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Sensor-Based Balance Measures Outperform Modified Balance Error Scoring System in Identifying Acute Concussion

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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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Abbreviations

NCAA:

National Collegiate Athletic Association

BESS:

Balance error scoring system

mBESS:

Modified BESS

DS:

Double stance

TS:

Tandem stance

SLS:

Single limb stance

SCAT-3:

Sport concussion assessment tool 3

PCS:

Post-concussive syndrome

BMI:

Body mass index

AUC:

Area under the receiver operating characteristic curve

AP:

Anteroposterior

ML:

Mediolateral

SOT:

Sensory organization test

COP:

Center of pressure

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Acknowledgments

This project was supported by the Oregon Clinical and Translational Research Institute (KL2TR000152) from the National Center for Advancing Translational Sciences at the National Institutes of Health (NIH); (UL1TR000128) and Eunice Kennedy Shriver National Institute of Child Health & Human Development of the NIH under Award Number (R21HD080398). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors would like to thank all of the participating universities and athletic trainers who contributed to recruitment of subjects and athletes for their participation. All inertial sensor data presented in this paper was obtained using APDM wearable technologies. The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation.

Conflict of Interest

The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Parkinson Center of Oregon, Department of Neurology, School of Medicine, Oregon Health & Science University, OP32, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239-3098, USA

    Laurie A. King, Martina Mancini, Peter C. Fino & Clayton W. Swanson

  2. Department of Orthopedics and Rehabilitation, School of Medicine, Oregon Health & Science University, Portland, OR, USA

    James Chesnutt

  3. Department of Public Health & Preventive Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA

    Sheila Markwardt

  4. Department of Neurology, Veterans Affairs Medical Center, Washington, DC, USA

    Julie C. Chapman

  5. Department of Neurology, Georgetown University School of Medicine, Washington, DC, USA

    Julie C. Chapman

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  1. Laurie A. King
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  2. Martina Mancini
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  3. Peter C. Fino
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Correspondence to Laurie A. King.

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Associate Editor Dan Elson oversaw the review of this article.

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King, L.A., Mancini, M., Fino, P.C. et al. Sensor-Based Balance Measures Outperform Modified Balance Error Scoring System in Identifying Acute Concussion. Ann Biomed Eng 45, 2135–2145 (2017). https://doi.org/10.1007/s10439-017-1856-y

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