title: Evaluation of Nintendo Wii Balance Board as a Tool for Measuring Postural Stability After Sport-Related Concussion.
abstract: BACKGROUND
  Recent changes to postconcussion guidelines indicate that postural-stability assessment may augment traditional neurocognitive testing when making return-to-participation decisions. The Balance Error Scoring System (BESS) has been proposed as 1 measure of balance assessment. A new, freely available software program to accompany the Nintendo Wii Balance Board (WBB) system has recently been developed but has not been tested in concussed patients.
  
  
  OBJECTIVE
  To evaluate the feasibility of using the WBB to assess postural stability across 3 time points (baseline and postconcussion days 3 and 7) and to assess concurrent and convergent validity of the WBB with other traditional measures (BESS and Immediate Post-Concussion Assessment and Cognitive Test [ImPACT] battery) of assessing concussion recovery.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Athletic training room and collegiate sports arena.
  
  
  METHODS
  We collected preseason baseline data from 403 National Collegiate Athletic Association Division I and III student-athletes participating in contact sports and studied 19 participants (age = 19.2 ± 1.2 years, height = 177.7 ± 8.0 cm, mass = 75.3 ± 16.6 kg, time from baseline to day 3 postconcussion = 27.1 ± 36.6 weeks) who sustained concussions.
  
  
  METHODS
  We assessed balance using single-legged and double-legged stances for both the BESS and WBB, focusing on the double-legged, eyes-closed stance for the WBB, and used ImPACT to assess neurocognition at 3 time points. Descriptive statistics were used to characterize the sample. Mean differences and Spearman rank correlation coefficients were used to determine differences within and between metrics over the 3 time points. Individual-level changes over time were also assessed graphically.
  
  
  RESULTS
  The WBB demonstrated mean changes between baseline and day 3 postconcussion and between days 3 and 7 postconcussion. It was correlated with the BESS and ImPACT for several measures and identified 2 cases of abnormal balance postconcussion that would not have been identified via the BESS.
  
  
  CONCLUSIONS
  When accompanied by the appropriate analytic software, the WBB may be an alternative for assessing postural stability in concussed student-athletes and may provide additional information to that obtained via the BESS and ImPACT. However, verification among independent samples is required.
authors.affiliation: Departments of * Emergency Medicine.
authors.forename: Kian
authors.initials: K
authors.lastname: Merchant-Borna
authors.affiliation: Departments of * Emergency Medicine.|Public Health Sciences, and.
authors.forename: Courtney Marie Cora
authors.initials: CM
authors.lastname: Jones
authors.affiliation: Departments of * Emergency Medicine.
authors.forename: Mattia
authors.initials: M
authors.lastname: Janigro
authors.affiliation: Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill.
authors.forename: Erin B
authors.initials: EB
authors.lastname: Wasserman
authors.affiliation: School of Exercise Science, Australian Catholic University, Fitzroy, Victoria.
authors.forename: Ross A
authors.initials: RA
authors.lastname: Clark
authors.affiliation: Departments of * Emergency Medicine.|Public Health Sciences, and.|Neurology, Neurosurgery, and Physical Medicine and Rehabilitation, University of Rochester School of Medicine and Dentistry, NY.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Bazarian
mesh_terms: D000293:Adolescent; D056352:Athletes / Q000706:statistics & numerical data; D001265:Athletic Injuries / Q000175:diagnosis / Q000503:physiopathology*; D001924:Brain Concussion / Q000175:diagnosis / Q000503:physiopathology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D004856:Postural Balance / Q000502:physiology*; D011581:Psychological Tests; D013178:Sports Medicine / Q000295:instrumentation* / Q000379:methods; D013334:Students / Q000706:statistics & numerical data; D018910:Video Games; D055815:Young Adult
keywords: athletes; balance; mild traumatic brain injury; neurocognitive testing; recovery; return-to-play guidelines