Sensitivity of the Balance Error Scoring System and the Sensory Organization Test in the Combat Environment

Haran, F. Jay; Slaboda, Jill C.; King, Laurie A.; Wright, W. Geoff; Houlihan, Daniel; Norris, Jacob

doi:10.1089/neu.2015.4060

Cited by 33 publications

(23 citation statements)

References 53 publications

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“…The first test was the Balance Error Scoring System (BESS), which has been used previously to assess static postural stability. [39][40][41][42][43][44][45] As part of this test, subjects were instructed to close their eyes and hold three different stances (double leg, single leg, and tandem) and two different surfaces (firm floor and a foam pad). In the double leg stance, subjects stand straight, feet together (side by side), with hands on their hip.…”

Section: Neurological Testingmentioning

confidence: 99%

Voluntary Head Rotational Velocity and Implications for Brain Injury Risk Metrics

Hernandez

Camarillo

2019

Journal of Neurotrauma

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We investigated whether humans could sustain high head rotational velocities without brain injury. Rotational velocity has long been implicated for predicting concussion risk, and has recently been used to develop the rotational velocity-based Brain Injury Criterion (BrIC). To assess the efficacy of rotational velocity and BrIC for predicting concussion risk, we instrumented 9 male subjects with sensor-laden mouthguards and measured six-degree-of-freedom head accelerations for 27 rapid voluntary head rotations. The fastest rotations produced peak rotational velocities of 12.6, 17.4, and 25.0 rad/s in the coronal, sagittal, and horizontal planes, respectively. All of these exceeded the corresponding medians from padded sports impacts (8.9, 10.7, and 8.4 rad/s, respectively) and, in the case of sagittal and horizontal rotation, were within 1 standard deviation of published concussion averages. In the horizontal plane, four voluntary rotations exceeded the concussive impact median BrIC. The area under the precision-recall curve was lower in BrIC (0.49) than just using horizontal rotational acceleration (0.8), which distinguished concussive and subconcussive motions better. Voluntary motions produced less than 4% max principal strain (MPS) in finite element simulation, 5 times below predictions from dummy impacts used to develop BrIC. Despite having the highest critical velocity in BrIC, coronal rotation produced more tract-oriented strain in the corpus callosum than other planes. Baseline and post-experiment neurological testing revealed no significant deficits. We find that the head can tolerate high-velocity, low-acceleration rotational inputs too slow to produce substantial brain deformation. These findings suggest that the time regime over which angular velocities occur must be carefully considered for concussion prediction.

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Section: Neurological Testingmentioning

confidence: 99%

Voluntary Head Rotational Velocity and Implications for Brain Injury Risk Metrics

Hernandez

Camarillo

2019

Journal of Neurotrauma

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“…6,13,16,19,53 Although postural sway has traditionally been quantified using force plates, recent advances in wearable technology have yielded portable and accurate instruments that have been validated against the gold standard of force platforms. 34,55 We previously reported that postural sway measures from a single inertial sensor over the lumbar spine were able to better discriminate between those with and without PCS than the standard clinical mBESS error count.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…44 The precise mechanism underlying this dysfunction is unknown, but impaired integration of vestibular and proprioceptive information is a potential candidate as integration of vestibular and pelvis-to-feet proprioceptive information is necessary to maintain a heading direction. 35,45 It is currently unclear how sensory integration deficitis in persons with chronic mTBI during static postural tasks 46 translate into nonstatic tasks such as gait and turning. Yet, it is possible that difficulty integrating vestibular and proprioceptive information could be associated with the abnormal turning characteristics seen here.…”

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confidence: 99%

Abnormal Turning and Its Association with Self-Reported Symptoms in Chronic Mild Traumatic Brain Injury

Fino

Parrington

Walls

et al. 2018

Journal of Neurotrauma

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Turning is common in daily activity and requires rapid, coordinated reorientation of the head, trunk, and pelvis toward the new direction of travel. Yet, turning gait has not been well explored in populations with mild traumatic brain injury (mTBI) who may alter their turning behavior according to self-perceived symptoms or motor dysfunction. The purpose of this study was to examine turning velocities and coordination in adults with chronic mTBI (>3 months post-injury and still reporting balance complaints) during a task simulating everyday ambulation. We hypothesized that individuals with chronic mTBI would reduce their angular velocity when turning and increase the variability of head-pelvis coordination compared with controls, and that the reduction in velocity and increased variability would be associated with their self-reported symptom score. Forty-two adults (14 chronic mTBI, 28 controls) completed the Neurobehavioral Symptom Inventory before walking 12 laps around a marked course containing two 45-degree turns, four 90-degree turns, and two 135-degree turns. Inertial sensors collected angular velocities of the head and pelvis. After adjusting for covariates, participants with chronic mTBI had significantly slower lap times and peak angular velocities of the pelvis (p < 0.01) compared with the control group. The peak velocity timing (PVT) between peak velocities of the head and pelvis, and the variability of that timing was significantly greater in participants with chronic mTBI (p < 0.01). Within the chronic mTBI group, somatosensory symptoms were associated with slower angular velocities of the head and pelvis (p = 0.03) and increased PVT variability (p < 0.01). The results suggest individuals with chronic mTBI with worse somatic symptoms have impaired head stabilization during turning in situations similar to everyday life. These results encourage future research on turning gait to examine the causal relationship between symptoms and daily locomotor function in adults with chronic mTBI.

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Sensitivity of the Balance Error Scoring System and the Sensory Organization Test in the Combat Environment

Cited by 33 publications

References 53 publications

Voluntary Head Rotational Velocity and Implications for Brain Injury Risk Metrics

Voluntary Head Rotational Velocity and Implications for Brain Injury Risk Metrics

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

Abnormal Turning and Its Association with Self-Reported Symptoms in Chronic Mild Traumatic Brain Injury

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