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

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.

Inflection points in longitudinal models: Tracking recovery and return to play following concussion

“…The instrumented outcomes assessed within this article included the total sway area and the range of acceleration in the mediolateral direction for the double-leg stance condition, both found to be significantly different between concussed and controls when tested within 1-4 days of injury. 11 These 2 outcome measures were collected as a part of a larger study. We report all measures, conditions, exclusions, and products of the larger study herein, and within the Appendix S1 provided.…”

“…Participants were instructed to stand as still as possible with eyes closed for 30 seconds under different stance conditions including double stance, single leg stance using the non‐dominant leg, and tandem stance. Here, the BESS test was slightly modified from the original 20 seconds of stance to a longer 30 seconds of stance for the instrumented measures . The additional 10 seconds of instrumented sway were recorded to acquire reliable postural sway data .…”

“…Data from the Opal sensors were collected at 128 Hz using Mobility Lab Software Version 1 (APDM Inc., Portland, OR), which calculated sway outcome measures. The instrumented outcomes assessed within this article included the total sway area and the range of acceleration in the mediolateral direction for the double‐leg stance condition, both found to be significantly different between concussed and controls when tested within 1‐4 days of injury . These 2 outcome measures were collected as a part of a larger study.…”

“…Here, the BESS test was slightly modified from the original 20 seconds of stance to a longer 30 seconds of stance for the instrumented measures. 11,14 The additional 10 seconds of instrumented sway were recorded to acquire reliable postural sway data. 15 The clinical error count was performed only on the initial 20 seconds of each condition consistent with the standard duration of the BESS.…”

“…Recruitment procedures for concussed and controls, inclusion and exclusion criteria have previously been reported. 11 Briefly, diagnosis of concussion was based on clinical judgment, guided by the definition for sport-related concussion adopted by the 4th Consensus Statement on Concussion in Sport. 12 All concussions were diagnosed or confirmed by a team physician.…”