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Author Notes:

Daniel Corwin, MD, The Children’s Hospital of Philadelphia, Division of Emergency Medicine, Colket Translation Research Building, 3501 Civic Center Blvd 9th Floor/CTRB 9013B, Philadelphia, PA 19104, 215-590-1959, Email: corwind@email.chop.edu

We would like to acknowledge Ronni Kessler, Olivia Podolak, Ari Fish, Julia Vanni, and Shelly Sharma for their contributions to data collection. We are grateful to the students and parents from the Shipley School and families at the Children’s Hospital of Philadelphia for their participation in this research study. We would also like thank the Shipley School administration and athletic training staff, in particular Mark Duncan, Director of Athletics, and Dr. Steve Piltch, Head of School, for their support.

The authors have no conflicts of interest relevant to this article to disclose. The results of the present study do not constitute endorsement by the American College of Sports Medicine. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation.

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Research Funding:

Funding for this research has been provided by the Pennsylvania Department of Health. Research reported in this publication was also supported by National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award number R01NS097549. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Sport Sciences
  • COMPLEX TANDEM GAIT
  • MODIFIED BALANCE ERROR SCORING SYSTEM
  • PEDIATRIC CONCUSSION
  • VISIO-VESTIBULAR EXAMINATION
  • DUAL-TASK
  • SINGLE-TASK
  • RELIABILITY
  • PERFORMANCE
  • DEFICITS
  • CHILDREN

Clinical and Device-based Metrics of Gait and Balance in Diagnosing Youth Concussion

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Journal Title:

MEDICINE AND SCIENCE IN SPORTS AND EXERCISE

Volume:

Volume 52, Number 3

Publisher:

, Pages 542-548

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Purpose Evaluate the discriminatory ability of two clinical measures and one device-based measure of gait and balance for concussed youth. Methods We enrolled 81 cases and 90 controls age 14-18 yr old from August 2017 to June 2018. Controls were recruited from a suburban high school, and cases were recruited from the concussion program of an academic pediatric tertiary care center. Tests included two clinical measures: 1) complex tandem gait, scored as sway/errors walking forward and backward eyes open and closed; 2) Modified Balance Error Scoring System (mBESS), scored as total number of errors on three standing tasks; and one device-based measure; 3) Modified Clinical Test of Sensory Interaction and Balance (mCTSIB) using the Biodex Biosway Balance System, scored as a sway index. Sensitivity, specificity, ideal cutpoint, and area under the receiver operating characteristic curve (AUC) were calculated for all test components. Results Ideal cutpoint for total number of sway/errors for tandem gait = 5, sensitivity 41%, specificity 90%. Ideal cutpoint for total mBESS errors = 4, sensitivity 55%, specificity 75%. Ideal cutpoint for mCTSIB = 1.37, sensitivity 37%, specificity 88%. Among each test, some individual components outperformed overall composites, in particular tandem gait (specificity forward eyes open = 99%, sensitivity backward eyes closed = 81%). Among the 40 cases and 65 controls with all three assessments, AUC (95% CI) for tandem gait = 0.63 (0.52,0.75), mBESS = 0.70 (0.60,0.81), and mCTSIB = 0.54 (0.42,0.66). Conclusions A device-based measure of balance did not produce better discriminatory ability than two clinical assessments. Complex tandem gait has the additional benefit of being an easy-to-perform and graded test with highly sensitive and specific individual components.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/rdf).
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