April 18, 2015 Ithaca College Ithaca, NY Upstate Concussion
Center and Motion Analysis Laboratory at the Institute for Human
Performance, Upstate Medical University, Syracuse, NY Christopher
Neville, PhD, PT Director of Research Concussion Management Program
Associate Professor Upstate Medical University Department of PT
Education, Orthopedic Surgery, and Physiology Brian Rieger, PhD
Director Concussion Management Program Claudine Ward, MD Medical
Director Concussion Management Program 1
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Concussion ED visits for concussion increased 62% between 2001
and 2009 (CDC 2011) 1.6 and 3.8 million sports-related concussions
each year in the US 49+ states have laws directing response to
suspected concussion 2
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However. Current diagnosis and management of concussion is
largely driven by self-reported symptoms and expert opinion 3
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Crucial Point The appropriate management of sport-related
concussion, specifically determining better objective determinants
is critical and constantly evolving. 4
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Current Trends Insufficient evidence for age or level of
competition on risk Sex: Greater Males in sports but risk and sex
varies by sport. Risk greater for females in soccer or basketball
Sport: American football and Australian rugby greater risk than
other sports BMI> 27kg/m 2 and training time less than 3 hrs
weekly Helmets have a protective effect (no superior helmet).
Insufficient data on soccer headgear. Giza, 2013 5
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Current Tools Post-concussive symptom scale or graded symptom
checklist Standardized Assessment of Concussion (SAC) (sensitivity
80-94%, specificity 76-91%) Neuropsychological Testing:
(sensitivity 71-88%) Balance Error Scoring System (BESS):
(sensitivity 34- 64%, specificity 91%) Combination of self-report,
cognitive, and balance 89%-96% (Broglio, 2007) 7
Slide 8
Dual Task- Cognition and Balance Together Functional in nature
If not given specific instructions about which task to prioritize,
then the brain must decide to unconsciously prioritize Competition
for attention Register-Mihalik, 2013 8
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Balance Central Nervous System Manages and Interprets Signals
from the Vestibular, Visual, and Somatosensory Systems 9
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Balance using IMU 10
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Cognition 11
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Stroop Color Word Test (T1) 12
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Stroop Test (T2) 13
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Stroop Test (T3) 14
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Measuring Postural Stability with an Inertial Sensor:
Concurrent Validity and Sensitivity Christopher Neville, PT, PhD,
Brian Rieger, PhD, Caleb Ludlow, DPT Student 15
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Methods 16 IMU Captures Acceleration at 250Hz Forceplate
Captures movement of the COP at 1000Hz Kinematic Movement of the
L4L5 Segment at 120Hz
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Balance Test Conditions 1.TLEO- Standing feet together, hands
on hips, with eyes open 2.TLEC- Standing feet together, hands on
hips, with eyes closed 3.TSEO- Tandem stance (dominant foot
forward), hands on hips, with eyes open 4.TSEC- Tandem stance
(dominant foot forward), hands on hips, with eyes closed 5.TLEOfp-
Standing feet together, hands on hips, with eyes open, on a
foam-pad 6.TLECfp- Standing feet together, hands on hips, with eyes
closed, on a foam-pad 7.TSEOfp- Tandem stance (dominant foot
forward), hands on hips, with eyes open, on a foam-pad 8.TSECfp-
Tandem stance (dominant foot forward), hands on hips, with eyes
open, on a foam-pad 17
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Validation Initial Validation (Bivariate Correlations to FP =
0.79; to Kinematics= 0.89) 6
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Sensitivity 9 Firm SurfaceFoam Surface Two LegsTandem StanceTwo
LegsTandem Stance Eyes Open Eyes Closed
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Root Mean Squared Figure 2. The magnitude of dispersion (RMS)
for the Inertial Sensor across 8 balance tests 20
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Centroid Frequency Centroid frequency of the Inertial Sensor
acceleration across the 8 balance tests 21
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Case Based Application: Utilizing the Mi Sensor, we were able
to collect balance scores for baseline testing for a college
football team. We collected the same measures of balance collected
in our validation study with the addition of two cognitive tasks
performed in tandem stance while recording the balance during those
tasks. We then were able to compare these scores to Balance Error
Scoring System (BESS) score testing which is a part of the mandated
balance testing for New York collegiate football players. Over the
course of the season one of the members on the football team
unfortunately sustained a concussion. We however, were able to
track his progress as he recovered from his concussion. The subject
was an 18 year old African American male who is a dual sport
athlete. He reported no history of concussions, no prior orthopedic
injuries, and that he was not currently on any kind of medication.
22
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Bess Error Scoring System Table 2. BESS Scores for this
recently concussed individual 23
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Symptoms 24
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Mi balance Injury Date: 10/21/2014 25
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Progress after concussion Figure 4. Tracking balance scores
across time and condition 26
Slide 27
Reliability and Effects of Intentional Effort Manipulation on
Balance Tested under Dual-Task Christopher Neville, PT, PhD, Ryan
Charboneau, BA, Grace McIntosh, DPT Student 27
Malingering Case Scenario Automobile accidents are a fact of
life and can happen to anyone. We are interested in your opinion of
how people would fake or exaggerate symptoms after an automobile
accident. We would like you to imagine that you were driving to the
store at night about six months ago when another car turned into
you. You were knocked out for a while and when you woke up you were
in the hospital. Imagine that you had to stay in the hospital for a
week or two to recover. Try to imagine that you had this accident
about six months ago and you have decided to fake or exaggerate
symptoms to get more insurance money. If you can make your symptoms
seem real, you will make a lot of money. If it seems you are
faking, you probably wont get much. 30
