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Title:Concussions in wheelchair users: quantifying seated postural control
Author(s):Wessels, Karla
Director of Research:Sosnoff, Jacob J.
Doctoral Committee Chair(s):Sosnoff, Jacob J.
Doctoral Committee Member(s):Broglio, Steven P.; Motl, Robert W.; Rice, Ian M.
Department / Program:Kinesiology & Community Health
Degree Granting Institution:University of Illinois at Urbana-Champaign
wheelchair user
wheelchair athletics
mild traumatic brain injury
seated postural control
Abstract:Introduction Approximately 1.6-3.8 million traumatic brain injuries (TBI) occur each year in sport and recreational activity in the United States (Langlois, Rutland-Brown, & Wald, 2006). With concussions occurring in all aspects of sport, it is imperative for proper assessment and management to take place. The National Athletic Trainers’ Association calls for evaluation of symptoms, cognition, and balance when a suspected concussion occurs (Guskiewicz et. al., 2004). Although current symptom scales and cognition measures can be utilized in wheelchair athletes all balance measures (e.g. the Balance Error Scoring System) are completed while standing and consequently not applicable to wheelchair athletes, therefore leaving a void in quantifying balance in this population. To properly detect concussions in this population, a seated postural control test was developed. It was the aim of this investigation to determine if this test was valid, reliable and sensitive to concussions in wheelchair athletes. . Methods Participants Wheelchair athletes who were part of a collegiate wheelchair athletics program were recruited for participation. Participants were included if they were able to sit upright without support, had no recent surgeries, and had not reported a concussion within the past month. Procedures A seated postural control test, the Wheelchair Error Scoring System (WESS), was developed to quantify balance in wheelchair users. In order to determine if the WESS was appropriate, validity, reliability, and sensitivity had to be shown. To determine the validity of the WESS, seated postural control was indexed with a force platform. WESS scores were correlated to 95% confidence ellipse area, a force platform measure, to examine if the WESS measured postural control. Additionally, a dual-task condition was utilized to test cognitive and motor function simultaneously as sport is performed in this manner. The WESS was completed twice, 45 days apart, to establish if there were any differences in testing sessions to determine test-retest reliability. Each participants’ testing sessions were videotaped and examined by 4 certified athletic trainers. Scores were compared between the 4 athletic trainers to determine the intertester reliability of the WESS. Additionally, each athletic trainer watched and scored the videos 7 days from the original viewing to determine intratester reliability of the WESS. Recent investigations have examined the use of dual-task testing to increase sensitivity of testing batteries to detecting concussions. This had been tested due to sport requiring both cognition and balance to occur simultaneously. For this reason, a cognitive task was added to the WESS to examine this dual-task paradigm. Three additional trials were added to the WESS to complete the Paced Auditory Serial Addition Task in each testing position. WESS scores and 95% confidence ellipse area were examined to discover the effect of adding a cognitive task to the WESS. Five cases of concussion were examined to determine if the WESS is sensitive to changes in postural control after a concussion. Participants were baseline tested on a graded symptom scale, the standardized assessment of concussion, and the WESS. Post-injury scores were compared to baseline values or a control in one case to determine if the WESS detected changes in postural control after concussion. Results Significant bivariate correlations were found between WESS error scores in specific positions and 95% confidence ellipse areas, showing validity of the WESS in measuring postural control. The WESS was found to have test-retest reliability as the scores between the 2 testing dates were not significantly different. The WESS also showed intertester and intratester reliability, thus making it usable between different administrators and across time. The addition of the cognitive task, the PASAT, improved balance performance in the wheelie position. In each of the case studies, WESS scores showed a decrease in postural control after concussion indicated by changes in WESS scores compared to baseline values. Discussion The WESS was developed to meet the void in balance measurement for concussion assessment in wheelchair athletes. The standard sideline balance assessment tool for concussions in ambulatory athletes is the BESS in which the WESSS was modeled after. Both tests are quick, inexpensive, and easy to utilize on the sidelines of athletic events. Given the WESS is comparable and has similar testing instructions to the BESS, this allows clinicans already familiar with the BESS to easily implement the WESS in wheelchair sport and wheelchair users. The addition of the cognitive task, the PASAT, increased postural control during the wheelie position. In theory, this could be due to the participant’s focus being externally diverted to the cognitive task. This allows for less overcorrections to be made and for balance to occur as it nomally occurs, subconsciously. The WESS detected changes in postural control in each of the five cases of concussion in this investigation. With each case study showing increased WESS scores after concussive injury, this strongly suggests the WESS would be an appropriate test for quantifying seated postural control in wheelchair users during concussion assessment. Conclusion This investigation suggests the WESS is an appropriate test for quantifying seated postural control in wheelchair users. While a few documented concussions have shown the WESS is sensitive to detecting postural changes associated with concussion, further investigations are needed to examine this statistical relationship.
Issue Date:2014-01-16
Rights Information:Copyright 2013 Karla Wessels
Date Available in IDEALS:2014-01-16
Date Deposited:2013-12

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