Comparison of the Balance Accelerometer Measure and Balance Error Scoring System in Adolescent Concussions in Sports

Abstract

Background High-technology methods demonstrate that balance problems may persist up to 30 days after a concussion, whereas with low-technology methods such as the Balance Error Scoring System (BESS), performance becomes normal after only 3 days based on previously published studies in collegiate and high school athletes. Purpose To compare the National Institutes of Health’s Balance Accelerometer Measure (BAM) with the BESS regarding the ability to detect differences in postural sway between adolescents with sports concussions and age-matched controls. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods Forty-three patients with concussions and 27 control participants were tested with the standard BAM protocol, while sway was quantified using the normalized path length (mG/s) of pelvic accelerations in the anterior-posterior direction. The BESS was scored by experts using video recordings. Results The BAM was not able to discriminate between healthy and concussed adolescents, whereas the BESS, especially the tandem stance conditions, was good at discriminating between healthy and concussed adolescents. A total BESS score of 21 or more errors optimally identified patients in the acute concussion group versus healthy participants at 60% sensitivity and 82% specificity. Conclusion The BAM is not as effective as the BESS in identifying abnormal postural control in adolescents with sports concussions. The BESS, a simple and economical method of assessing postural control, was effective in discriminating between young adults with acute concussions and young healthy people, suggesting that the test has value in the assessment of acute concussions.

Reliability and concurrent validity of instrumented balance error scoring system using a portable force plate system

“…Using inertial sensors and accelerometers to detect postural sway, King et al reported that instrumented BESS exhibited superior sensitivity (38%) and specificity (100%) in identifying adolescents with concussion compared with clinically scored BESS sensitivity and specificity scores of 23 and 92%, respectively [26]. However, Furman et al found that clinically scored BESS is superior to Balance Accelerometer Measure (BAM) in identifying adolescents with concussion [27]. Validation of instrumented measures against the original BESS is affected by the psychometric weaknesses of BESS.…”

“…Recent technological advancements (e.g. portable force plates, inertial sensors, accelerometers and gyroscopes) have allowed for the instrumentation of clinical balance tests that may augment clinical decisions [25][26][27][28]. To overcome cost and accessibility concerns with laboratory force plates, portable clinical force plates were developed to provide detailed objective balance assessment.…”

Objective Classification of Dynamic Balance Using a Single Wearable Sensor

“…Such systems address some of the aforementioned limitations of traditional motion capture, as they allow for inexpensive, accessible quantification of human movement, in an unconstrained environment (Giggins et al, 2013). These IMU systems have been used in the objective quantification of a range of activities, from static balance tasks (King et al, 2014, Alberts et al, 2015, Furman et al, 2013, to dynamic tasks such as the squat and single leg squat , walking (Zijlstra andHof, 2003, Yang et al, 2013) and running (Lee et al, 2010). Early work investigating the use of IMUs in balance assessment has shown that a static balance assessment, instrumented with an IMU mounted on the lumbar spine, was not as effective as the traditional subjectively scored assessment in identifying balance deficits post-concussion (Furman et al, 2013).…”

“…These IMU systems have been used in the objective quantification of a range of activities, from static balance tasks (King et al, 2014, Alberts et al, 2015, Furman et al, 2013, to dynamic tasks such as the squat and single leg squat , walking (Zijlstra andHof, 2003, Yang et al, 2013) and running (Lee et al, 2010). Early work investigating the use of IMUs in balance assessment has shown that a static balance assessment, instrumented with an IMU mounted on the lumbar spine, was not as effective as the traditional subjectively scored assessment in identifying balance deficits post-concussion (Furman et al, 2013). More recently, King et al (2014) demonstrated improved levels of sensitivity and specificity from the instrumented balance error scoring system (BESS).…”

“…It is likely that the conflicting results are due to the different quantified variables selected in the two studies. King et al (2014) utilised root mean squared acceleration, whereas Furman et al (2013) used sway path length, which may not be capable of detecting subtle changes in balance, when measured using a lumbar mounted IMU. While these initial studies have demonstrated the ability of IMUs to detect differences in static balance between groups, there is a paucity of evidence surrounding their ability to classify dynamic balance performance during tasks such as the YBT.…”