Participants did not have concomitant extremity injuries at baseline or any follow-up assessments. We documented a history of TBI more than 2 weeks before baseline. Additional exclusion criteria were use of drugs or alcohol on the day of consent or at baseline, pregnancy, or a history of traumatic brain injury (TBI) within 2 weeks before the baseline measures. We excluded individuals who were unable to speak and read English or Spanish because the ImPACT is available in only these languages. Both men and women aged 18 years and older were invited to participate, and we placed no restrictions on race or ethnicity. Over this period, a total of 403 National Collegiate Athletic Association Division I and III student-athletes participating in contact sports (ie, basketball, football, ice hockey, lacrosse, and soccer) were enrolled before the beginning of each respective sport season. We performed a prospective study comparing the WBB with the BESS and ImPACT at 2 universities in Rochester, New York, from 2010 to 2013. Last, we assessed temporal trends in balance and neurocognition using participant-specific (ie, paired) data. We also hypothesized that both balance measures would be correlated with ImPACT but that the magnitude of these correlations would be lower because they measure unique, yet related, constructs of interest. We hypothesized that the BESS and WBB would demonstrate changes from baseline to the follow-up time points and positive correlations. We compared metrics from the WBB with those from the BESS and symptom reporting and neurocognitive function as measured by the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT ImPACT Applications, Inc, Pittsburgh, PA). Therefore, the purpose of our study was to evaluate WBB performance for assessing temporal changes in postural stability among concussed student-athletes by comparing balance metrics at 3 time points: preinjury, 3 days postconcussion, and 7 days postconcussion.
Whereas a biological connection between cognition and postural stability may exist, perhaps via the cerebellum, 18 this aim was motivated more by the practical need to determine whether both tests are necessary to track concussion recovery. Furthermore, given that cognitive testing is widely used in concussion management, we aimed to determine the extent to which the WBB measures provide additional information about concussion recovery that is not captured by cognitive testing. 11, 14 However, few researchers have quantified postconcussion balance symptoms using a WBB, 15– 17 and no studies have included prospective data, with preinjury and postconcussion balance assessments. 13 Thus, the WBB may be a useful tool for assessing postconcussion balance impairments, given that force platforms have previously shown their utility. 12 In addition, when compared with scientific-grade force plates, the WBB has demonstrated better validity and test-retest reliability than the BESS. The WBB has also demonstrated good to excellent test-retest reliability (intraclass correlation coefficient = 0.66–0.94) and excellent concurrent validity (intraclass correlation coefficient = 0.77–0.89) compared with a laboratory-grade force platform, 11 with nearly identical COP traces reported. 11 Whereas the BESS relies on discrete error counting by the test administrator, the WBB tracks COP using internal components similar to laboratory-grade force platforms.
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The Nintendo Wii Balance Board (WBB Nintendo of America Inc, Redmond, WA) is a portable and relatively inexpensive force platform that, although originally designed as part of a video-game console system, can be used as an indirect method to assess postural center of pressure (COP).
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