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Andrea Cripps and Scott C. Livingston

Clinical Scenario:

Sport-related concussions are a significant health issue due to the high incidence of concussions sustained each sports season. Current approaches to the evaluation of acutely concussed athletes include the use of balance assessments to identify and monitor underlying postural instability arising from concussion. Balance assessment has been recommended as a primary measurement tool for monitoring recovery and for making return-to-play decisions. Balance impairments have been shown to occur in the initial postconcussion period (ie, 1–10 d). Numerous clinical and laboratory measures have been used in the assessment of balance immediately after concussion, and clinicians are faced with deciding which measures to use.

Focused Clinical Question:

How do clinical or field-based balance-assessment tools compare to laboratory-based balance measures in identifying deficits in postural stability among acutely concussed athletes?

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Abbis H. Jaffri, Thomas M. Newman, Brent I. Smith, Giampietro L. Vairo, Craig R. Denegar, William E. Buckley and Sayers J. Miller

to determine if the novel dynamic balance assessment, the DLBT, can reveal differences in dynamic balance performance between CAI involved and uninvolved limbs. We observed significant differences between the involved and the uninvolved limbs of subjects with unilateral CAI. Interestingly, we did not

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Cristina Jácome, Joana Cruz, Raquel Gabriel, Daniela Figueiredo and Alda Marques

This study assessed functional balance among older adults at all grades of chronic obstructive pulmonary disease (COPD) and explored balance impairment predictors. A cross-sectional study with outpatients with COPD (N = 160; M = 72.2 years, SD = 7.9; mean forced expiratory volume in 1 s = 63.8% predicted, SD = 23.7) was conducted. The Timed Up and Go (TUG) test was used to assess functional balance. Functional balance impairment was defined as a TUG score exceeding the upper limit of the confidence intervals of normative values for healthy older adults. Participants performed the TUG test in 11.0 s (SD = 4.8 s). Functional balance impairment was present in 44.4% of the participants and was significantly more frequent in severe to very severe COPD (62.5%). Body mass index (odds ratio [OR] = 1.12), number of medications (OR = 1.20), restriction in recreational activities (OR = 1.66), and depression score (OR = 1.14) were multivariate predictors of functional balance impairment. Functional balance impairment is present in early COPD, although more evident at advanced grades. These findings highlight the importance of balance assessment in older patients at all COPD grades.

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Phakkanut Mathurapongsakul and Akkradate Siriphorn

Falls are one of the most common problems in older adults, which leading to unintentional injuries ( Stevens, Corso, Finkelstein, & Miller, 2006 ). The effectiveness of fall prevention arises from the appropriate balance assessments. There are several standardized balance assessment tools for

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Jason P. Mihalik, Luv Kohli and Mary C. Whitton

Context:

Virtual reality environments may allow researchers to investigate functional balance performance without risks associated with testing in the real world.

Objective:

To investigate the effects of the mass of a head-mounted display (HMD) on balance performance.

Design:

Counterbalanced pretest-posttest.

Setting:

Virtual reality laboratory.

Participants:

20 healthy college students.

Intervention(s):

Balance Error Scoring System (BESS) with a tracker-only headband and again with tracker plus HMD was performed.

Main Outcome Measures:

BESS error scores, elliptical sway area, and center of pressure travel distance were recorded.

Results:

No effect of the HMD mass on balance performance was observed. A significant stance by surface interaction was present but was negated when the HMD conditions were included in the model.

Conclusions:

The mass of a HMD has not been proven to adversely affect balance performance. These data suggest the HMD mass is not a contraindication to the use of immersive virtual environments in future concussion research involving balance.

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Martin G. Jorgensen, Uffe Laessoe, Carsten Hendriksen, Ole B.F. Nielsen and Per Aagaard

The aims of the current study were to examine the intrarater intersession reproducibility of the Nintendo Wii agility and stillness tests and explore the concurrent validity in relation to gold-standard force-plate analysis. Within-day intersession reproducibility was examined in 30 older adults (age 71.8 ± 5.1 yr). No systematic test–retest differences were found for the Wii stillness test; however, the Wii agility test scores differed systematically between test sessions (p < .05). The Wii stillness test yielded a test–retest ICC of .86 (95% CI 0.74–0.93), CV of 6.4%, LOA of 11.0, and LOA% of 17.9%. Likewise for the Wii agility test ICC was .73 (95% CI 0.50-0.86), CV 5.3%, LOA 1.8, and LOA% of 14.6%. Wii stillness scores correlated to force plate measures (r = .65–.82, p < .01), reflecting moderate to excellent validity. In conclusion, it appears that the Wii stillness test represents a low-cost, objective, reproducible, and valid test of undisturbed postural balance in community-dwelling older adults.

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Ryan Morrison, Kyle M. Petit, Chris Kuenze, Ryan N. Moran and Tracey Covassin

The most commonly reported symptoms following a sport-related concussion (SRC) are headaches, dizziness, and balance problems. 1 Best practices for SRC assessment include symptom evaluation, neuropsychological testing, vestibular and ocular motor testing, and balance assessment. 1 The National

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Jeremy A. Patterson, Ryan Z. Amick, Priyanka D. Pandya, Nils Hakansson and Michael J. Jorgensen

Context:

The most widely used method for postural balance assessment relies on the subjective observations of a test administrator. Accelerometry has been shown to provide a valid and reliable method for assessment of balance, and recent advances in microelectromechanical systems have made the technology available in mobile electronic devices.

Objective:

To compare a mobile technology application with a commonly used subjective balance assessment.

Setting:

Biomechanics laboratory.

Participants:

Twenty-one nonathlete college-aged individuals (7 men, 14 women; mean age 23 ± 3 years) volunteered to participate. Subjects were excluded if they reported any preexisting condition that might affect postural balance.

Results:

A strong inverse correlation was found between the scores for the two balance assessment methods (r = -.767, p < .01).

Conclusions:

Advances in technology have provided an attractive means to objectively quantify postural balance with off-the-shelf mobile consumer electronic devices.

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Kevin M. Guskiewicz and Samuel R. Walton

.P. ( 2019 ). Functional balance assessment in recreational college-aged individuals with a concussion history . Journal of Science and Medicine in Sport, 22 ( 5 ), 503 – 508 . doi:10.1016/j.jsams.2018.10.012 10.1016/j.jsams.2018.10.012 Mannix , R. , Meehan , W.P. , & Pascual-Leone , A. ( 2016

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Tzu Chuan Yen, Nima Toosizadeh, Carol Howe, Michael Dohm, Jane Mohler and Bijan Najafi

Balance assessments could render useful objective performance measures to evaluate the efficacy of low back surgeries, yet these assessments have not been collectively examined to determine longitudinal sensitivity across surgical interventions. The purpose of this review was to determine sensitivity of balance measurements for disparate spinal disorders after surgical intervention. We searched PubMed, Embase, Scopus, the Cochrane Library, Web of Science, and CINAHL. Articles were selected based on: (1) sample consisted of low back disorder individuals and (2) balance measurements were obtained both pre- and postsurgery. Most of the articles addressed 2 specific low back disorders: (1) adolescent idiopathic scoliosis/spinal fusion and (2) disc herniation/decompression surgery. For scoliosis patients, body sway increased (14–97%) immediately following surgery but gradually reduced (1–33%) approaching the 1-year post spinal fusion assessment. For patients with disc herniation, sway range, sway velocity, sway area, and sway variability all decreased (19–42%) immediately postsurgery. Balance assessments for adolescents with idiopathic scoliosis who underwent surgical intervention should be performed with visual occlusion, focus on time domain parameters, and evaluated with longer follow-up times. Patients with disc herniation who underwent decompression surgery should have balance assessments with visual deprivation, test conditions specifically addressing hip strategy, and correlation with pain.