Normative Data for the BTrackS Balance Test Concussion-Management Tool: Results From 10 045 Athletes Aged 8 to 21 Years

Normative data for instrumented posturography: a systematic review and meta-analysis

Postural control is a multisensory adaptive system performing predictive (anticipatory) and/or reactive (compensatory) actions, with varying degrees of accuracy, to maintain balance in a changing environmental context. Common instrumentation to evaluate balance includes static and dynamic force platforms; added sway-referenced perturbations on the dynamic platform constitute its main advantage. Clinical applications notwithstanding, normative data are needed for interpretation in clinical settings. Posturography norms are used to compare a reference group (healthy individuals) and a specific patient population. This work, to the best of our knowledge, represents the first attempt to synthesize the literature on normative data for computerized posturography using a combined mixed method. The search strategy resulted in the retrieval of 1,244 articles from PubMed, Web of Science, and Science Direct. After deduplication, 689 articles were screened based on title and abstract. One hundred and seven articles met the criteria after the first screening. In-depth, full-text screening resulted in the inclusion of 44 studies for the systematic review and 17 studies for the meta-analyses. The main findings of the systematic review are (1) extensive heterogeneity was found in methodological characteristics, (2) there was insufficient risk of bias mitigation, (3) the majority of tasks evaluated less than four components of the systems framework for postural control (SFPC), and (4) studies mostly used distance domain sway parameters and did not report the influence of other variables on postural sway. Based on the multilevel meta-analyses, females appeared to outperform males in eyes closed (EC) conditions significantly. Based on the network meta-analyses, we found that younger children swayed more than those aged between 8 and 14 years both in eyes open (EO) conditions and EC conditions significantly. The results also revealed a significant difference in sway between individuals of age range between 50 and 79 years old and younger individuals, with more instability observed in older participants both in EO conditions and in EC conditions. Thus, future studies need to ensure that enough information about participants is provided. Standardization of experimental conditions and sway parameters harmonization are still needed to ensure high-quality assessment (QA). Finally, evidence-based postural impairment management requires both age- and sex-related normative data. Systematic review registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023378144, identifier PROSPERO 2023 CRD42023378144.

Differences in pre-season balance among student athletes based on level of contact, age, and sex

BACKGROUND

Assessing postural control is important for the assessment of motor function after concussion. Data used for postural control assessment typically do not take the sport played, age, or sex of the athlete into consideration. It is plausible these variables may be significant when making return-to-play decisions.

RESEARCH QUESTION

This study used the BTrackS database to examine differences in postural control in athletes playing different types of sports and across sex and age.

METHODS

BTrackS data from 9093 high school to college-aged athletes (aged 14-22 years) were examined employing a One-way ANOVA with a post-hoc test to compare CoP path length between sport types. A moderation analysis was used to test interaction effects of sex and age on a CoP/BMI ratio.

RESULTS

Significant differences were observed between sport types, F(3,9089) = 42.4, p <.001, η2 = 0.014. Post hoc tests indicated that collision (M = 25.0, SD = 7.6) sport athletes exhibited significantly higher CoP measures compared to the contact (M = 23.4, SD = 7.4), limited contact (M = 22.9, SD = 6.9), and non-contact (M = 23.0, SD = 7.4) athletes. There was no difference between other sport types (p >.20). A significant mean sex difference (Mmale = 0.924, Mfemale = 0.898, p <.001) and a quadratic association with age, (β = -0.042, p <.001) was observed. Further, magnitude of those age differences decreased with age (β = 0.011, p <.001). An interaction of age and sex was significant for linear (β = 0.020, p <.001) and quadratic terms (β = -0.006, p <.001).

SIGNIFICANCE

Athletes exhibited different postural control when the type of sport, age, and sex was taken into consideration. This data possess clinical significance as this suggests that normative postural control data for collision sport athletes should be derived from data based upon type of sport played, age, and sex of the athlete.

An initial set of reference values for the Balance Tracking System (BTrackS) Limits of Stability protocol

BACKGROUND

The Balance Tracking System (BTrackS) Limits of Stability (LOS) protocol is a relatively new means of evaluating unconstrained dynamic postural control ability. While the reliability of this protocol has previously been established, reference data is currently unavailable to assist in the interpretation of results.

RESEARCH QUESTION

What are typical reference values for the BTrackS LOS protocol with respect to sex, height, and BMI?

METHODS

A cross= -section of 800 healthy, young adults (aged 18-29 years; 368 men, 432 women) were administered the BTrackS LOS protocol. Sex, height and weight variables were also captured for the participants.

RESULTS

Results of a stepwise linear regression showed that the outcome measure for BTrackS LOS testing (i.e. LOS Area) was larger in taller individuals and in men. Based on these findings, four percentile ranking categories were established and associated look-up tables created.

SIGNIFICANCE

The reference values provided by this study offer much needed guidance to clinicians and researchers for the determination of dynamic balance abnormalities based on BTrackS LOS testing.

Neurological soft signs are associated with reduced medial-lateral postural control in adolescent athletes

INTRODUCTION

Neurological soft signs (NSS) are minor deviations from the norm in motor performance that are commonly assessed using neurological examinations. NSS may be of clinical relevance for evaluating the developmental status of adolescents. Here we investigate whether quantitative force plate measures may add relevant information to observer-based neurological examinations.

METHODS

Male adolescent athletes (n = 141) aged 13-16 years from three European sites underwent a neurological examination including 28 tests grouped into six functional clusters. The performance of tests and functional clusters was rated as optimal/non-optimal resulting in NSS+/NSS- groups and a continuous total NSS score. Participants performed a postural control task on a Balance Tracking System measured as path length, root mean square and sway area. ANCOVAs were applied to test for group differences in postural control between the NSS+ and NSS- group, and between optimal/non-optimal performance on a cluster- and test-level. Moreover, we tested for correlations between the total NSS score and postural control variables.

RESULTS

There was no significant overall difference between the NSS+ and NSS- group in postural control. However, non-optimal performing participants in the diadochokinesis test swayed significantly more in the medial-lateral direction than optimal performing participants. Moreover, a lower total NSS score was associated with reduced postural control in the medial-lateral direction.

CONCLUSION

Our findings demonstrate that NSS are related to postural control in adolescent athletes. Thus, force plate measures may add a quantitative, objective measurement of postural control to observer-based qualitative assessments, and thus, may complement clinical testing.

EVALUATION OF POSTURAL BALANCE INDICATORS IN HEALTHY INDIVIDUALS

OBJECTIVE

The aim: To determine and generalize the indicators of stabilometry in healthy individuals for their further use as a control group in studies of pathologies of the musculoskeletal system.

PATIENTS AND METHODS

Materials and methods: The study was conducted on a stable platform with biofeedback TYMO (Tyromotion). 30 male and female patients aged 18-25 years participated in the study. The following indicators were studied : distance traveled, medial-lateral deviation, anterior-posterior deviation, area of the statokinesiogram (COF), average speed, feedback system, Romberg index. Stabilometry was performed in a bipodal position, standing, in four functional positions: on a hard surface with eyes open and closed, on a soft surface with eyes open and closed.

RESULTS

Results: The reference values of the stabilometric parameters: the traveled distance, medio-lateral deviation, anterior-posterior deviation, the area of the statokinesiogram, the average speed, the feedback system, the Romberg index in healthy individuals aged 18-25 years were determined . When evaluating the feedback system, it was established that the visual component was 34% (32.0; 36.0), the vestibular 34% (32.0; 35.0), the somatosensory 33% (30.0; 36.0). The reflex-driven index was 0.55 (0.46, 0.62), the central nervous system (CNS)-driven index was 1.55 (1.25, 1.89) . The Romberg index M1/ M2 was 0.94 (0.78, 1.07), M2/M3 was 0.98 (0.86, 1.10).

CONCLUSION

Conclusions: The obtained indicators of movement in the sagittal plane, the area of the statokinesiogram, the average speed of movement, the feedback system (visual, vestibular, proprioceptive (somatosensory) components), the Romberg index (RI) can be considered reference values for healthy individuals aged 18-25 years .

Elbow Joint Position and Force Senses in Young and Adult Untrained People and Gymnasts

Joint position (JPS) and force senses (FS) are the proprioception modalities. While the development of JPS was investigated both in children/adult and athlete/untrained conditions, there is a lack of insight into the development of FS. Overall, 28 gymnasts and 25 untrained controls underwent proprioception testing. They were divided into two groups: 9 to 11-year-old boys (13 gymnasts and 10 non-athletes) and 18 to 25-year-old adults (15 gymnasts and 15 non-athletes). The testing was performed at an isokinetic dynamometer and included elbow JPS and FS (20% and 50% maximal voluntary contraction) tasks. Children had two times higher error in JPS (p < 0.01) and 50% higher errors in FS of both flexor (p < 0.001) and extensor muscles (p < 0.05) in comparison with adults. Only in the 50% maximal voluntary contraction task, gymnasts showed 33% lower error than the controls (p < 0.01). Untrained boys presented 54%, 132%, and 169% higher error for elbow flexor performance than young gymnasts, untrained adults, and adult gymnasts, respectively (p < 0.01). The 9 to 11-year-old participants were characterized by a lower precision of JPS and FS performance in comparison with adults. Gymnastic training can possibly accelerate the development of FS when higher loads are considered.

Reference centiles based on year-to-year changes for a longitudinal evaluation of motor performance in children and adolescents

Objectives

The aim was to evaluate the longitudinal course of motor skills development in children with a view to improve the understanding of intra-individual variance. Previous publications have been based on cross-sectional data or analyzed longitudinal studies in a cross-sectional manner.

Design

Longitudinal. Year-to-year change.

Methods

The present study is based on motor function data collected in the LIFE Child study (Germany). The participants (6 to 17 years) completed parts of the motor tests according to the standard of the German Motor Performance Test 6–18 (DMT). For a total of 1653 participants, 4616 motor tests with an annual interval in the period 2011 to 2019 were included in the evaluation.

Results

We were able to produce gender and age-specific change centiles for the test items standing long jump, jumping sideways, push-ups, stand and reach and balancing walking backwards. Each set of centiles revealed a range of variability in motor development in children and adolescents, with distinct progressive patterns in the different test items and different genders. The supplied tables offer an indication of expected year-to-year change for each test item depending on age and gender. Depending on the test item and the mean age, a deterioration in test results after a one-year interval was observed, despite cross-sectional centiles showing an upward trend.

Conclusion

We present a user-friendly tool as a way to assess individual dynamic changes in motor development of children and adolescents. In combination with the well-known cross-sectional centiles as baseline, this can be helpful for the scientific evaluation of motor skills tests and can also be used in school settings.

Technology and concussion: A scoping review

Background

Technology for concussion identification and management is rapidly expanding across the continuum of care. Although many technologies offer a range of services around concussion, there is an absence of a non-commercial online location for medical providers to access regarding the functionality of the various technologies used in concussion identification and management.

Objective

The purpose of this review is to present research findings on technology for concussion identification and management.

Methods

Searches for eligible studies were conducted using the PubMed, EMBASE, and Scopus databases with specific search criteria. Through a stepwise process, full-text articles were selected for inclusion if they described clinically useful electronic technologies (i.e. electronics able to be used in standard clinical environments including telehealth) by healthcare providers or end users (i.e. parents or athletes).

Results

A total of 29 articles were included in this review and described technology used to measure symptoms (3), neurocognitive performance (7), the visual system (4), and balance or dual task performance (18). Within the results, various technologies demonstrated increased utility for concussion identification, often detecting subtle deficits not possible with current low-tech clinical methods, differentiating those with concussion from those without concussion, with strong reliability and validity.

Conclusion

Innovative technologies included in this review demonstrate enhanced ability to identify and manage symptoms of concussion, neurocognitive deficits, visual deficits, and balance and dual-task deficits.

Normative data for the Balance Tracking System modified Clinical Test of Sensory Integration and Balance protocol

Purpose: Force plate balance testing technology has traditionally been underutilized in clinical and research settings due to the high cost and lack of portability. A relatively new force plate called the Balance Tracking System (BTrackS) has been developed to overcome these barriers. BTrackS recently implemented the modified Clinical Test of Sensory Integration and Balance (mCTSIB) as a means of evaluating various sources of sensory information for postural sway control. The present study aimed to provide much needed normative data for the BTrackS mCTSIB protocol.

Materials and methods: Data from 604 healthy adults (308 women; 296 men) between the ages of 18 and 29 years were collected according to the BTrackS mCTSIB protocol. The protocol consisted of four, 20-second static standing trials that manipulated relative contributions of the vision, proprioception and vestibular sensory systems through various eyes open/closed and foam/no foam conditions. Comparisons of men versus women and the impact of body size (ie body mass index) were determined so that relevant percentile rankings could be calculated.

Results: Analysis of variance showed an interaction between sex and task condition on the BTrackS mCTSIB (p<0.001). This interaction indicated that women outperformed men on all conditions, but especially in the fourth trial where eyes were closed and standing was done on a compliant foam surface. Percentile rankings were calculated based on sex and BTrackS mCTSIB condition. No relationship was found between BTrackS mCTSIB results and body size.

Conclusion: Normative data provided in this study are vital for establishing potential sensory feedback-based balance dysfunctions that may exist clinically or in laboratory settings. In addition, this data can aid in the tracking of changes over a rehabilitation period and/or the effectiveness of balance interventions.