Validity of Postural Sway Assessment on the Biodex BioSway™ Compared With the NeuroCom Smart Equitest

in Journal of Sport Rehabilitation
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Context: Current tools for sideline assessment of balance following a concussion may not be sufficiently sensitive to identify impairments, which may place athletes at risk for future injury. Quantitative field-expedient balance assessments are becoming increasingly accessible in sports medicine and may improve sensitivity to enable clinicians to more readily detect these subtle deficits. Objective: To determine the validity of the postural sway assessment on the Biodex BioSway™ compared with the gold standard NeuroCom Smart Equitest System. Design: Cross-sectional cohort study. Setting: Clinical research laboratory. Participants: Forty-nine healthy adults (29 females: 24.34 [2.45] y, height 163.65 [7.57] cm, mass 63.64 [7.94] kg; 20 males: 26.00 [3.70] y, height 180.11 [7.16] cm, mass 82.97 [12.78] kg). Intervention(s): The participants completed the modified clinical test of sensory interaction in balance on the Biodex BioSway™ with 2 additional conditions (head shake and firm surface; head shake and foam surface) and the Sensory Organization Test and Head Shake Sensory Organization Test on the NeuroCom Smart Equitest. Main Outcome Measures: Interclass correlation coefficient and Bland–Altman limits of agreement for Sway Index, equilibrium ratio, and area of 95% confidence ellipse. Results: Fair–good reliability (interclass correlation coefficient = .48–.65) was demonstrated for the stance conditions with eyes open on a firm surface. The Head Shake Sensory Interaction and Balance Test condition on a firm surface resulted in fair reliability (interclass correlation coefficient = .50–.59). The authors observed large ranges for limits of agreement across outcome measures, indicating that the systems should not be used interchangeably. Conclusions: The authors observed fair reliability between BioSway™ and NeuroCom, with better agreement between systems with the assessment of postural sway on firm/static surfaces. However, the agreement of these systems may improve by incorporating methods that mitigate the floor effect in an athletic population (eg, including a head shake condition). BioSway™ may provide a surrogate field-expedient measurement tool.

Miner is with the Department of Physical Therapy, Radford University Carilion, Radford University, Roanoke, VA, USA. Glass is with the Department of Physical Therapy, Radford University, Radford, VA, USA. Harper is with the Department of Physical Therapy, Chapman University, Orange, CA, USA.

Miner (dminer1@radford.edu) is corresponding author.
  • 1.

    Mancini M, Horak FB. The relevance of clinical balance assessment tools to differentiate balance deficits. Eur J Phys Rehabil Med. 2010;46(2):239248. PubMed ID: 20485226

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Clark S, Iltis PW. Effects of dynamic head tilts on sensory organization test performance: a comparison between college-age athletes and nonathletes. J Orthop Sports Phys Ther. 2008;38(5):262268. PubMed ID: 18448882 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Buckley TA, Burdette G, Kelly K. Concussion-management practice patterns of national collegiate athletic association division II and III athletic trainers: how the other half lives. J Athl Train. 2015;50(8):879888. PubMed ID: 26196701 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Wrisley DM, Whitney SL. The effect of foot position on the modified clinical test of sensory interaction and balance. Arch Phys Med Rehabil. 2004;85(2):335338. PubMed ID: 14966723 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Paniccia M, Wilson KE, Hunt A, et al. Postural stability in healthy child and youth athletes: the effect of age, sex, and concussion-related factors on performance. Sports Health. 2018;10(2):175182. PubMed ID: 29131721 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Schmitz R, Arnold B. Intertester and intratester reliability of a dynamic balance protocol using the biodex stability system. J Sport Rehabil. 1998;7(2):95101. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Hinman MR. Factors affecting reliability of the biodex balance system: a summary of four studies. J Sport Rehabil. 2000;9(3):240252. doi:

  • 8.

    Corwin DJ, McDonald CC, Arbogast KB, et al. Clinical and device-based metrics of gait and balance in diagnosing youth concussion. Med Sci Sports Exerc. 2020;52(3):542548. PubMed ID: 31524833 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Imhoff S, Fait P, Carrier-Toutant F, Boulard G. Efficiency of an active rehabilitation intervention in a slow-to-recover paediatric population following mild traumatic brain injury: a pilot study. J Sports Med. 2016;2016:5127374. PubMed ID: 28078321 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Dewan BM, Roger James C, Kumar NA, Sawyer SF. Kinematic validation of postural sway measured by biodex biosway (force plate) and SWAY balance (accelerometer) technology. Biomed Res Int. 2019;2019:8185710. PubMed ID: 31930140 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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