title: Reliability and validity evidence of multiple balance assessments in athletes with a concussion.
abstract: BACKGROUND
  An estimated 300 000 sport-related concussion injuries occur in the United States annually. Approximately 30% of individuals with concussions experience balance disturbances. Common methods of balance assessment include the Clinical Test of Sensory Organization and Balance (CTSIB), the Sensory Organization Test (SOT), the Balance Error Scoring System (BESS), and the Romberg test; however, the National Collegiate Athletic Association recommended the Wii Fit as an alternative measure of balance in athletes with a concussion. A central concern regarding the implementation of the Wii Fit is whether it is reliable and valid for measuring balance disturbance in athletes with concussion.
  
  
  OBJECTIVE
  To examine the reliability and validity evidence for the CTSIB, SOT, BESS, Romberg test, and Wii Fit for detecting balance disturbance in athletes with a concussion.
  
  
  METHODS
  Literature considered for review included publications with reliability and validity data for the assessments of balance (CTSIB, SOT, BESS, Romberg test, and Wii Fit) from PubMed, PsycINFO, and CINAHL.
  
  
  METHODS
  We identified 63 relevant articles for consideration in the review. Of the 63 articles, 28 were considered appropriate for inclusion and 35 were excluded.
  
  
  RESULTS
  No current reliability or validity information supports the use of the CTSIB, SOT, Romberg test, or Wii Fit for balance assessment in athletes with a concussion. The BESS demonstrated moderate to high reliability (interclass correlation coefficient = 0.87) and low to moderate validity (sensitivity = 34%, specificity = 87%). However, the Romberg test and Wii Fit have been shown to be reliable tools in the assessment of balance in Parkinson patients.
  
  
  CONCLUSIONS
  The BESS can evaluate balance problems after a concussion. However, it lacks the ability to detect balance problems after the third day of recovery. Further investigation is needed to establish the use of the CTSIB, SOT, Romberg test, and Wii Fit for assessing balance in athletes with concussions.
authors.affiliation: Department of Health and Kinesiology, Georgia Southern University, Statesboro.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Murray
authors.forename: Anthony
authors.initials: A
authors.lastname: Salvatore
authors.forename: Douglas
authors.initials: D
authors.lastname: Powell
authors.forename: Rebecca
authors.initials: R
authors.lastname: Reed-Jones
mesh_terms: D056352:Athletes; D001265:Athletic Injuries / Q000175:diagnosis* / Q000503:physiopathology; D001924:Brain Concussion / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D004856:Postural Balance / Q000502:physiology*; D015203:Reproducibility of Results; D013177:Sports / Q000502:physiology*
keywords: Balance Error Scoring System; Clinical Test of Sensory Organization and Balance; Romberg test; Sensory Organization Test; Wii Fit; sensitivity; specificity