082/jssm.2023.36] [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: 11/29/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
The Balance Error Scoring System (BESS), a subjective examiner-based assessment, is often employed to assess postural balance in individuals with chronic ankle instability (CAI); however, inertial sensors may enhance the detection of balance deficits. This study aimed to compare the BESS results between the CAI and healthy groups using conventional BESS scores and inertial sensor data. The BESS test (six conditions: double-leg, single-leg, and tandem stances on firm and foam surfaces, respectively) was performed for the CAI (n = 16) and healthy control (n = 16) groups with inertial sensors mounted on the sacrum and anterior shank. The BESS score was calculated visually by the examiner by counting postural sway as an error based on the recorded video. The root mean square for resultant acceleration (RMSacc) in the anteroposterior, mediolateral, and vertical directions was calculated from each inertial sensor affixed to the sacral and shank surfaces during the BESS test. The mixed-effects analysis of variance and unpaired t-test were used to assess the effects of group and condition on the BESS scores and RMSacc. No significant between-group differences were found in the RMSacc of the sacral and shank surfaces, and the BESS scores (P > 0.05), except for the total BESS score in the foam condition (CAI: 14.4 ± 3.7, control: 11.7 ± 3.4; P = 0.039). Significant main effects of the conditions were found with respect to the BESS scores and RMSacc for the sacral and anterior shank (P < 0.05). The BESS test with inertial sensors can detect differences in the BESS conditions for athletes with CAI. However, our method could not detect any differences between the CAI and healthy groups.
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Affiliation(s)
- Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Moeko Akimoto
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Daiki Kawahara
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | | | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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Fraser MA, Kuo M, Boeckmann AM, Kilchrist LM. Evidence to Eliminate Double-Leg Conditions From the Modified Balance Error Scoring System and Balance Error Scoring System. Clin J Sport Med 2022; 32:e521-e526. [PMID: 35316822 DOI: 10.1097/jsm.0000000000001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/29/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of our study was to assess the differences between the Balance Error Scoring System (BESS), modified BESS (mBESS), and both measures with the double-leg (DL) stances removed [BESS-revised (BESS-R) and mBESS-revised (mBESS-R)] among healthy and concussed collegiate student-athletes. DESIGN Retrospective, repeated-measures cohort study. SETTING Clinical. PATIENTS OR OTHER PARTICIPANTS Healthy and concussed collegiate athletes (baseline n = 622, postinjury n = 41) from 12 National Collegiate Athletic Association Division I sports cheer and dance at a single university. INTERVENTION OR INDEPENDENT VARIABLES Balance Error Scoring System, mBESS, BESS-R, and mBESS-R test versions from baseline and postinjury testing. MAIN OUTCOME MEASURES The mBESS and BESS and their revised versions with DL stances removed (mBESS-R and BESS-R) scores were compared at baseline. Baseline and postinjury scores for all 4 BESS variations and the 6 BESS conditions were compared for those who sustained a concussion. RESULTS The BESS and BESS-R were statistically different at baseline for the entire sample (99.6% confidence interval 0.32, 0.38, P > 0.0001). None of the other comparisons were significantly different ( P > 0.004). CONCLUSION Although our results do suggest statistically significant differences between the BESS and BESS-R test versions, they do not represent clinically meaningful differences. The greatest mean difference between all test versions was <1 error; therefore, these BESS versions may not be specific enough to identify balance deficits at baseline or postinjury. Elimination of the time intensive DL measures in the revised BESS variations may be a more clinically practical alternative.
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Affiliation(s)
- Melissa A Fraser
- Department of Health and Human Performance, Texas State University, San Marcos, Texas
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Duarte MB, da Costa Moraes AA, Ferreira EV, da Silva Almeida GC, da Rocha Santos EG, Pinto GHL, de Oliveira PR, Amorim CF, Dos Santos Cabral A, Saunier G, Costa E Silva ADA, Belgamo A, Souza GDS, Callegari B. Validity and reliability of a smartphone-based assessment for anticipatory and compensatory postural adjustments during predictable perturbations. Gait Posture 2022; 96:9-17. [PMID: 35533431 DOI: 10.1016/j.gaitpost.2022.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postural adjustments involve displacements of the center of mass (COM), controlled by the central nervous system (CNS), to maintain equilibrium whilst standing. Postural adjustments can be anticipatory (APAs) or compensatory (CPAs), and are triggered to counteract predictable perturbations. RESEARCH QUESTION Is the new smartphone application, Momentum, a valid and reliable tool for the assessment of body balance, by measuring APAs and CPAs using accelerometer readings? METHODS 20 young adults were exposed to external predictable perturbations induced at the shoulder level, whilst standing. COM linear acceleration was recorded by Momentum (extracting data from a smartphone's accelerometer) and a 3D motion capture system. RESULTS The key results demonstrated a very high, significant correlation (r ≥ 0.7, p < 0.05) between the two device settings in the APA parameters, which obtained r = 0.65, denoting a high correlation. Considering the reliability, variables that are compensatory in nature are presented on a scale of good to excellent in measurement methods, kinematics, and Momentum. However, the anticipatory variables presented excellent reliability only for the kinematics. SIGNIFICANCE These experiments show that Momentum is a valid method for measuring COM acceleration under predictable perturbations and is reliable for compensatory events.
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Affiliation(s)
- Manuela Brito Duarte
- Laboratório de Estudos da Motricidade Humana, Av. Generalíssimo deodoro 01, Belém 66073-00, PA, Brazil.
| | | | - Eduardo Veloso Ferreira
- Laboratório de Estudos da Motricidade Humana, Av. Generalíssimo deodoro 01, Belém 66073-00, PA, Brazil.
| | | | - Enzo Gabriel da Rocha Santos
- Instituto de Ciências Exatas e Naturais, Universidade Federal do Pará, R. Augusto Corrêa, 01, Belém 66093-020, PA, Brazil
| | - Gustavo Henrique Lima Pinto
- Instituto de Ciências Exatas e Naturais, Universidade Federal do Pará, R. Augusto Corrêa, 01, Belém 66093-020, PA, Brazil
| | - Paulo Rui de Oliveira
- Doctoral and Masters Program in Physical Therapy, UNICID, 448/475 Cesário Galeno St., São Paulo, SP, Brazil.
| | - César Ferreira Amorim
- Doctoral and Masters Program in Physical Therapy, UNICID, 448/475 Cesário Galeno St., São Paulo, SP, Brazil; Département des Sciences de la Santé, Programme de physiothérapie de l'université McGill offert en extension à l'UQAC, Saguenay, Québec, Canada; Physical Therapy and Neuroscience Departments, Wertheims' Colleges of Nursing and Health Sciences and Medicine, Florida International University (FIU), Miami, FL, United States
| | - André Dos Santos Cabral
- Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, Tv. Perebebuí, 2623 - Marco, Belém, PA 66087-662, Brazil.
| | - Ghislain Saunier
- Laboratório de Cognição Motora, Departamento de Anatomia, Universidade Federal do Pará, Rua Augusto Corrêa 01, Belém 66075-110, PA, Brazil.
| | - Anselmo de Athayde Costa E Silva
- Programa de Pós Graduação em Ciências do Movimento, Universidade Federal do Pará, Av. Generalíssimo deodoro 01, Belém 66073-00, PA, Brazil.
| | - Anderson Belgamo
- Departamento de Ciência da Computação, Instituto Federal de São Paulo, Piracicaba, Brazil.
| | - Givago da Silva Souza
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Rua Augusto Corrêa 01, Belém 66075-110, PA, Brazil.
| | - Bianca Callegari
- Laboratório de Estudos da Motricidade Humana, Av. Generalíssimo deodoro 01, Belém 66073-00, PA, Brazil; Programa de Pós Graduação em Ciências do Movimento, Universidade Federal do Pará, Av. Generalíssimo deodoro 01, Belém 66073-00, PA, Brazil.
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Guo L, Kou J, Wu M. Ability of Wearable Accelerometers-Based Measures to Assess the Stability of Working Postures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4695. [PMID: 35457561 PMCID: PMC9030489 DOI: 10.3390/ijerph19084695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 01/27/2023]
Abstract
With the rapid development and widespread application of wearable inertial sensors in the field of human motion capture, the low-cost and non-invasive accelerometer (ACC) based measures have been widely used for working postural stability assessment. This study systematically investigated the abilities of ACC-based measures to assess the stability of working postures in terms of the ability to detect the effects of work-related factors and the ability to classify stable and unstable working postures. Thirty young males participated in this study and performed twenty-four load-holding tasks (six working postures × two standing surfaces × two holding loads), and forty-three ACC-based measures were derived from the ACC data obtained by using a 17 inertial sensors-based motion capture system. ANOVAs, t-tests and machine learning (ML) methods were adopted to study the factors’ effects detection ability and the postural stability classification ability. The results show that almost all forty-three ACC-based measures could (p < 0.05) detect the main effects of Working Posture and Load Carriage, and their interaction effects. However, most of them failed in (p ≥ 0.05) detecting Standing Surface’s main or interaction effects. Five measures could detect both main and interaction effects of all the three factors, which are recommended for working postural stability assessment. The performance in postural stability classification based on ML was also good, and the feature set exerted a greater influence on the classification accuracy than sensor configuration (i.e., sensor placement locations). The results show that the pelvis and lower legs are recommended locations overall, in which the pelvis is the first choice. The findings of this study have proved that wearable ACC-based measures could assess the stability of working postures, including the work-related factors’ effects detection ability and stable-unstable working postures classification ability. However, researchers should pay more attention to the measure selection, sensors placement, feature selection and extraction in practical applications.
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Affiliation(s)
- Liangjie Guo
- Department of Safety Engineering, Faculty of Engineering, China University of Geosciences, Wuhan 430074, China; (J.K.); (M.W.)
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Physical Activity, Exercise, and Sports in Individuals with Skeletal Dysplasia: What Is Known about Their Benefits? SUSTAINABILITY 2022. [DOI: 10.3390/su14084487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
There is a lack of knowledge about the practice of physical activity, exercise, and sports in people with skeletal dysplasia (SD). This study aimed to characterize the physical fitness of people with SD; investigate the benefits of physical activity, exercise, or sports programs for people with SD; identify the adapted physical activities that can be prescribed to individuals with SD; and identify the most common and effective structural characteristics and guidelines for the evaluation of individuals with SD and corresponding activity prescriptions. Electronic searches were carried out in the PubMed, Scopus, SPORTDiscus, Psycinfo, and Web of Science databases in October 2021 and March 2022 and included papers published until 3 March 2022. The search strategy terms used were “dwarfism”, “dwarf”, “skeletal dysplasia”, “achondroplasia”, “pseudoachondroplasia”, “hypochondroplasia”, “campomelic dysplasia”, “hair cartilage hypoplasia”, “x-linked hypophosphatemia”, “metaphyseal chondrodysplasia schmid type”, “multiple epiphyseal dysplasia”, “three M syndrome”, “3-M syndrome”, “hypophosphatasia”, “fibrodysplasia ossificans progressive”, “type II collagen disorders”, “type II collagenopathies”, “type II collagenopathy”, “physical activity”, “exercise”, “sport”, “training”, and “physical fitness”, with the Boolean operators “AND” or “OR”. After reading the full texts of the studies, and according to previously defined eligibility criteria, fifteen studies met the inclusion criteria; however, there was not a single intervention study with physical exercise. Several cross-sectional, review, or qualitative studies presented a set of essential aspects that future intervention studies can consider when evaluating, prescribing, and implementing physical exercise programs, as they allowed the physical characterization of the SD population. This study demonstrated an apparent scarcity in the literature of experimental studies with physical exercise implementation in the SD population.
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Schoenfeld R, Drendel A, Ahamed SI, Thomas D. Longitudinal Assessment of Acute Concussion Outcomes Through SMS Text (ConText Study). Pediatr Emerg Care 2022; 38:e37-e42. [PMID: 34986585 DOI: 10.1097/pec.0000000000002596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Mild traumatic brain injury (mTBI), or concussion, is a common health problem that has seen a recent increase in US adolescents. This study uses SMS text messaging (a mobile health [mHealth] tool) to report patient symptoms. We aim to better characterize mTBI recovery and hypothesize that this mHealth tool will have high retention rates and correlate with a conventional means of assessing symptoms, the Post-Concussion Symptom Inventory (PCSI). METHODS A prospective observational cohort pilot study. Thirty-one pediatric patients with acute mTBI were recruited to characterize their injury and report their symptoms via text messaging. Patients reported symptoms once every 3 days for the first 21 days, then once a week for 6 weeks. RESULTS There was a strong and positive correlation between the PCSI and the mHealth tool (rs = 0.875, P < 0.000, n = 22). Retention was 74% until symptom resolution and 42% until study completion. Patients with balance deficits had a significantly higher somatization score than those with normal balance (6.53 ± 3.25 vs 2.56 ± 2.30, t(22) = 3.211, P < 0.01). CONCLUSIONS This pilot study demonstrates that this tool is a valid and easy-to-use method of reporting pediatric mTBI symptoms-it replicates and identifies novel findings. Our results suggest that there may be a relationship between balance and the manifestation of somatic symptoms. Retention rates were lower than predicted, indicating that text messaging may not be the ideal format in this population. Text messaging may still have other applications for short-term communication/symptom measurement.
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Affiliation(s)
| | - Amy Drendel
- Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Sheikh Iqbal Ahamed
- Department of Mathematics Statistics and Computer Science, Marquette University
| | - Danny Thomas
- Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI
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Potential Mechanisms of Acute Standing Balance Deficits After Concussions and Subconcussive Head Impacts: A Review. Ann Biomed Eng 2021; 49:2693-2715. [PMID: 34258718 DOI: 10.1007/s10439-021-02831-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023]
Abstract
Standing balance deficits are prevalent after concussions and have also been reported after subconcussive head impacts. However, the mechanisms underlying such deficits are not fully understood. The objective of this review is to consolidate evidence linking head impact biomechanics to standing balance deficits. Mechanical energy transferred to the head during impacts may deform neural and sensory components involved in the control of standing balance. From our review of acute balance-related changes, concussions frequently resulted in increased magnitude but reduced complexity of postural sway, while subconcussive studies showed inconsistent outcomes. Although vestibular and visual symptoms are common, potential injury to these sensors and their neural pathways are often neglected in biomechanics analyses. While current evidence implies a link between tissue deformations in deep brain regions including the brainstem and common post-concussion balance-related deficits, this link has not been adequately investigated. Key limitations in current studies include inadequate balance sampling duration, varying test time points, and lack of head impact biomechanics measurements. Future investigations should also employ targeted quantitative methods to probe the sensorimotor and neural components underlying balance control. A deeper understanding of the specific injury mechanisms will inform diagnosis and management of balance deficits after concussions and subconcussive head impact exposure.
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Gawronska A, Pajor A, Zamyslowska-Szmytke E, Rosiak O, Jozefowicz-Korczynska M. Usefulness of Mobile Devices in the Diagnosis and Rehabilitation of Patients with Dizziness and Balance Disorders: A State of the Art Review. Clin Interv Aging 2020; 15:2397-2406. [PMID: 33376315 PMCID: PMC7764625 DOI: 10.2147/cia.s289861] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022] Open
Abstract
Objective The gold standard for objective body posture examination is posturography. Body movements are detected through the use of force platforms that assess static and dynamic balance (conventional posturography). In recent years, new technologies like wearable sensors (mobile posturography) have been applied during complex dynamic activities to diagnose and rehabilitate balance disorders. They are used in healthy people, especially in the aging population, for detecting falls in the older adults, in the rehabilitation of different neurological, osteoarticular, and muscular system diseases, and in vestibular disorders. Mobile devices are portable, lightweight, and less expensive than conventional posturography. The vibrotactile system can consist of an accelerometer (linear acceleration measurement), gyroscopes (angular acceleration measurement), and magnetometers (heading measurement, relative to the Earth’s magnetic field). The sensors may be mounted to the trunk (most often in the lumbar region of the spine, and the pelvis), wrists, arms, sternum, feet, or shins. Some static and dynamic clinical tests have been performed with the use of wearable sensors. Smartphones are widely used as a mobile computing platform and to evaluate the results or monitor the patient during the movement and rehabilitation. There are various mobile applications for smartphone-based balance systems. Future research should focus on validating the sensitivity and reliability of mobile device measurements compared to conventional posturography. Conclusion Smartphone based mobile devices are limited to one sensor lumbar level posturography and offer basic clinical evaluation. Single or multi sensor mobile posturography is available from different manufacturers and offers single to multi-level measurements, providing more data and in some instances even performing sophisticated clinical balance tests.
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Affiliation(s)
- Anna Gawronska
- Balance Disorders Unit, Department of Otolaryngology, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
| | - Anna Pajor
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
| | - Ewa Zamyslowska-Szmytke
- Balance Disorders Unit, Department of Audiology and Phoniatrics, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Oskar Rosiak
- Balance Disorders Unit, Department of Otolaryngology, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
| | - Magdalena Jozefowicz-Korczynska
- Balance Disorders Unit, Department of Otolaryngology, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
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de Vries OM, Johansen H, Fredwall SO. Physical fitness and activity level in Norwegian adults with achondroplasia. Am J Med Genet A 2020; 185:1023-1032. [PMID: 33382213 PMCID: PMC7986635 DOI: 10.1002/ajmg.a.62055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 12/17/2022]
Abstract
This cross-sectional Physical Fitness Study compared cardiorespiratory fitness (VO2 peak), six-minute walk test (6MWT), muscle strength (30sSTS), balance (BESS), and self-reported physical activity level (IPAQ) in Norwegian adults with achondroplasia (ACH) to reference values of average-statured individuals. The feasibility of the physical fitness tests and IPAQ was explored. Forty-three adults (22 women) participated. Mean age was 38 years (range 16-69 years). Mean differences (95% CI) for men and women with ACH compared to reference values were: VO2 peak. -7.0 m/min/kg (-13.6 to -0.5, p = .037), and - 7.9 ml/kg/min (-11.6 to -4.3, p < .001); 6MWT -270.8 m (-340.4 to -201.2, p < .001), and - 196.7 m (-244.3 to -149.0, p = .001); 30sSTS -4.6 repetitions (-7.8 to -1.5, p = .006), and - 1.1 repetitions (-3.4 to 1.1, p = .335). There were no differences within ACH participants, except for VO2 peak, where men performed better. Sufficient physical activity (> 600 metabolic equivalent of task weekly) was achieved by 79% of the participants. The feasibility of the 6MWT and 30sSTS was good. There was a strong correlation between the VO2 peak and 6MWT (men: r = 0.63, p = .007; women: r = 0.71, p < .001). The findings indicate that the 6MWT and 30sSTS test are useful in assessing functional exercise capacity and muscle strength in adults with ACH.
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Affiliation(s)
- Olga Marieke de Vries
- Sunnaas Rehabilitation Hospital, TRS National Resource Centre for Rare Disorders, Nesodden, Norway
| | - Heidi Johansen
- Sunnaas Rehabilitation Hospital, TRS National Resource Centre for Rare Disorders, Nesodden, Norway
| | - Svein Otto Fredwall
- Sunnaas Rehabilitation Hospital, TRS National Resource Centre for Rare Disorders, Nesodden, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
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12
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Ralston JD, Raina A, Benson BW, Peters RM, Roper JM, Ralston AB. Physiological Vibration Acceleration (Phybrata) Sensor Assessment of Multi-System Physiological Impairments and Sensory Reweighting Following Concussion. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:411-438. [PMID: 33324120 PMCID: PMC7733539 DOI: 10.2147/mder.s279521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/02/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the utility of a head-mounted wearable inertial motion unit (IMU)-based physiological vibration acceleration (“phybrata”) sensor to support the clinical diagnosis of concussion, classify and quantify specific concussion-induced physiological system impairments and sensory reweighting, and track individual patient recovery trajectories. Methods Data were analyzed from 175 patients over a 12-month period at three clinical sites. Comprehensive clinical concussion assessments were first completed for all patients, followed by testing with the phybrata sensor. Phybrata time series data and spatial scatter plots, eyes open (Eo) and eyes closed (Ec) phybrata powers, average power (Eo+Ec)/2, Ec/Eo phybrata power ratio, time-resolved phybrata spectral density (TRPSD) distributions, and receiver operating characteristic (ROC) curves are compared for individuals with no objective impairments and those clinically diagnosed with concussions and accompanying vestibular impairment, other neurological impairment, or both vestibular and neurological impairments. Finally, pre- and post-injury phybrata case report results are presented for a participant who was diagnosed with a concussion and subsequently monitored during treatment, rehabilitation, and return-to-activity clearance. Results Phybrata data demonstrate distinct features and patterns for individuals with no discernable clinical impairments, diagnosed vestibular pathology, and diagnosed neurological pathology. ROC curves indicate that the average power (Eo+Ec)/2 may be utilized to support clinical diagnosis of concussion, while Eo and Ec/Eo may be utilized as independent measures to confirm accompanying neurological and vestibular impairments, respectively. All 3 measures demonstrate area under the curve (AUC), sensitivity, and specificity above 90% for their respective diagnoses. Phybrata spectral analyses demonstrate utility for quantifying the severity of concussion-induced physiological impairments, sensory reweighting, and subsequent monitoring of improvements throughout treatment and rehabilitation. Conclusion Phybrata testing assists with objective concussion diagnosis and provides an important adjunct to standard concussion assessment tools by objectively ascertaining neurological and vestibular impairments, guiding targeted rehabilitation strategies, monitoring recovery, and assisting with return-to-sport/work/learn decision-making.
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Affiliation(s)
| | - Ashutosh Raina
- Center of Excellence for Pediatric Neurology, Rocklin, CA 95765, USA.,Concussion Medical Clinic, Rocklin, CA 95765, USA
| | - Brian W Benson
- Benson Concussion Institute, Calgary, Alberta T3B 6B7, Canada.,Canadian Sport Institute Calgary, Calgary, Alberta T3B 5R5, Canada
| | - Ryan M Peters
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta T2N 1N4, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada
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13
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Chua LK, Wulf G, Lewthwaite R. Choose your words wisely: Optimizing impacts on standardized performance testing. Gait Posture 2020; 79:210-216. [PMID: 32442896 DOI: 10.1016/j.gaitpost.2020.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/19/2020] [Accepted: 05/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The OPTIMAL theory of motor learning identifies motivational (enhanced expectancies, EE, and autonomy support, AS) and attentional (an external attentional focus, EF) factors that affect motor performance and learning [1]. One implication of this theory is that standardized clinical and laboratory assessments of physical capacity and motor performance that do not incorporate optimizing conditions may underestimate true maximal capabilities. The influence of "optimized" conditions on a clinical-applied test of balance control was examined with healthy participants. Given the motor performance benefits of optimized conditions predicted by the OPTIMAL theory, it was hypothesized that providing participants with information that induced EE, provided them with AS, and promoted their use of EF would reduce balance errors and postural sway. METHODS We used as an exemplar assessment, the Balance Error Scoring System (BESS), and center-of-pressure (COP) velocity measurements of postural sway. Participants performed under two different conditions, separated by two days: an optimized (EE, AS, and EF) condition and a control ("neutral") condition, with sample-wide order counterbalancing. In each condition, participants performed three stances (double-leg, single-leg, and tandem) on two support surfaces (firm and foam). Stance order was participant-determined in the optimized condition and, for the control condition, yoked to a participant in the optimized condition. RESULTS Participants committed fewer balance errors in the optimized condition than in the control condition (p < .001) and their resultant COP velocity in the optimized condition was lower than that in the control condition (p = .004). BESS scores were correlated with resultant COP velocity (r = .593, p < .001). SIGNIFICANCE Our results demonstrated the impact of implementing optimized, as opposed to "neutral" control, conditions for better insight into balance capabilities in normal and challenging situations. Practitioners' roles in mediating test situations and using subtle wording to promote optimized performance may have consequential impacts on motor assessment outcomes.
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Affiliation(s)
- Lee-Kuen Chua
- Neurorestoration Center, University of Southern California, Los Angeles, CA, USA; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
| | - Gabriele Wulf
- Department of Kinesiology and Nutrition Services, University of Nevada, Las Vegas, NV, USA
| | - Rebecca Lewthwaite
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA; Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
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14
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Reliability, Validity and Utility of Inertial Sensor Systems for Postural Control Assessment in Sport Science and Medicine Applications: A Systematic Review. Sports Med 2020; 49:783-818. [PMID: 30903440 DOI: 10.1007/s40279-019-01095-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Recent advances in mobile sensing and computing technology have provided a means to objectively and unobtrusively quantify postural control. This has resulted in the rapid development and evaluation of a series of wearable inertial sensor-based assessments. However, the validity, reliability and clinical utility of such systems is not fully understood. OBJECTIVES This systematic review aims to synthesise and evaluate studies that have investigated the ability of wearable inertial sensor systems to validly and reliably quantify postural control performance in sports science and medicine applications. METHODS A systematic search strategy utilising the PRISMA guidelines was employed to identify eligible articles through ScienceDirect, Embase and PubMed databases. In total, 47 articles met the inclusion criteria and were evaluated and qualitatively synthesised under two main headings: measurement validity and measurement reliability. Furthermore, studies that investigated the utility of these systems in clinical populations were summarised and discussed. RESULTS After duplicate removal, 4374 articles were identified with the search strategy, with 47 papers included in the final review. In total, 28 studies investigated validity in healthy populations, and 15 studies investigated validity in clinical populations; 13 investigated the measurement reliability of these sensor-based systems. CONCLUSIONS The application of wearable inertial sensors for sports science and medicine postural control applications is an evolving field. To date, research has primarily focused on evaluating the validity and reliability of a heterogeneous set of assessment protocols, in a laboratory environment. While researchers have begun to investigate their utility in clinical use cases such as concussion and musculoskeletal injury, most studies have leveraged small sample sizes, are of low quality and use a variety of descriptive variables, assessment protocols and sensor-mounting locations. Future research should evaluate the clinical utility of these systems in large high-quality prospective cohort studies to establish the role they may play in injury risk identification, diagnosis and management. This systematic review was registered with the International Prospective Register of Systematic Reviews on 10 August 2018 (PROSPERO registration: CRD42018106363): https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=106363 .
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15
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Prim JH, Favorov OV, Cecchini AS, Scherer MR, Weightman MM, McCulloch KL. Clinical Utility and Analysis of the Run-Roll-Aim Task: Informing Return-to-Duty Readiness Decisions in Active-Duty Service Members. Mil Med 2020; 184:e268-e277. [PMID: 30690450 DOI: 10.1093/milmed/usy425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/12/2018] [Accepted: 12/10/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The Assessment of Military Multitasking Performance (AMMP1) consists of six dual-task and multitask military-relevant performance-based assessments which were developed to provide assistance in making return-to-duty decisions after concussion or mild traumatic brain injury (mTBI.) The Run-Roll-Aim (RRA) task, one component of the AMMP, was developed to target vulnerabilities following mTBI including attention, visual function, dynamic stability, rapid transition, and vestibular function. One aim of this study was to assess the known-group and construct validity of the RRA, and additionally to further explore reliability limitations reported previously. MATERIALS AND METHODS A cross-sectional study consisting of 84 Active Duty service members in two groups (healthy control - HC and individuals experiencing persistent mTBI symptoms) completed neurocognitive tests and the RRA. The RRA task requires a high level of mobility and resembles military training activities in a maneuver that includes combat rolls, fast transitions, obstacle avoidance, and visual search. Observational and inertial sensor data were compared between groups and performance across four trial times was compared within groups. Correlations between RRA results and neurocognitive test scores were analyzed. RESULTS Simple observational measures (time, errors) did not differ between groups. Spectral power analysis of the inertial sensor data showed significant differences in motor performance between groups. Within group one-way ANOVAs showed that in HC trial 1, time was significantly different than trials 2,3 and 4 (F(3,47) = 4.60, p < 0.01, Tukey HSD p < 0.05) while the mTBI group showed no significant difference in time between trials. During testing individuals with mTBI were less likely to complete the multiple test trials or required additional rest between trials than HCs (χ2 = 10.78, p < 0.01). Small but significant correlations were seen with two neurocognitive tests of attention and RRA performance time. CONCLUSION While observational scores were not sensitive to group differences, inertial sensor data showed motor performance on the forward run, combat roll, and backward run differed significantly between groups. The RRA task appeared challenging and provoked symptoms in the mTBI group, causing 8 of 33 mTBI participants to stop the task or require additional rest between trials while none of the HC participants had to stop. Individuals with mTBI demonstrated slower learning of the complex motor sequence compared to HCs who had significant improvement after one trial of RRA. Complex novel training maneuvers like RRA may aid clinicians in informing return to duty decisions.
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Affiliation(s)
- Julianna H Prim
- Curriculum in Human Movement Science, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, 3070 Bondurant Hall, 321 S. Columbia St. Chapel Hill, NC
| | - Oleg V Favorov
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, NC
| | - Amy S Cecchini
- Intrepid Spirit Clinic, Contractor for The Geneva Foundation, Fort Bragg, NC
| | - Matthew R Scherer
- Clinical and Rehabilitative Medicine Research Program, U.S. Army Medical Research and Materiel Command, Fort Detrick, MD
| | | | - Karen L McCulloch
- Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, NC
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16
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Ghislieri M, Gastaldi L, Pastorelli S, Tadano S, Agostini V. Wearable Inertial Sensors to Assess Standing Balance: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2019; 19:E4075. [PMID: 31547181 PMCID: PMC6806601 DOI: 10.3390/s19194075] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 02/06/2023]
Abstract
Wearable sensors are de facto revolutionizing the assessment of standing balance. The aim of this work is to review the state-of-the-art literature that adopts this new posturographic paradigm, i.e., to analyse human postural sway through inertial sensors directly worn on the subject body. After a systematic search on PubMed and Scopus databases, two raters evaluated the quality of 73 full-text articles, selecting 47 high-quality contributions. A good inter-rater reliability was obtained (Cohen's kappa = 0.79). This selection of papers was used to summarize the available knowledge on the types of sensors used and their positioning, the data acquisition protocols and the main applications in this field (e.g., "active aging", biofeedback-based rehabilitation for fall prevention, and the management of Parkinson's disease and other balance-related pathologies), as well as the most adopted outcome measures. A critical discussion on the validation of wearable systems against gold standards is also presented.
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Affiliation(s)
- Marco Ghislieri
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy.
| | - Laura Gastaldi
- Department of Mathematical Sciences, Politecnico di Torino, 10129 Torino, Italy.
| | - Stefano Pastorelli
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129 Torino, Italy.
| | - Shigeru Tadano
- National Institute of Technology, Hakodate College, Hakodatate 042-8501, Japan.
- Division of Human Mechanical Systems and Design, Faculty of Engineering, Hokkaido University, Sapporo 060-0808, Japan.
| | - Valentina Agostini
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy.
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17
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Houston MN, Hoch MC, Malvasi SR, Peck KY, Svoboda SJ, Cameron KL. Level of Agreement Between Human-Rated and Instrumented Balance Error Scoring System Scores. Ann Biomed Eng 2019; 47:2128-2135. [PMID: 31011917 DOI: 10.1007/s10439-019-02274-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/15/2019] [Indexed: 11/27/2022]
Abstract
Clinicians have used the Balance Error Scoring System (BESS) to quantify postural control for concussion management. However, the reliability of the human rated BESS has varied prompting the development of instrumented BESSs. A cross-sectional design was used to determine the level of agreement (LOA) between human rated and instrumented BESS scores. Sixty participants completed the BESS on video. An instrumented mat was used to quantify BESS errors while a live human rater simultaneously scored the BESS. A second human rated BESS performance via video. Bland-Altman LOA analyses evaluated agreement between scoring methods (Mat-Human, Mat-Video, Video-Live) for each stance. Mean biases between scores, for each stance, with 95% confidence intervals (95%CIs) were calculated. Agreement between scoring methods was not assessed for the Firm-Double-Limb stance because very few errors were recorded. Agreement between both human raters and the mat was poor based on mean bias estimates > ± 1 and/or wide 95%CIs for all stances including BESS-Total. Agreement between the human raters was better, having displayed consistently smaller mean bias estimates and tighter 95%CIs for all stances and BESS Total. As a result, human rated and instrumented BESS scores may not be comparable. One method should be used to measure BESS errors for consistency.
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Affiliation(s)
- Megan N Houston
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, 900 Washington Road, West Point, NY, 10996, USA.
| | - Matthew C Hoch
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY, USA
| | - Steven R Malvasi
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, 900 Washington Road, West Point, NY, 10996, USA
| | - Karen Y Peck
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, 900 Washington Road, West Point, NY, 10996, USA
| | | | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, 900 Washington Road, West Point, NY, 10996, USA
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18
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Verschueren J, Tassignon B, Pluym B, Van Cutsem J, Verhagen E, Meeusen R. Bringing context to balance: development of a reactive balance test within the injury prevention and return to sport domain. Arch Physiother 2019; 9:6. [PMID: 31019737 PMCID: PMC6469097 DOI: 10.1186/s40945-019-0057-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/22/2019] [Indexed: 12/26/2022] Open
Abstract
Background Balance tests are commonly used in clinical practice with applicability in injury prevention and return to sport decisions. While most sports injuries occur in a changing environment where reacting to a non-planned stimulus is of great importance, these balance tests only evaluate pre-planned movements without taking these dynamics environmental aspects into account. Therefore, the goal of this paper was to develop a clinician-friendly test that respects these contextual interactions and to describe the test protocol of an adapted Y-balance test that includes environmental perception and decision-making. Methods Within the theoretical construct of balance and adaptability, balance errors were selected as outcome measures for balance ability and, visuomotor reaction time and accuracy are selected as outcome measures for adaptability. A reactive balance task was developed and described using the Y-balance test for the balance component, while the FitLight training systemTM was chosen for the environmental perception and decision-making component of the test. Results This paper describes the test protocol of a reactive balance test as an adapted Y-balance test. The LED-lights of the FitLight training systemTM are placed at 80% of the maximal reach distance for each axis along the Y-Balance test kitTM. To induce cognitive load within the visuomotor task, colours were fixed to a corresponding axis, and both the order of the visual stimuli as the interstimulus time were randomised to integrate environmental perception and decision-making. Conclusion The reactive balance test is a functional test that allows clinicians to score balance ability and athlete adaptability easily.
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Affiliation(s)
- Jo Verschueren
- 1Faculty of Physical Education and Physiotherapy, Human Physiology Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bruno Tassignon
- 1Faculty of Physical Education and Physiotherapy, Human Physiology Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bert Pluym
- 1Faculty of Physical Education and Physiotherapy, Human Physiology Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jeroen Van Cutsem
- 1Faculty of Physical Education and Physiotherapy, Human Physiology Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Evert Verhagen
- 2Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands
| | - Romain Meeusen
- 1Faculty of Physical Education and Physiotherapy, Human Physiology Research Group, Vrije Universiteit Brussel, Brussels, Belgium
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19
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Abstract
The Balance Error Scoring System (BESS) is a human-scored, field-based balance test used in cases of suspected concussion. Recently developed instrumented alternatives to human scoring carry substantial advantages over traditional testing, but thus far report relatively abstract outcomes which may not be useful to clinicians or coaches. In contrast, the Automated Assessment of Postural Stability (AAPS) is a computerized system that tabulates error events in accordance with the original description of the BESS. This study compared AAPS and human-based BESS scores. Twenty-five healthy adults performed the modified BESS. Tests were scored twice each by human raters (3) and the computerized system. Interrater (between-human) and inter-method (AAPS vs. human) agreement (ICC(2,1)) were calculated alongside Bland-Altman limits of agreement (LOA). Interrater analyses were significant (p<0.005) and demonstrated good to excellent agreement. Inter-method agreement analyses were significant (p<0.005), with agreement ranging from poor to excellent. Computerized scores were equivalent across rating occasions. LOA ranges for AAPS vs. the Human Average exceeded the average LOA ranges between human raters. Coaches and clinicians may consider a system such as AAPS to automate balance testing while maintaining the familiarity of human-based scoring, although scores should not yet be considered interchangeable with those of a human rater.
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20
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McGeown JP, Zerpa C, Lees S, Niccoli S, Sanzo P. Implementing a structured exercise program for persistent concussion symptoms: a pilot study on the effects on salivary brain-derived neurotrophic factor, cognition, static balance, and symptom scores. Brain Inj 2018; 32:1556-1565. [DOI: 10.1080/02699052.2018.1498128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Joshua P. McGeown
- School of Kinesiology, Lakehead University, Department of Health and Behavioural Sciences, Thunder Bay, Canada
- Sports Performance Research Institute New Zealand - Auckland University of Technology, Auckland, New Zealand
| | - Carlos Zerpa
- School of Kinesiology, Lakehead University, Department of Health and Behavioural Sciences, Thunder Bay, Canada
| | - Simon Lees
- Northern Ontario School of Medicine, Medical Sciences Division, Lakehead University, Thunder Bay, Canada
| | - Sarah Niccoli
- Northern Ontario School of Medicine, Medical Sciences Division, Lakehead University, Thunder Bay, Canada
| | - Paolo Sanzo
- School of Kinesiology, Lakehead University, Department of Health and Behavioural Sciences, Thunder Bay, Canada
- Northern Ontario School of Medicine, Medical Sciences Division, Lakehead University, Thunder Bay, Canada
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21
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Trecroci A, Cavaggioni L, Lastella M, Broggi M, Perri E, Iaia FM, Alberti G. Effects of traditional balance and slackline training on physical performance and perceived enjoyment in young soccer players. Res Sports Med 2018; 26:450-461. [PMID: 29963921 DOI: 10.1080/15438627.2018.1492392] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of this study was to evaluate the effects of 12-week balance and slackline training programs on physical performance and perceived enjoyment scale in young soccer players. Forty-one preadolescent soccer players were assigned to two experimental groups performing traditional balance (BLT) or slackline training (SLT), and a control group. Pre-post assessment encompassed Balance Error Scoring System (BESS), Star Excursion Balance test (SEBT), sprint with 90° turns (S90), and countermovement jump (CMJ). The rate of perceived enjoyment scale (PACES) was applied at the end of the experimental period. SLT and BLT improved similarly in BESS, SEBT and S90. No changes were detected in the CMJ. Regarding PACES score, SLT presented significantly higher values than BLT. Young athletes may benefit from a motivating training approach, thus, a designed program based on slackline drills should be preferable to improve physical performance in terms of balance and change of direction ability in preadolescent soccer players.
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Affiliation(s)
- Athos Trecroci
- a Department of Biomedical Sciences for Health , Università degli Studi di Milano , Milan , Italy
| | - Luca Cavaggioni
- a Department of Biomedical Sciences for Health , Università degli Studi di Milano , Milan , Italy
| | - Michele Lastella
- b Appleton Institute for Behavioural Science, School of Health, Medical and Applied Sciences , Central Queensland University , Adelaide , SA , Australia
| | - Marco Broggi
- a Department of Biomedical Sciences for Health , Università degli Studi di Milano , Milan , Italy
| | - Enrico Perri
- a Department of Biomedical Sciences for Health , Università degli Studi di Milano , Milan , Italy
| | - F Marcello Iaia
- a Department of Biomedical Sciences for Health , Università degli Studi di Milano , Milan , Italy
| | - Giampietro Alberti
- a Department of Biomedical Sciences for Health , Università degli Studi di Milano , Milan , Italy
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22
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Abstract
CONTEXT Capturing baseline data before a concussion can be a valuable tool in individualized care. However, not all athletes, including dancers, have access to baseline testing. When baseline examinations were not performed, clinicians consult normative values. Dancers are unique athletes; therefore, describing values specific to dancers may assist those working with these athletes in making more informed decisions. OBJECTIVE To describe values for key concussion measures of dancers. Our secondary aim was to examine whether differences existed between sexes and professional status. Finally, we explored factors that may affect dancers' scores. DESIGN Cross-sectional study. SETTING Professional dance companies and a collegiate dance conservatory. PATIENTS OR OTHER PARTICIPANTS A total of 238 dancers (university = 153, professional = 85; women = 171; men = 67; age = 21.1 ± 4.8 years). MAIN OUTCOME MEASURE(S) We calculated the total symptom severity from the Sport Concussion Assessment Tool-3rd edition; the Standardized Assessment of Concussion score; the modified Balance Error Scoring System score; and the King-Devick score for each participant. Group differences were analyzed with Mann-Whitney or t tests, depending on the data distribution. We used bivariate correlations to explore the effects of other potential influencing factors. RESULTS Participants demonstrated the following baseline outcomes: symptom severity = 16.6 ± 12.8; Standardized Assessment of Concussion = 27.5 ± 1.8; modified Balance Error Scoring System = 3.2 ± 3.1 errors; and King-Devick = 41.5 ± 8.2 seconds. A Mann-Whitney test revealed differences in King-Devick scores between female (40.8 ± 8.0 seconds) and male (43.4 ± 8.4 seconds) dancers ( P = .04). An independent-samples t test also demonstrated a difference in modified Balance Error Scoring System scores between female (2.95 ± 3.1 errors) and male (3.8 ± 3.1 errors) dancers ( P = .02). Age, hours of sleep, height, and history of concussion, depression, or injury did not display moderate or strong associations with any of the outcome measures. CONCLUSIONS Dancers' symptom severity scores appeared to be higher than the values reported for other athletes. Additional studies are needed to establish normative values and develop a model for predicting baseline scores.
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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.
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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
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24
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Zhu M, Huang Z, Ma C, Li Y. An Objective Balance Error Scoring System for Sideline Concussion Evaluation Using Duplex Kinect Sensors. SENSORS 2017; 17:s17102398. [PMID: 29053602 PMCID: PMC5677441 DOI: 10.3390/s17102398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 11/16/2022]
Abstract
Sports-related concussion is a common sports injury that might induce potential long-term consequences without early diagnosis and intervention in the field. However, there are few options of such sensor systems available. The aim of the study is to propose and validate an automated concussion administration and scoring approach, which is objective, affordable and capable of detecting all balance errors required by the balance error scoring system (BESS) protocol in the field condition. Our approach is first to capture human body skeleton positions using two Microsoft Kinect sensors in the proposed configuration and merge the data by a custom-made algorithm to remove the self-occlusion of limbs. The standing balance errors according to BESS protocol were further measured and accessed automatically by the proposed algorithm. Simultaneously, the BESS test was filmed for scoring by an experienced rater. Two results were compared using Pearson coefficient r, obtaining an excellent consistency (r = 0.93, p < 0.05). In addition, BESS test–retest was performed after seven days and compared using intraclass correlation coefficients (ICC), showing a good test–retest reliability (ICC = 0.81, p < 0.01). The proposed approach could be an alternative of objective tools to assess postural stability for sideline sports concussion diagnosis.
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Affiliation(s)
- Mengqi Zhu
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing 100081, China.
| | - Zhonghua Huang
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing 100081, China.
| | - Chao Ma
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing 100081, China.
| | - Yinlin Li
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing 100081, China.
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25
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Gardner AJ, Wojtowicz M, Terry DP, Levi CR, Zafonte R, Iverson GL. Video and clinical screening of national rugby league players suspected of sustaining concussion. Brain Inj 2017; 31:1918-1924. [DOI: 10.1080/02699052.2017.1358399] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Andrew J. Gardner
- Hunter New England Sports Concussion Program, John Hunter Hospital; Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Magdalena Wojtowicz
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, MassGeneral Hospital for Children™ Sport Concussion Program, & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts, USA
| | - Douglas P. Terry
- Center for Health and Rehabilitation Research, Spaulding Rehabilitation Network, MassGeneral Hospital for Children™ Sports Concussion Program Boston, USA
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher R. Levi
- Hunter New England Sports Concussion Program, John Hunter Hospital; Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, MassGeneral Hospital for Children™ Sports Concussion Program, & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts, USA
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Abstract
OBJECTIVE Postural stability is often affected by sport-related injuries and subsequently evaluated during postinjury examinations. Intrinsic factors, however, may also affect postural control. We sought to compare the postural control of female and male athletes as measured simultaneously by (1) the modified balance error scoring system (mBESS) and (2) a video-force plate system. DESIGN Cross-sectional study. SETTING Sports injury prevention center. PARTICIPANTS Pediatric, adolescent, and young adult athletes who performed mBESS during an injury prevention evaluation. INDEPENDENT VARIABLES We compared the postural control of female and male athletes. We also accounted for independent variables associated with postural stability, including age, body mass index, and history of ankle injury, concussion, and migraine headache. MAIN OUTCOME MEASURES Total errors committed during the mBESS and measurements derived from integrated kinematic and kinetic data obtained by a video-force plate system. Differences between males and females were tested using analysis of covariance. RESULTS Participants (n = 409) ranged in age from 10 to 29 years (mean = 14.6 ± 2.8); 60% were female. No significant differences on mBESS were detected between females and males; however, female athletes demonstrated significantly better postural stability on the video-force plate analysis during double-leg (P = 0.03, d = 0.28), single-leg (P < 0.001, d = 0.62), and tandem stances (P < 0.001, d = 0.53) when compared with males. CONCLUSIONS Uninjured female athletes demonstrate better postural stability on video-force plate analysis than their uninjured male counterparts. These findings provide an important information assistive to clinicians during interpretation of postinjury balance tests.
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Kleffelgaard I, Langhammer B, Sandhaug M, Pripp AH, Søberg HL. Measurement properties of the modified and total Balance ERror SCoring System – the BESS, in a healthy adult sample. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2017.1352020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ingerid Kleffelgaard
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Oslo, Norway
- Oslo University College of Applied Sciences, Institute of Physiotherapy, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Birgitta Langhammer
- Oslo University College of Applied Sciences, Institute of Physiotherapy, Oslo, Norway
| | | | - Are Hugo Pripp
- Oslo University College of Applied Sciences, Institute of Physiotherapy, Oslo, Norway
| | - Helene Lundgaard Søberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Oslo, Norway
- Oslo University College of Applied Sciences, Institute of Physiotherapy, Oslo, Norway
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Sensor-Based Balance Measures Outperform Modified Balance Error Scoring System in Identifying Acute Concussion. Ann Biomed Eng 2017; 45:2135-2145. [PMID: 28540448 DOI: 10.1007/s10439-017-1856-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/17/2017] [Indexed: 01/20/2023]
Abstract
Balance assessment is an integral component of concussion evaluation and management. Although the modified balance error scoring system (mBESS) is the conventional clinical tool, objective metrics derived from wearable inertial sensors during the mBESS may increase sensitivity in detecting subtle balance deficits post-concussion. The aim of this study was to identify which stance condition and postural sway metrics obtained from an inertial sensor placed on the lumbar spine during the mBESS best discriminate athletes with acute concussion. Fifty-two college athletes in the acute phase of concussion and seventy-six controls participated in this study. Inertial sensor-based measures objectively detected group differences in the acutely concussed group of athletes while the clinical mBESS did not (p < 0.001 and p = 0.06, respectively). Mediolateral postural sway during the simplest condition of the mBESS (double stance) best classified those with acute concussion. Inertial sensors provided a sensitive and objective measure of balance in acute concussion. These results may be developed into practical guidelines to improve and simplify postural sway analysis post-concussion.
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Johnston W, Doherty C, Büttner FC, Caulfield B. Wearable sensing and mobile devices: the future of post-concussion monitoring? Concussion 2017; 2:CNC28. [PMID: 30202569 PMCID: PMC6096439 DOI: 10.2217/cnc-2016-0025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 11/24/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- William Johnston
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Ireland.,School of Public Health, Physiotherapy & Sports Science, University College Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Ireland
| | - Cailbhe Doherty
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Ireland.,School of Public Health, Physiotherapy & Sports Science, University College Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Ireland
| | - Fionn Cleirigh Büttner
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Ireland.,School of Public Health, Physiotherapy & Sports Science, University College Dublin, Ireland
| | - Brian Caulfield
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Ireland.,School of Public Health, Physiotherapy & Sports Science, University College Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Ireland
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30
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Doherty C, Zhao L, Ryan J, Komaba Y, Inomata A, Caulfield B. Quantification of postural control deficits in patients with recent concussion: An inertial-sensor based approach. Clin Biomech (Bristol, Avon) 2017; 42:79-84. [PMID: 28110244 DOI: 10.1016/j.clinbiomech.2017.01.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to quantify postural control ability in a group with concussion compared with a healthy control group. METHOD Fifteen concussion patients (4 females, 11 males) and a group of fifteen age- and sex-matched controls were recruited. Participants were tested during the performance of the three stance variants (bilateral, tandem and unilateral) of the balance error scoring system standing on a force place, while wearing an inertial measurement unit placed at the posterior aspect of the sacrum. FINDINGS The area of postural sway was computed using the force-plate and the '95% ellipsoid volume of sway' was computed from the accelerometer data. Concussed patients exhibited increased sway area (1513mm2 [95% CI: 935 to 2091mm2] vs 646mm2 [95% CI: 519 to 772mm2]; p=0.02) and sway volume (9.46m3s-6 [95% CI: 8.02 to 19.94m3s-6] vs 2.68m3s-6 [95% CI: 1.81 to 3.55m3s-6]; p=0.01) in the bilateral stance position of the balance error scoring system. The sway volume metric also had excellent accuracy in identifying task 'errors' (tandem stance: 91% accuracy [95% CI: 85-96%], p<0.001; unilateral stance: 91% accuracy [95% CI: 86-96%], p<0.001). INTERPRETATION Individuals with concussion display increased postural sway during bilateral stance. The sway volume that was calculated from the accelerometer data not only differentiated a group with concussion from a healthy control group, but successfully identified when task errors had occurred. This may be of value in the development of a pitch-side assessment system for concussion.
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Affiliation(s)
- Cailbhe Doherty
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.
| | - Liang Zhao
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.
| | - John Ryan
- St. Vincent's University Hospital, Dublin, Ireland
| | | | | | - Brian Caulfield
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
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31
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Howell DR, Osternig LR, Chou LS. Single-task and dual-task tandem gait test performance after concussion. J Sci Med Sport 2017; 20:622-626. [PMID: 28169147 DOI: 10.1016/j.jsams.2016.11.020] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/19/2016] [Accepted: 11/28/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare single-task and dual-task tandem gait test performance between athletes after concussion with controls on observer-timed, spatio-temporal, and center-of-mass (COM) balance control measurements. DESIGN Ten participants (19.0±5.5years) were prospectively identified and completed a tandem gait test protocol within 72h of concussion and again 1 week, 2 weeks, 1 month, and 2 months post-injury. Seven uninjured controls (20.0±4.5years) completed the same protocol in similar time increments. METHODS Tandem gait test trials were performed with (dual-task) and without (single-task) concurrently performing a cognitive test as whole-body motion analysis was performed. Outcome variables included test completion time, average tandem gait velocity, cadence, and whole-body COM frontal plane displacement. RESULTS Concussion participants took significantly longer to complete the dual-task tandem gait test than controls throughout the first 2 weeks post-injury (mean time=16.4 [95% CI: 13.4-19.4] vs. 10.1 [95% CI: 6.4-13.7] seconds; p=0.03). Single-task tandem gait times were significantly lower 72h post-injury (p=0.04). Dual-task cadence was significantly lower for concussion participants than controls (89.5 [95% CI: 68.6-110.4] vs. 127.0 [95% CI: 97.4-156.6] steps/minute; p=0.04). Moderately-high to high correlations between tandem gait test time and whole-body COM medial-lateral displacement were detected at each time point during dual-task gait (rs=0.70-0.93; p=0.03-0.001). CONCLUSIONS Adding a cognitive task during the tandem gait test resulted in longer detectable deficits post-concussion compared to the traditional single-task tandem gait test. As a clinical tool to assess dynamic motor function, tandem gait may assist with return to sport decisions after concussion.
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Affiliation(s)
- David R Howell
- The Micheli Center for Sports Injury Prevention, USA; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, USA; Brain Injury Center, Boston Children's Hospital, USA
| | - Louis R Osternig
- Motion Analysis Laboratory, Department of Human Physiology, University of Oregon, USA
| | - Li-Shan Chou
- Motion Analysis Laboratory, Department of Human Physiology, University of Oregon, USA.
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32
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Howell DR, Shore BJ, Hanson E, Meehan WP. Evaluation of postural stability in youth athletes: the relationship between two rating systems. PHYSICIAN SPORTSMED 2016; 44:304-10. [PMID: 27266445 DOI: 10.1080/00913847.2016.1197763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The Balance Error Scoring System (BESS) has been documented as a useful way to evaluate postural control following sport-related concussions sustained by youth athletes. However, limitations have been reported with its use due to the reliance on visual observation as the primary measurement outcome. The primary purpose of this study was to examine the correlation between the modified BESS (mBESS) as rated by a clinician and a simultaneous analysis performed by an integrated video-force plate system. The secondary purpose was to assess if a history of prior concussion affected postural control. METHODS A group of healthy youth athletes (n = 398; mean age 13.7 ± 2.4 years) completed the mBESS while simultaneously undergoing an integrated video-force plate evaluation to measure postural stability. Spearman rank-order correlations were used to determine the strength of correlation between the 2 rating systems. In addition, performance on the mBESS between those with and without a history of concussion was compared using univariate ANCOVAs. RESULTS A moderately high correlation was found during single-leg stance (ρ = -0.64, p < .001), while a weak correlation was found during tandem stance (ρ = -0.30, p < .001). No postural control differences were found between groups with and without a concussion history. CONCLUSION The video-force plate rating system correlates well with the clinician rating during the single-leg stance of the mBESS, but not during double-leg or tandem stances. A history of concussion did not affect mBESS scores.
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Affiliation(s)
- David R Howell
- a The Micheli Center for Sports Injury Prevention , Waltham , MA , USA.,b Division of Sports Medicine , Boston Children's Hospital , Boston , MA , USA.,c Department of Orthopaedics , Boston Children's Hospital , Boston , MA , USA.,d Brain Injury Center , Boston Children's Hospital , Boston , MA , USA
| | - Benjamin J Shore
- c Department of Orthopaedics , Boston Children's Hospital , Boston , MA , USA.,e Department of Orthopaedic Surgery , Harvard Medical School , Boston , MA , USA
| | - Emily Hanson
- a The Micheli Center for Sports Injury Prevention , Waltham , MA , USA.,b Division of Sports Medicine , Boston Children's Hospital , Boston , MA , USA.,c Department of Orthopaedics , Boston Children's Hospital , Boston , MA , USA
| | - William P Meehan
- a The Micheli Center for Sports Injury Prevention , Waltham , MA , USA.,b Division of Sports Medicine , Boston Children's Hospital , Boston , MA , USA.,c Department of Orthopaedics , Boston Children's Hospital , Boston , MA , USA.,d Brain Injury Center , Boston Children's Hospital , Boston , MA , USA.,e Department of Orthopaedic Surgery , Harvard Medical School , Boston , MA , USA
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33
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Abstract
The objective of this study was to provide normative data for young athletes during the three stances of the modified Balance Error Scoring System (mBESS) using an objective video-force plate system. Postural control was measured in 398 athletes between 8 and 18 years of age during the three stances of the mBESS using a video-force plate rating system. Girls exhibited better postural control than boys during each stance of the mBESS. Age was not significantly associated with postural control. We provide normative data for a video-force plate assessment of postural stability in pediatric athletes during the three stances of the mBESS.
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34
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Alberts JL, Thota A, Hirsch J, Ozinga S, Dey T, Schindler DD, Koop MM, Burke D, Linder SM. Quantification of the Balance Error Scoring System with Mobile Technology. Med Sci Sports Exerc 2016; 47:2233-40. [PMID: 26378948 DOI: 10.1249/mss.0000000000000656] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of this project was to develop a biomechanically based quantification of the Balance Error Scoring System (BESS) using data derived from the accelerometer and gyroscope of a mobile tablet device. METHODS Thirty-two healthy young adults completed the BESS while an iPad was positioned at the sacrum. Data from the iPad were compared to position data gathered from a three-dimensional motion capture system. Peak-to-peak (P2P), normalized path length (NPL), and root mean squared (RMS) were calculated for each system and compared. Additionally, a 95% ellipsoid volume, iBESS volume, was calculated using center of mass (CoM) movements in the anteroposterior (AP), mediolateral (ML), and trunk rotation planes of movement to provide a comprehensive, 3D metric of postural stability. RESULTS Across all kinematic outcomes, data from the iPad were significantly correlated with the same outcomes derived from the motion capture system (rho range, 0.37-0.94; P < 0.05). The iBESS volume metric was able to detect a difference in postural stability across stance and surface, showing a significant increase in volume in increasingly difficult conditions, whereas traditional error scoring was not as sensitive to these factors. CONCLUSIONS The kinematic data provided by the iPad are of sufficient quality relative to motion capture data to accurately quantify postural stability in healthy young adults. The iBESS volume provides a more sensitive measure of postural stability than error scoring alone, particularly in conditions 1 and 4, which often suffer from floor effects, and condition 5, which can experience ceiling effects. The iBESS metric is ideally suited for clinical and in the field applications in which characterizing postural stability is of interest.
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Affiliation(s)
- Jay L Alberts
- 1Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH; 2Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH; 3Cleveland Clinic Concussion Center, Cleveland Clinic, Cleveland, OH; and 4Qualitative Health Services, Cleveland Clinic, Cleveland, OH
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35
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Evidence-Based Management of Sport-Related Concussion: Completing the Puzzle. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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36
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Starling AJ, Leong DF, Bogle JM, Vargas BB. Variability of the modified Balance Error Scoring System at baseline using objective and subjective balance measures. Concussion 2015; 1:CNC5. [PMID: 30202550 PMCID: PMC6114022 DOI: 10.2217/cnc.15.5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/25/2015] [Indexed: 11/22/2022] Open
Abstract
Aim: To investigate preseason modified Balance Error Scoring System (mBESS) performance in a collegiate football cohort; to compare scores to an objective mobile balance measurement tool. Materials & methods: Eighty-two athletes completed simultaneous balance testing using mBESS and the King–Devick Balance Test, an objective balance measurement tool. Errors on mBESS and objective measurements in the double-leg, single-leg (SS) and tandem stances were compared. Results: Mean mBESS error score was 7.23 ± 4.65. The SS accounted for 74% of errors and 21% of athletes demonstrated the maximum error score. There was no significant correlation between mBESS score and objective balance score. Conclusion: The high variability and large number of errors in the SS raises concerns over the utility of the SS in identifying suspected concussion.
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Affiliation(s)
- Amaal J Starling
- Department of Neurology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.,Department of Neurology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
| | - Danielle F Leong
- King-Devick Test, Inc., 2 Mid America Plaza, Suite 110, Oakbrook Terrace, IL 60181, USA.,King-Devick Test, Inc., 2 Mid America Plaza, Suite 110, Oakbrook Terrace, IL 60181, USA
| | - Jamie M Bogle
- Department of Otorhinolaryngology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85260, USA.,Department of Otorhinolaryngology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85260, USA
| | - Bert B Vargas
- Department of Neurology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.,Department of Neurology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
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Howell D, Osternig L, Chou LS. Monitoring recovery of gait balance control following concussion using an accelerometer. J Biomech 2015; 48:3364-8. [PMID: 26152463 DOI: 10.1016/j.jbiomech.2015.06.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 06/03/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
Abstract
Despite medical best-practice recommendations, no consistent standard exists to systematically monitor recovery from concussion. Studies utilizing camera-based systems have reported center-of-mass (COM) motion control deficits persisting in individuals with concussion up to two months post-injury. The use of an accelerometer may provide an efficient and sensitive method to monitor COM alterations following concussion that can be employed in clinical settings. This study examined: (1) frontal/sagittal plane acceleration characteristics during dual-task walking for individuals with concussion and healthy controls; and (2) the effectiveness of utilizing acceleration characteristics to classify concussed and healthy individuals via receiver operating characteristic (ROC) curve analyses. Individuals with concussion completed testing within 72 h as well as 1 week, 2 weeks, 1 month, and 2 months post-injury. Control subjects completed the same protocol in similar time increments. Participants walked and simultaneously completed a cognitive task while wearing an accelerometer attached to L5. Participants with concussion walked with significantly less peak medial-lateral acceleration during 55-75% gait cycle (p=0.04) throughout the testing period compared with controls. Moderate levels of sensitivity and specificity were found at the 72 h and 1 week testing times (sensitivity=0.70, specificity=0.71). ROC analysis revealed significant AUC values at the 72 h (AUC=0.889) and two week (AUC=0.810) time points. Accelerometer-derived measurements may assist in detecting frontal plane control deficits during dual-task walking post-concussion, consistent with camera-based studies. These initial findings demonstrate potential for using accelerometry as a tool for clinicians to monitor gait balance control following concussion.
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Affiliation(s)
- David Howell
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Louis Osternig
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Li-Shan Chou
- Department of Human Physiology, University of Oregon, Eugene, OR, USA.
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In vivo characterization of chronic traumatic encephalopathy using [F-18]FDDNP PET brain imaging. Proc Natl Acad Sci U S A 2015; 112:E2039-47. [PMID: 25848027 DOI: 10.1073/pnas.1409952112] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is an acquired primary tauopathy with a variety of cognitive, behavioral, and motor symptoms linked to cumulative brain damage sustained from single, episodic, or repetitive traumatic brain injury (TBI). No definitive clinical diagnosis for this condition exists. In this work, we used [F-18]FDDNP PET to detect brain patterns of neuropathology distribution in retired professional American football players with suspected CTE (n = 14) and compared results with those of cognitively intact controls (n = 28) and patients with Alzheimer's dementia (AD) (n = 24), a disease that has been cognitively associated with CTE. [F-18]FDDNP PET imaging results in the retired players suggested the presence of neuropathological patterns consistent with models of concussion wherein brainstem white matter tracts undergo early axonal damage and cumulative axonal injuries along subcortical, limbic, and cortical brain circuitries supporting mood, emotions, and behavior. This deposition pattern is distinctively different from the progressive pattern of neuropathology [paired helical filament (PHF)-tau and amyloid-β] in AD, which typically begins in the medial temporal lobe progressing along the cortical default mode network, with no or minimal involvement of subcortical structures. This particular [F-18]FDDNP PET imaging pattern in cases of suspected CTE also is primarily consistent with PHF-tau distribution observed at autopsy in subjects with a history of mild TBI and autopsy-confirmed diagnosis of CTE.
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39
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The Utilization of Biomechanics to Understand and Manage the Acute and Long-term Effects of Concussion. ACTA ACUST UNITED AC 2015. [DOI: 10.1123/kr.2014-0080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The acute and long-term effects of concussive and subconcussive head impacts on brain health have gained tremendous attention over the past five years. The treatment and management of concussion involves multiple providers from multiple disciplines and backgrounds. Varied backgrounds and approaches to assessing cognitive and motor function before and post-concussion are limiting factors in the efficient and effective management of concussion as discipline-specific rating scales and assessments serve as a barrier to effective patient hand-offs between providers. Combining principles of motor behavior with biomechanical approaches to data analysis has the potential to improve the continuity of care across the multiple providers managing athletes with concussion. Biomechanical measures have been developed and validated using mobile devices to provide objective and quantitative assessments of information processing, working memory, set switching, and postural stability. These biomechanical outcomes are integral to a clinical management algorithm, the Concussion Care Path, currently used across the Cleveland Clinic Health System. The objective outcomes provide a common data set that all providers in the spectrum of care can access which facilitates communication and the practice of medicine and in understanding the acute and long-term effects of concussion and subconcussive exposure on neurological function.
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