Instrumenting the Balance Error Scoring System for Use With Patients Reporting Persistent Balance Problems After Mild Traumatic Brain Injury

OBJECTIVE: To determine whether alterations to the Balance Error Scoring System (BESS), such as modified conditions and/or instrumentation, would improve the ability to correctly classify TBI status in patients with mild TBI with persistent self-reported balance complaints. DESIGN: A cross-sectional study. SETTING: An outpatient clinic in the Department of Rehabilitation Services at Oregon Health & Sciences University (OHSU). SUBJECTS: Thirteen subjects (age 16.3 ±2) with a recent history of concussion (mTBI group) and 13 demographically matched control subjects (age 16.7 ±2) (control group). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Outcome measures included the BESS, Modified BESS (Mod. BESS), Instrumented BESS (Instr. BESS), and Instrumented Modified BESS (Instr. Mod. BESS). All subjects were tested on the non-instrumented BESS and Mod. BESS, scored by visual observation of instability in six and three stance conditions, respectively. Instrumentation of these 2 tests utilized one inertial sensor (APDM-3D), with an accelerometer and gyroscope to quantify bi-directional body sway. RESULTS: Scores from the BESS and the Mod. BESS tests were similar between groups. However, results from the instrumented measures using the inertial sensor() were significantly different between groups. The Instr. Mod. BESS had superior diagnostic classification and the largest Area Under the Curve (AUC) when compared to the other balance measures. CONCLUSIONS: A concussion may disrupt the sensory processing required for optimal postural control, measured by sway during quiet stance. These results suggest that the use of portable inertial sensors() may be useful in the move towards more objective and sensitive measures of balance control post-concussion but more work is needed to increase sensitivity.