ObjectiveBalance problems are a frequent symptom after head trauma including concussion, and the Balance Error Scoring System (BESS) is routinely used as a subjective screening test. Low-cost inertial sensors are an attractive objective alternative to elaborative force plates in objective testing balance in athletes.DesignCase series.SettingTraining area of professional players.Participants310 professional male and female football players from highest league in Switzerland (19/20 (95%) teams).InterventionSubjects were scored on their ability to maintain posture while standing in the six BESS conditions. Errors were counted by a test administrator, while an IPOD worn in a waist belt recorded linear acceleration and rotational velocity.Outcome measuresA variety of measures of stability (e.g., area of 2D surface plot, normalised path length (NPL)) were computed. In order to determine which measure was most sensitive to changes in balance, receiver operating characteristic (ROC) curves were created comparing firm to foam surfaces, and then the area under the ROC was calculated.Main resultsBESS and inertial measures correlated well overall (>0.7). Inertial measurements perform well in easier conditions (ROC area >0.95 for double stance), whereas BESS is insensitive to subtle changes in balance (ROC area=0.5). BESS, however, performs better on difficult conditions (ROC area >0.9 for single stance).ConclusionsAccelerometer assisted balance tests are a useful laboratory test in assessing balance problems. Normative values for athletes should be established.Competing interestsNone.

ObjectiveVertigo, dizziness and visual problems are among the main symptoms of a prolong course after concussion. Adequate diagnostic tools are rare. The computerized sensory organization test (SOT) differentiates the sensory integration between somatosensory, vision, vestibular and visual preference. This analysis may help to create an individual rehabilitation program and observe the progress.DesignCase series.SettingRehabilitation center.ParticipantsAmong 31 post-injury tested athletes with a diagnosed concussion 5 male professional players completed a follow-up test by the end of April 2016. Interventions: 5 players performed a post-injury baseline on the computerized dynamic posturograph (Equitest) and repeated the test as follow-up after personalized vestibulo-oculomotor therapy and improvement of symptoms during the rehabilitation process.Outcome measuresOutcome measures were total score (calculated by 6 SOT conditions) and identification of the integrational deficits (calculated by results of sensory analysis). Both values serve to guide and monitor the individual rehabilitation.Main resultsAt post-injury baseline a deficient total score and vestibular impairment was verified in all 5 athletes. After specific individualized vestibulo-oculomotor therapy and a significant reduction of symptoms the follow-up test demonstrated improvement in total score (22% ± 10% SD) to a point where entering intensive training (return to play protocol stage 3) was recommended. Regarding the vestibular system patients improved their score 57% ± 20% SD.ConclusionsThe computerized SOT can be a useful tool to identify specific sensory deficits and to help specify post-injury therapy and observe the individual rehabilitation process regarding the return to play protocol. Further research is required.Competing interestsNone.

ObjectiveApart from headache dizziness, vertigo or visual problems are common symptoms after a head trauma. Making an adequate diagnose of the symptoms remains challenging and only a few laboratory tests exist. The computerised sensory organisation test (SOT) differentiates the sensory integration between somatosensory, vision, vestibular and visual preference and therefore helps to objectify symptoms.Designconsecutive case series.Settingrehabilitation centre.Participants29 consecutive post injury symptomatic and asymptomatic athletes with a diagnosed concussion (n=24) or combined injury (concussion plus commotio/contusio labyrinthi (n=5)).InterventionsAll athletes performed a post injury SOT on the computerised dynamic posturograph (Smart Equitest, 6 conditions). The sensory scores (somatosensory, vestibular and vision) were compared to the normative data (n=112).Outcome measuresThe main aim was to determine the sensory source of post-concussive symptoms by application of the sensory analysis after performance of the SOT.Main resultsHalf of the athletes (n=15) achieved a normal sensory score, the other half (n=14) were below average (−9.4%) in visual (n=2), vestibular system (n=5) or both (n=7). In these athletes an individual specific vestibulo-oculomotor therapy was recommended.ConclusionsThe computerised SOT is a useful tool to determine the specific sensory deficits in patients with or without symptoms after a head trauma.Competing interestsNone.