Sports Injuries & Medicine (ISSN: 2576-9596)
Article / research article
"Use of The SWAY Balance Application for The Apple IPhone as an Objective Assessment for Sports-Related Concussion Balance Testing in High School and College Athletes"
Thomas M Mullin1*, Nicholas R Phillips2, Corina Martinez3, Claude T Moorman III4, Jeffrey R Bytomski5
1Orthopedic Sports Medicine FirstLight Health System Mora, Minnesota,USA
2Samaritan Athletic Medicine Corvallis, Oregon, USA
3Department of Physical and Occupational Therapy, Duke
University Medical Center Durham, North Carolina, USA
4Sports Medicine Section Department of Orthopedic
Surgery, Duke University Medical Center Durham, NC, USA
5Department of Community and Family Medicine, Duke University Medical Center Durham, North Carolina, USA
*Corresponding author: Thomas M Mullin, Orthopedic Sports Medicine First Light Health System Mora, Minnesota, USA. Tel: +13206791313; Email: TMMullin@gmail.com
Received Date: 25 July, 2017; Accepted Date: 27 October, 2017; Published Date: 06 November, 2017
1. Abstract
1.1. Objective: Balance assessment is an important component of concussion assessment. We compared an objective measure of balance using the SWAY Balance application for the Apple iPhone to the balance error scoring system (BESS) in non-concussed high school and collegiate athletes.
1.2. Design: Cross-sectional study.
1.3. Setting: Division I University and High Schools.
1.4. Participants:17 male collegiate athletes, 52 male and female high school athletes.
1.5. Interventions: Baseline BESS and SWAY Balance tests were performed on non-concussed high school and collegiate athletes.
1.6. Main Outcome Measures: The relationship between the baseline BESS and SWAY Balance tests were compared using linear regression analyses.
1.7. Results: Across age and gender,there was an inverse relationship between overall SWAY and the global BESS score (r= –0.402, P<0.001), the BESS firm score (r= –0.34, P=0.004) and the BESS foam score (r= –0.27, P=0.024).For high school age subjects, there was an inverse relationship between the SWAY score and the global BESS score (r= −0.33, P=0.017) and for BESS Firm (r= −0.35, P=0.01). For the college age subjects (all were male), there was an inverse relationship between the SWAY score and the global BESS score (r= −0.52, P=0.032).
1.8. Conclusions: There is a significant inverse relationship between BESS testing and SWAY balance testing in non-concussed high school and collegiate athletes. Use of a smart phone with software utilizing the accelerometer may one day provide an objective tool for the assessment of balance in sport-related concussion.
2. Keywords: Balance error scoring system;College athlete;
Concussion;High school athlete; SWAY balance;Traumatic brain injury
Figure
1: SWAY Balance
test positionsa. aEyes are closed for each trial.
Each position held for 10-seconds. iPhone is pressed against the sternum with
both hands. A tone indicates the end of each 10-second trial.
|
High school |
College |
Overall |
Overall |
||||||
|
Male (n=24) |
Female (n=28) |
Male (n=17) |
Female (n=0) |
Male (n=41) |
Female (n=28) |
HS (n=52) |
College (n=17) |
OVERALL (N=69) |
|
|
SWAY Score |
80.0±14.5 |
80.2±14.7 |
75.1±18.1 |
|
77.9±16.1 |
80.25±14.7 |
80.1±14.5 |
75.1±18.1 |
78.9±15.5 |
|
Bess Score |
15.0±6.4 |
14.5±5.4 |
7.8±1.9 |
15.4±6.9 |
14.5±5.4 |
14.7±5.9 |
16.0±7.8 |
15±6.4 |
|
|
Bess Firm |
4.3±3.6 |
3.4±2.9 |
2.9±0.7 |
4.2±3.3 |
3.4±2.9 |
3.8±3.2 |
4.0±2.9 |
3.8±3.1 |
|
|
Bess Foam |
3.8±0.8 |
11.1±3.3 |
10.8±3.0 |
10.8±3.5 |
11.1±3.3 |
10.9±3.5 |
10.8±3.0 |
10.9±3.4 |
|
Table 2: Means and standard deviations of errors by test scores.
The results of the linear regression analyses are summarized in Table 3. There was a significant negative correlation between overall SWAY and the global BESS score (r=-0.402, P<0.001), the BESS firm score (r=-0.34, P=0.004) and the BESS Foam score (r=-0.27, P=0.024).
|
BESS scores |
r= |
P= |
Y-intercept |
slope |
s.e.e |
|
Overall |
–0.40 |
<0.001 |
28.06 |
–0.16 |
5.86 |
|
Firm |
–0.34 |
0.004 |
9.27 |
–0.07 |
2.97 |
|
Foam |
–0.27 |
0.024 |
15.57 |
–0.06 |
3.27 |
Table 3: Summary of the overall (n=69) linear regression analysis of SWAY with the BESS scores
s.e.e = standard error of estimate.
Subgroup analyses (gender, competitive level) were also performed to evaluate the correlation between the SWAY score and the various BESS scores. For males (n=41), there was a significant negative correlation between the SWAY score and the global BESS score (r=-0.47, P=0.002) and the BESS Foam (r=-0.42, P=0.007), but not for BESS Firm (r=-0.28, P=0.7). For females (n=28, all were high school aged), there was no correlation between the SWAY score and the global BESS score (r=-0.25, P=0.203) or with BESS Foam (r=-0.04, P=0.85), but there was a significant correlation with BESS Firm (r=-0.43, P=0.023).
For the high school subjects (n=52), there was a significant correlation between the SWAY score and the global BESS score (r= 0.33, P=0.017) and for BESS Firm (r= 0.35, P=0.01), but not with the BESS Foam (r=0.23, P=0.11).
For the college age subjects (n=17, all were male) there was a significant correlation between the SWAY score and the global BESS score (r= 0.52, P=0.032), but not for BESS Firm (r= 0.32, P=0.21) or with BESS Foam (r=0.33, P=0.08).
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