Center for Injury Research and Prevention

Clinical and Device-based Metrics of Gait and Balance in Diagnosing Youth Concussion

TitleClinical and Device-based Metrics of Gait and Balance in Diagnosing Youth Concussion
Publication TypeJournal Article
Year of Publication2019
AuthorsCorwin DJ, McDonald CC, Arbogast KB, Mohammed FN, Metzger K, Pfeiffer MR, Patton DA, Huber CM, Margulies SS, Grady MF, Master CL
JournalMed Sci Sports Exerc
Date Published2019 Sep 12
Type of ArticleJournal

PURPOSE: Evaluate the discriminatory ability of two clinical measures and one device-based measure of gait and balance for concussed youth.

METHODS: We enrolled 81 cases and 90 controls age 14-18 years old from August 2017-June 2018. Controls were recruited from a suburban high school, and cases were recruited from the concussion program of an academic pediatric tertiary care center. Tests included two clinical measures: (1) Complex tandem gait, scored as sway/errors walking forward and backward eyes open (EO) and closed (EC); (2) Modified balance error scoring system (mBESS), scored as total number of errors on three standing tasks; and one device-based measure: (3) modified clinical test of sensory interaction and balance (mCTSIB) using the Biodex Biosway Balance System, scored as a sway index. Sensitivity, specificity, ideal cut-point, and area under the receiver operating characteristic curve (AUC) were calculated for all test components.

RESULTS: Ideal cut-point for total number of sway/errors for tandem gait=5, sensitivity 41%, specificity 90%. Ideal cut-point for total mBESS errors=4, sensitivity 55%, specificity 75%. Ideal cut-point for mCTSIB=1.37, sensitivity 37%, specificity 88%. Among each test, some individual components outperformed overall composites, in particular tandem gait (specificity forward eyes open = 99%, sensitivity backward eyes closed = 81%). Among the 40 cases and 65 controls with all 3 assessments, AUC (95% CI) for tandem gait=0.63 (0.52,0.75), mBESS=0.70 (0.60,0.81), and mCTSIB=0.54 (0.42,0.66).

CONCLUSIONS: A device-based measure of balance did not produce better discriminatory ability than two clinical assessments. Complex tandem gait has the additional benefit of being an easy-to-perform and graded test with highly sensitive and specific individual components.

Alternate JournalMed Sci Sports Exerc
PubMed ID31524833