AN INITIAL EVALUATION OF THE BTRACKS BALANCE PLATE AND SPORTS BALANCE SOFTWARE FOR CONCUSSION DIAGNOSIS

Abstract

Background: As recently dictated by the American Medical Society, balance testing is an important component in the clinical evaluation of concussion. Despite this, previous research on the efficacy of balance testing for concussion diagnosis suggests low sensitivity (∼30%), based primarily on the popular Balance Error Scoring System (BESS). The Balance Tracking System (BTrackS, Balance Tracking Systems Inc., San Diego, CA, USA) consists of a force plate (BTrackS Balance Plate) and software (BTrackS Sport Balance) which can quickly (<2 min) perform concussion balance testing with gold standard accuracy.

Purpose: The present study aimed to determine the sensitivity of the BTrackS Balance Plate and Sports Balance Software for concussion diagnosis.

Study design: Cross-Sectional Study.

Methods: Preseason baseline balance testing of 519 healthy Division I college athletes playing sports with a relatively high risk for concussions was performed with the BTrackS Balance Test. Testing was administered by certified athletic training staff using the BTrackS Balance Plate and Sport Balance software. Of the baselined athletes, 25 later experienced a concussion during the ensuing sport season. Post-injury balance testing was performed on these concussed athletes within 48 of injury and the sensitivity of the BTrackS Balance Plate and Sport Balance software was estimated based on the number of athletes showing a balance decline according to the criteria specified in the Sport Balance software. This criteria is based on the minimal detectable change statistic with a 90% confidence level (i.e. 90% specificity).

Results: Of 25 athletes who experienced concussions, 16 had balance declines relative to baseline testing results according to the BTrackS Sport Balance software criteria. This corresponds to an estimated concussion sensitivity of 64%, which is twice as great as that reported previously for the BESS.

Conclusions: The BTrackS Balance Plate and Sport Balance software has the greatest concussion sensitivity of any balance testing instrument reported to date.

Level of evidence: Level 2 (Individual cross sectional diagnostic study).

Keywords: BTrackS; balance; concussion; diagnostic accuracy; sensitivity.

Figures

Figure 1.

The BTrackS Sport Balance package, consisting of the BTrackS Balance Plate (left) and the BTrackS Sport Balance software (right) running on a tablet computing device.

Figure 2.

A depiction of the typical BBT administration. The athlete stands quietly on the BTrackS Balance Plate with eyes closed, feet shoulder width apart and hands on hips while the tester collects body sway information with a connected computing device running the BTrackS Sport Balance software.

Figure 3.

Example baseline (top) and post-concussion (bottom) COP data from a single BBT trial. The amount of body sway is shown by the path length (i.e. excursion) of the yellow COP trace, which is quantified in centimeters in the bottom right hand corner of each respective depiction of the BTrackS Balance Plate. Note the increase in COP path length following concussion.