Tracking postural stability of young concussion patients using dual-task interference (original) (raw)
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Reliability and Validity Evidence of Multiple Balance Assessments in Athletes With a Concussion
Journal of Athletic Training, 2014
Context: An estimated 300 000 sport-related concussion injuries occur in the United States annually. Approximately 30% of individuals with concussions experience balance disturbances. Common methods of balance assessment include the Clinical Test of Sensory Organization and Balance (CTSIB), the Sensory Organization Test (SOT), the Balance Error Scoring System (BESS), and the Romberg test; however, the National Collegiate Athletic Association recommended the Wii Fit as an alternative measure of balance in athletes with a concussion. A central concern regarding the implementation of the Wii Fit is whether it is reliable and valid for measuring balance disturbance in athletes with concussion. Objective: To examine the reliability and validity evidence for the CTSIB, SOT, BESS, Romberg test, and Wii Fit for detecting balance disturbance in athletes with a concussion. Data Sources: Literature considered for review included publications with reliability and validity data for the assessmen...
Journal of science and medicine in sport, 2017
To determine if self-reported balance symptoms can be used as a proxy for measures of the center of pressure (COP) to identify balance deficits in a group of concussed adolescents. Case-control. Thirteen adolescents 1-month post-concussion who reported ongoing balance problems (Balance+), 20 adolescent 1-month post-concussion who reported no balance problems (Balance-), and 30 non-injured adolescents (control) completed a series of balance tests. Participants completed two 2-min trials standing on a Nintendo Wii Balance Board™ during which the COP under their feet was recorded: i) double-leg stance, eyes open; ii) double-leg stance, eyes closed. Participants also completed a dual-task condition combining a double-leg stance and a Stroop Colour-word test. Participants in both the Balance+ and Balance- group swayed over a larger ellipse area compared to the control group while completing the Eyes Closed (Balance+, p=0.002; Balance-, p=0.002) and Dual-Task (Balance+, p=0.001; Balance-,...
Altered balance control following concussion is better detected with an attention test during gait
Gait & Posture, 2007
The purpose of this study was to examine the effects of concussion on gait stability when either a cognitive or motor perturbation is imposed. Fourteen individuals suffering from a grade II concussion and 14 matched controls performed a single task of level walking, a continuous sequential question and answer task while walking, and an obstacle-crossing task. Common gait spatial/temporal measurements, whole-body center of mass motion, and center of pressure trajectory were assessed. Concussed individuals adopted a more conservative strategy to maintain gait stability. Some measurements indicating conservative gait were seen during obstacle crossing, but this was most evident during the Q&A task. Concussed individuals also displayed signs of possible instability during the Q&A task. The question and answer task was most sensitive to distinguishing concussed individuals from healthy individuals, supporting the use of a similar dual-task modality in future testing after concussion to determine a proper time for return to activity.
2021
BACKGROUND Although postural impairments have long been reported following a concussion in the pediatric population, we still know very little about who is more at risk of presenting those balance problems and how the mechanism of injury (sport vs non-sport) could influence balance problems after concussions. The purpose of this study was to compare balance function in children having sustained a sport-related (SRC) or non-sport-related (NSRC) concussion, to that of children with an orthopedic injury (OI) and to non-injured (NI), over a one-year period. METHODS One-hundred and twelve participants were included in this study. Among them, 38 were concussed, with 27 having sustained a SRC; and 11 an NSRC, as well as 38 NI, and 36 OI. Balance function was evaluated at 2 weeks, 3 months, 6 months, and 12 months after a concussion, and at the same time intervals for the control groups. The balance subtest of the Bruininks-Oseretsky Test of Motor Proficiency (BOT2) and Timed Foam Test was ...
Different gait tasks distinguish immediate vs. long-term effects of concussion on balance control
Journal of NeuroEngineering and Rehabilitation, 2009
The purpose of this study was to longitudinally compare the sensitivity of previously documented paradigms for measuring balance control during gait following a concussion. We hypothesized that gait with a concurrent cognitive task would be most sensitive to the effects of concussion on dynamic balance control. Individuals with concussion (n = 30) and matched controls (n = 30) performed a single task of level walking, attention divided walking, and an obstacle-crossing task at two heights. Testing occurred four times post-injury. Balance control during gait was assessed with whole-body center of mass and center of pressure motion. The single-task level walking task did not result in any significant differences in balance control between individuals with concussion and control subjects. Within 48 hours post-injury, individuals with concussion walked slower and allowed less motion of their center of mass in the sagittal plane when attention was divided during walking, but there were no group differences by day 6 for this task. Group differences in balance control during obstacle crossing was unremarkable during the first two testing sessions, but by day 14 individuals with concussion displayed less mediolateral motion of their center of mass. Attention divided gait is able to better distinguish gait adaptations immediately following a concussion, but obstacle crossing can be used further along in the recovery process to detect new gait adaptations.
Journal of Athletic Training
Context Balance tests are a recommended assessment of motor function in concussion protocols. The BTrackS Balance Test (BBT) is a tool for concussion balance testing that uses low-cost force-plate technology to objectively measure postural sway. Objective To provide normative data for the BBT in a large population of athletes. Design Cross-sectional study. Setting Concussion baseline testing at multiple facilities. Patients or Other Participants Male and female athletes (n = 10 045) ages 8 to 21 years. Intervention(s) Athletes performed three 20-second trials of eyes-closed standing on the BTrackS Balance Plate with feet shoulder-width apart and hands on hips. Main Outcome Measure(s) Postural sway was measured as the average total center-of-pressure path length over 3 testing trials. Results Postural sway was reduced (ie, balance improved) as athlete age increased and was less in female athletes than in male athletes. Percentile ranking tables were calculated based on sex and 2-year...
BTrackS Balance Test for Concussion Management is Resistant to Practice Effects
Objective: Recent guidelines advocate for ongoing balance testing in the assessment of management of concussion injuries. This study sought to determine whether the Balance Tracking System (BTrackS) provides stable balance results over repeated administration and, thus, is a reliable tool for concussion management. Design: Repeated measures and test–retest reliability. Setting: University Biomechanics Laboratory. Participants: Random sample of 20 healthy young adults. Interventions: Force plate balance testing using BTrackS on days 1, 3, 8, and 15. Main Outcome Measures: Practice-induced changes in the average center of pressure excursion over 4 repeated administrations of the BTrackS Balance Test (BBT). Test–retest reliability of center of pressure excursion from day 1 to day 15. Results: No significant practice-induced balance differences were found across testing days (P. 0.4), and test–retest reliability of the BBT was excellent from day 1 to day 15 (R 0.92). Conclusions: These findings indicate that the BBT does not elicit a practice effect over repeat administrations. BTrackS provides excellent reliability and objectivity, which can increase clinician accuracy when monitoring sport-related concussions. (Clin J Sport Med 2017;0:1–3)
Clinical Journal of Sports Medicine
Chang JO, Levy SS, Seay SW, Goble DJ. Source College of Health and Human Services, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California. Abstract OBJECTIVE:: Recent guidelines advocate sports medicine professionals to use balance tests to assess sensorimotor status in the management of concussions. The present study sought to determine whether a low-cost balance board could provide a valid, reliable, and objective means of performing this balance testing. DESIGN:: Criterion validity testing relative to a gold standard and 7 day test-retest reliability. SETTING:: University Biomechanics Laboratory. PARTICIPANTS:: Thirty healthy young adults. ASSESSMENT OF RISK FACTORS:: Balance ability was assessed on 2 days separated by 1 week using (1) a gold standard measure (ie, scientific grade force plate), (2) a low-cost Nintendo Wii Balance Board (WBB), and (3) the Balance Error Scoring System (BESS). MAIN OUTCOME MEASURES:: Validity of the WBB center of pressure path length and BESS scores were determined relative to the force plate data. Test-retest reliability was established based on intraclass correlation coefficients. RESULTS:: Composite scores for the WBB had excellent validity (r = 0.99) and test-retest reliability (R = 0.88). Both the validity (r = 0.10-0.52) and test-retest reliability (r = 0.61-0.78) were lower for the BESS. CONCLUSIONS:: These findings demonstrate that a low-cost balance board can provide improved balance testing accuracy/reliability compared with the BESS. CLINICAL RELEVANCE:: This approach provides a potentially more valid/reliable, yet affordable, means of assessing sports-related concussion compared with current methods.
Journal of athletic training, 2017
Recent changes to postconcussion guidelines indicate that postural-stability assessment may augment traditional neurocognitive testing when making return-to-participation decisions. The Balance Error Scoring System (BESS) has been proposed as 1 measure of balance assessment. A new, freely available software program to accompany the Nintendo Wii Balance Board (WBB) system has recently been developed but has not been tested in concussed patients. To evaluate the feasibility of using the WBB to assess postural stability across 3 time points (baseline and postconcussion days 3 and 7) and to assess concurrent and convergent validity of the WBB with other traditional measures (BESS and Immediate Post-Concussion Assessment and Cognitive Test [ImPACT] battery) of assessing concussion recovery. Cohort study. Athletic training room and collegiate sports arena. We collected preseason baseline data from 403 National Collegiate Athletic Association Division I and III student-athletes participati...