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Arch Phys Med Rehabil. 2014 Feb;95(2):353-9. doi: 10.1016/j.apmr.2013.10.015. Epub 2013 Nov 5.

Instrumenting the balance error scoring system for use with patients reporting persistent balance problems after mild traumatic brain injury.

Author information

1
Department of Neurology, Oregon Health & Science University, Portland, OR. Electronic address: kingla@ohsu.edu.
2
Department of Neurology, Oregon Health & Science University, Portland, OR.
3
Division of Biostatistics, Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR.
4
Department of Sports Medicine, Oregon Health & Science University, Portland, OR.
5
Department of Neurology, Georgetown University School of Medicine, Washington, DC.
6
War Related Illness and Injury Study Center, Washington, DC Veterans Affairs Medical Center, Washington, DC; Department of Neurology, Georgetown University School of Medicine, Washington, DC.

Abstract

OBJECTIVE:

To determine whether alterations to the Balance Error Scoring System (BESS), such as modified conditions and/or instrumentation, would improve the ability to correctly classify traumatic brain injury (TBI) status in patients with mild TBI with persistent self-reported balance complaints.

DESIGN:

Cross-sectional study.

SETTING:

Outpatient clinic.

PARTICIPANTS:

Subjects (n=13; age, 16.3±2y) with a recent history of concussion (mild TBI group) and demographically matched control subjects (n=13; age, 16.7±2y; control group).

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURES:

Outcome measures included the BESS, modified BESS, instrumented BESS, and instrumented modified BESS. All subjects were tested on the noninstrumented BESS and modified BESS and were scored by visual observation of instability in 6 and 3 stance conditions, respectively. Instrumentation of these 2 tests used 1 inertial sensor with an accelerometer and gyroscope to quantify bidirectional body sway.

RESULTS:

Scores from the BESS and the modified BESS tests were similar between groups. However, results from the instrumented measures using the inertial sensor were significantly different between groups. The instrumented modified BESS had superior diagnostic classification and the largest area under the curve when compared with the other balance measures.

CONCLUSIONS:

A concussion may disrupt the sensory processing required for optimal postural control, which was measured by sway during quiet stance. These results suggest that the use of portable inertial sensors may be useful in the move toward more objective and sensitive measures of balance control postconcussion, but more work is needed to increase sensitivity.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01377454.

KEYWORDS:

AP; AUC; BESS; Balance Error Scoring System; Brain concussion; Brain injuries; ML; NIH; National Institutes of Health; OHSU; Oregon Health & Science University; Postural balance; RMS; ROC; Rehabilitation; TBI; anterior-posterior; area under the curve; mTBI; mediolateral; mild traumatic brain injury; receiver operating characteristic; root-mean-square; traumatic brain injury

PMID:
24200875
DOI:
10.1016/j.apmr.2013.10.015
[Indexed for MEDLINE]

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