Abstract
Introduction: Standing balance assessments are used to help identify sports-related concussions and guide return-to-play decisions. However, field assessments of standing balance using the gold standard Balance Error Scoring System (BESS) are less accurate and reliable than laboratory based techniques. Our goal was to develop and validate a simple, reliable and affordable objective balance assessment tool for field use. Methods: Thirty healthy subjects performed the BESS test in a controlled laboratory setting wearing seven inertial measurement units (IMUs) that measured linear accelerations and angular velocities from seven landmarks on their body. All trials were filmed and each video was scored by four expert BESS raters. IMU data and mean expert BESS scores were used to develop an algorithm to compute objective BESS (oBESS) scores solely from IMU data. Inter-rater reliability and comparisons between the raters and algorithm-generated oBESS scores were assessed using intra-class correlations (ICC3,1). Results: Expert raters were consistent in scoring (ICC3,1 = 0.91), and oBESS scores computed using data from only one IMU placed at the forehead accurately fit mean expert BESS scores (ICC3,1 = 0.92) and predicted individual BESS scores (ICC3,1 = 0.90). Conclusion: The oBESS can reliably predict total BESS scores in normal subjects. With further validation, the oBESS could improve the clinical validity of on-field balance assessments for identifying sport-related concussions.
