Monitoring of postural sway with a head-mounted wearable device: effects of gender, participant state, and concussion

Scott T Grafton, Andreas B Ralston, John D Ralston, Scott T Grafton, Andreas B Ralston, John D Ralston

Abstract

Objective: To assess the utility of a head-mounted wearable inertial motion unit (IMU)-based sensor and 3 proposed measures of postural sway to detect outliers in athletic populations at risk of balance impairments. Methods: Descriptive statistics are used to define a normative reference range of postural sway (eyes open and eyes closed) in a cross-sectional sample of 347 college students using a wireless head-mounted IMU-based sensor. Three measures of postural sway were derived: linear sway power, eyes closed vs eyes open sway power ratio (Ec/Eo ratio), and weight-bearing asymmetry (L-R ratio), and confidence intervals for these measures were calculated. Questionnaires were used to identify potentially confounding state variables. A prospective study of postural sway changes in 47 professional, college, and high school athletes was then carried out in on-field settings to provide estimates of session-to-session variability and the influence of routine physical activity on sway measures. Finally, pre-post-injury changes in sway are measured for a participant who was diagnosed with a concussion. Results: Despite the heterogenous population and sampling environments, well-defined confidence intervals were established for all 3 sway measures. Men demonstrated significantly greater sway than women. Two state variables significantly increased sway: the use of nicotine and prescription medications. In the athletes, session-to-session variability and changes due to routine physical activity remained well within 95% confidence intervals defined by the cross-sectional sample for all 3 sway measures. The increase in sway power following a diagnosed concussion was more than an order of magnitude greater than the increases due to session-to-session variability, physical activity, or other participant state variables. Conclusion: The proposed postural sway measures and head-mounted wearable sensor demonstrate analytic utility for on-field detection of abnormal sway that could be potentially useful when making remove-from-activity and return-to-activity decisions for athletes at risk of impact-induced balance impairments.

Keywords: balance impairments; concussion; postural sway; wearable sensor.

Conflict of interest statement

John Ralston is the founder and CEO of Protxx, Inc., and has a financial interest in the company. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Combined head-impact and postural sway monitoring inertial motion unit sensors (A) worn with an athletic headband; and (B) attached to the skin using an adhesive patch.
Figure 2
Figure 2
Cumulative distributions for different measures of postural stability, plotted as a function of eye state and gender. Measures of sway power (in Watts) were significantly different for eyes open (Eo) versus eyes closed (Ec) and as a function of gender. After normalization, the ratio of sway power with Ec/Eo did not differ as a function of gender. The Front-back sway power ratio was significantly different: with eyes closed participants moved more posteriorly. There were no differences in the left-right sway power ratio as a function of gender or eye state.
Figure 3
Figure 3
The influence of nicotine use (within 1–8 hrs) on postural sway.
Figure 4
Figure 4
Repeated measures of sway in 22 men’s professional soccer players recorded over 15 sessions spanning 37 days. (A) Sway power; (B) Bias in lateral sway; (C) Eyes closed/eyes open sway power ratio. Abbreviation: L-R, left-right.
Figure 5
Figure 5
Variability of sway measurements from 22 men’s professional soccer players recorded over 15 sessions spanning 37 days. (A) Sway power; (B) Bias in lateral sway; (C) Eyes closed/eyes open sway power ratio. Abbreviation: L-R, left-right.
Figure 6
Figure 6
The effect of physical activity on sway in two sports. The measures were obtained in college women’s soccer and volleyball teams and reflect repeated measures before and after training sessions over 6 weeks during the fall 2018 season. Sway power increases significantly after physical activity. Abbreviation: L-R, Left-right
Figure 7
Figure 7
The effect of an acute concussion on sway power in a varsity high school football player. Player 4 sustained an in-practice concussion, leading to a significant increase of postural sway post practice (A). Over the next two weeks, there is a clear pattern of recovery to baseline (B). Abbreviations: Eo, eyes open; Ec, eyes closed.

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