title: Instrumenting the balance error scoring system for use with patients reporting persistent balance problems after mild traumatic brain injury.
abstract: 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 traumatic brain injury (TBI) status in patients with mild TBI with persistent self-reported balance complaints.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Outpatient clinic.
  
  
  METHODS
  Subjects (n=13; age, 16.3±2y) with a recent history of concussion (mild TBI group) and demographically matched control subjects (n=13; age, 16.7±2y; control group).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Outcome measures included the BESS, modified BESS, instrumented BESS, and instrumented modified BESS. All subjects were tested on the noninstrumented BESS and modified BESS and were scored by visual observation of instability in 6 and 3 stance conditions, respectively. Instrumentation of these 2 tests used 1 inertial sensor with an accelerometer and gyroscope to quantify bidirectional body sway.
  
  
  RESULTS
  Scores from the BESS and the modified BESS tests were similar between groups. However, results from the instrumented measures using the inertial sensor were significantly different between groups. The instrumented modified BESS had superior diagnostic classification and the largest area under the curve when compared with the other balance measures.
  
  
  CONCLUSIONS
  A concussion may disrupt the sensory processing required for optimal postural control, which was measured by sway during quiet stance. These results suggest that the use of portable inertial sensors may be useful in the move toward more objective and sensitive measures of balance control postconcussion, but more work is needed to increase sensitivity.
authors.affiliation: Department of Neurology, Oregon Health & Science University, Portland, OR. Electronic address: kingla@ohsu.edu.
authors.forename: Laurie A
authors.initials: LA
authors.lastname: King
authors.affiliation: Department of Neurology, Oregon Health & Science University, Portland, OR.
authors.forename: Fay B
authors.initials: FB
authors.lastname: Horak
authors.affiliation: Department of Neurology, Oregon Health & Science University, Portland, OR.
authors.forename: Martina
authors.initials: M
authors.lastname: Mancini
authors.affiliation: Division of Biostatistics, Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR.
authors.forename: Donald
authors.initials: D
authors.lastname: Pierce
authors.affiliation: Department of Neurology, Oregon Health & Science University, Portland, OR.
authors.forename: Kelsey C
authors.initials: KC
authors.lastname: Priest
authors.affiliation: Department of Sports Medicine, Oregon Health & Science University, Portland, OR.
authors.forename: James
authors.initials: J
authors.lastname: Chesnutt
authors.affiliation: Department of Neurology, Georgetown University School of Medicine, Washington, DC.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sullivan
authors.affiliation: War Related Illness and Injury Study Center, Washington, DC Veterans Affairs Medical Center, Washington, DC; Department of Neurology, Georgetown University School of Medicine, Washington, DC.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Chapman
mesh_terms: D061725:Accelerometry / Q000295:instrumentation*; D000293:Adolescent; D001930:Brain Injuries / Q000503:physiopathology* / Q000534:rehabilitation*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D004856:Postural Balance / Q000502:physiology*; D016896:Treatment Outcome
keywords: AP; AUC; BESS; Balance Error Scoring System; Brain concussion; Brain injuries; ML; NIH; National Institutes of Health; OHSU; Oregon Health & Science University; Postural balance; RMS; ROC; Rehabilitation; TBI; anterior-posterior; area under the curve; mTBI; mediolateral; mild traumatic brain injury; receiver operating characteristic; root-mean-square; traumatic brain injury