Comparison of Concurrent and Same-Day Balance Measurement Approaches in a Large Sample of Uninjured Collegiate Athletes

Overview

Journal Int J Sports Phys Ther

Specialty Rehabilitation Medicine

Date 2022 Feb 9

PMID 35136692

Authors

Jessica Saalfield

Kelsey L Piersol

Robert Monaco

Jason Womack

Scott A Weismiller

Carrie Esopenko

Sabrina M Todaro

Fiona N Conway

Kyle Brostrand

Jennifer F Buckman

Affiliations

Soon will be listed here.

Abstract

Background: Measures of postural stability are useful in assisting the diagnosing and managing of athlete concussion. Error counting using the Balance Error Scoring System (BESS) is the clinical standard, but has notable limitations. New technologies offer the potential to increase precision and optimize testing protocols; however, whether these devices enhance clinical assessment remains unclear.

Purpose: To examine the relationships between metrics of balance performance using different measurement systems in uninjured, healthy collegiate athletes.

Study Design: Cross-sectional.

Methods: Five hundred and thirty uninjured collegiate athletes were tested using the C3Logix app, which computes ellipsoid volume as a measure of postural stability during the six standard BESS conditions, while concurrently, errors were manually counted during each condition per standard BESS protocols. The association between concurrently measured ellipsoid volumes and error counts were examined with Spearman's correlations. From this sample, 177 participants also performed two double-leg conditions on the Biodex BioSway force plate system on the same day. This system computes Sway Index as a measure of postural stability. The association of ellipsoid volume (C3Logix) and Sway Index (Biodex) was examined with Spearman's correlations. Individual-level data were plotted to visually depict the relationships.

Results: C3Logix ellipsoid volume and concurrently recorded error counts were significantly correlated in five of the six BESS conditions (rs:.22-.62; p< 0.0001). C3Logix ellipsoid volume and Biodex Sway Index were significantly correlated in both conditions (rs=.22-.27, p< 0.004). However, substantial variability was shown in postural stability across all three measurement approaches.

Conclusion: Modest correlation coefficients between simultaneous and same-day balance assessments in uninjured collegiate athletes suggest a need to further optimize clinical protocols for concussion diagnosis.

Level Of Evidence: 2b.

Citing Articles

Hearing Status and Static Postural Control of Collegiate Athletes.

Brancaleone M, Talarico M, Boucher L, Yang J, Merfeld D, Onate J J Athl Train. 2022; 58(5):452-457.

PMID: 35984719 PMC: 11220902. DOI: 10.4085/1062-6050-0262.22.

References

Bonke E, Southard J, Buckley T, Reinsberger C, Koerte I, Howell D . The effects of repetitive head impacts on postural control: A systematic review. J Sci Med Sport. 2020; 24(3):247-257. PMC: 7854930. DOI: 10.1016/j.jsams.2020.09.003. View

Buckley T, Munkasy B, Clouse B . Sensitivity and Specificity of the Modified Balance Error Scoring System in Concussed Collegiate Student Athletes. Clin J Sport Med. 2017; 28(2):174-176. DOI: 10.1097/JSM.0000000000000426. View

Bernstein J, Calamia M, Pratt J, Mullenix S . Assessing the effects of concussion using the C3Logix Test Battery: An exploratory study. Appl Neuropsychol Adult. 2018; 26(3):275-282. DOI: 10.1080/23279095.2017.1416471. View

Hunt T, Ferrara M, Bornstein R, Baumgartner T . The reliability of the modified Balance Error Scoring System. Clin J Sport Med. 2009; 19(6):471-5. DOI: 10.1097/JSM.0b013e3181c12c7b. View

Miyashita T, Cote C, Terrone D, Diakogeorgiou E . Detecting changes in postural sway. J Biomech. 2020; 107:109868. DOI: 10.1016/j.jbiomech.2020.109868. View

Pinho A, Salazar A, Hennig E, Spessato B, Domingo A, Pagnussat A . Can We Rely on Mobile Devices and Other Gadgets to Assess the Postural Balance of Healthy Individuals? A Systematic Review. Sensors (Basel). 2019; 19(13). PMC: 6651227. DOI: 10.3390/s19132972. View

Finnoff J, Peterson V, Hollman J, Smith J . Intrarater and interrater reliability of the Balance Error Scoring System (BESS). PM R. 2009; 1(1):50-4. DOI: 10.1016/j.pmrj.2008.06.002. View

Alberts J, Thota A, Hirsch J, Ozinga S, Dey T, Schindler D . Quantification of the Balance Error Scoring System with Mobile Technology. Med Sci Sports Exerc. 2015; 47(10):2233-40. PMC: 4576723. DOI: 10.1249/MSS.0000000000000656. View

Bell D, Guskiewicz K, Clark M, Padua D . Systematic review of the balance error scoring system. Sports Health. 2012; 3(3):287-95. PMC: 3445164. DOI: 10.1177/1941738111403122. View

10.

Doherty C, Zhao L, Ryan J, Komaba Y, Inomata A, Caulfield B . Quantification of postural control deficits in patients with recent concussion: An inertial-sensor based approach. Clin Biomech (Bristol). 2017; 42:79-84. DOI: 10.1016/j.clinbiomech.2017.01.007. View

11.

King L, Horak F, Mancini M, Pierce D, Priest K, Chesnutt J . Instrumenting the balance error scoring system for use with patients reporting persistent balance problems after mild traumatic brain injury. Arch Phys Med Rehabil. 2013; 95(2):353-9. PMC: 6779123. DOI: 10.1016/j.apmr.2013.10.015. View

12.

Johnston W, Coughlan G, Caulfield B . Challenging concussed athletes: the future of balance assessment in concussion. QJM. 2017; 110(12):779-783. DOI: 10.1093/qjmed/hcw228. View

13.

Johnston W, OReilly M, Argent R, Caulfield B . Reliability, Validity and Utility of Inertial Sensor Systems for Postural Control Assessment in Sport Science and Medicine Applications: A Systematic Review. Sports Med. 2019; 49(5):783-818. DOI: 10.1007/s40279-019-01095-9. View

14.

Furman G, Lin C, Bellanca J, Marchetti G, Collins M, Whitney S . Comparison of the balance accelerometer measure and balance error scoring system in adolescent concussions in sports. Am J Sports Med. 2013; 41(6):1404-10. PMC: 4899870. DOI: 10.1177/0363546513484446. View

15.

Murray N, Salvatore A, Powell D, Reed-Jones R . Reliability and validity evidence of multiple balance assessments in athletes with a concussion. J Athl Train. 2014; 49(4):540-9. PMC: 4151843. DOI: 10.4085/1062-6050-49.3.32. View

16.

Simon M, Maerlender A, Metzger K, Decoster L, Hollingworth A, McLeod T . Reliability and Concurrent Validity of Select C3 Logix Test Components. Dev Neuropsychol. 2017; 42(7-8):446-459. DOI: 10.1080/87565641.2017.1383994. View

17.

Weismiller S, Monaco R, Womack J, Alderman B, Esopenko C, Conway F . Individual Baseline Balance Assessments in a Large Sample of Incoming NCAA Division I Athletes Using a Force Plate System. Int J Sports Phys Ther. 2021; 16(1):126-133. PMC: 7872460. View

18.

Downey R, Hutchison M, Comper P . Determining sensitivity and specificity of the Sport Concussion Assessment Tool 3 (SCAT3) components in university athletes. Brain Inj. 2018; 32(11):1345-1352. DOI: 10.1080/02699052.2018.1484166. View

19.

King L, Mancini M, Fino P, Chesnutt J, Swanson C, Markwardt S . Sensor-Based Balance Measures Outperform Modified Balance Error Scoring System in Identifying Acute Concussion. Ann Biomed Eng. 2017; 45(9):2135-2145. PMC: 5714275. DOI: 10.1007/s10439-017-1856-y. View

20.

Dierijck J, Wright A, Smirl J, Bryk K, van Donkelaar P . Sub-concussive trauma, acute concussion, and history of multiple concussions: Effects on quiet stance postural control stability. Int J Psychophysiol. 2018; 132(Pt A):74-80. DOI: 10.1016/j.ijpsycho.2018.03.005. View