Evaluation of Nintendo Wii balance board as a tool for measuring postural stability after sport-related concussion

J Athl Train. 2017 Mar;


Merchant-Borna, K., Jones, C. M., Janigro, M., Wasserman, E. B., Clark, R. A. and Bazarian, J. J..


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CONTEXT: 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. DESIGN: Cohort study. SETTING: Athletic training room and collegiate sports arena. PATIENTS OR OTHER PARTICIPANTS: 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. MAIN OUTCOME MEASURE(S): 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. KEYWORDS: athletes; balance; mild traumatic brain injury; neurocognitive testing; recovery; return-to-play guidelines PMID: 28387551 PMCID: PMC5384822 [Available on 2018-03-01] DOI: 10.4085/1062-6050-52.1.13

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