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.

Keywords: BESS; Balance; Brain injury; Concussion; Inertial sensors; Postural sway; mTBI.

Conflict of interest statement

CONFLICT OF INTEREST

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1

Representative sway tracings from an acutely concussed (black) and control (green) individual with eyes closed in all 3 stance condition of the mBESS; double stance (a), single limb stance (b) and tandem stance (c).

FIGURE 2

Random forest displaying the top measures for distinguishing between health controls and acutely concussed athletes. Measures from DS are shown in blue, and those from TS are shown in green. ML, AP, and two-dimensional measures are indicated with circles, squares, or hexagons, respectively.

FIGURE 3

ROC curves for the true positive and false positive rates for the clinical mBESS error count, and instrumented mBESS models of (1) ML RMS and (2) ML RMS + ML total power. Both instrumented models used only measures obtained from the DS condition.