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

Abstract

PURPOSE\nEvaluate the discriminatory ability of two clinical measures and one device-based measure of gait and balance for concussed youth.\n\n\nMETHODS\nWe 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.\n\n\nRESULTS\nIdeal 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).\n\n\nCONCLUSIONS\nA 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.