Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH.
Cleveland Clinic Concussion Center, Cleveland Clinic, Cleveland, OH.
Med Sci Sports Exerc. 2018 Oct;50(10):1998-2006. doi: 10.1249/MSS.0000000000001660.
Despite the widespread utilization of the Balance Error Scoring System (BESS) in the evaluation of concussion, it has been criticized for its error-based scoring that is susceptible to floor and ceiling effects and substantial inter-rater variability. A biomechanical outcome, Cleveland Clinic Postural Stability Index (CC-PSI), has been developed as an alternative to subjective BESS scoring. The CC-PSI uses inertial sensor data within a mobile device to provide an objective measure of postural sway during the BESS. This project aimed to determine the effect of age and sex on the CC-PSI and report normative values for healthy, active children, adolescents, and young adults.
A cross-sectional sample of 6762 student-athletes completed BESS testing. Participants were stratified according to three age groups for each sex. The groups included the following: youth (age, 5-13 yr), males (n = 360), females (n = 246); high school (age, 14-18 yr), males (n = 3743), females (n = 1673); and college (age, 19-23 yr), males (n = 497), females (n = 243). Percentile rankings were determined for each participant to characterize movement of COM in the medial-lateral, anterior-posterior, and trunk rotation directions relative to the entire cohort during the BESS stances.
Overall, postural stability was worse in youth compared with high school and collegiate athletes. Specifically, the CC-PSI was significantly worse in youth male athletes compared with high school and collegiate male athletes (P < 0.001). Females exhibited significantly better scores compared with males in youth and high school cohorts (P < 0.01).
The CC-PSI provides a quantitative, objective measure of postural stability, overcoming the limitations associated with conventional BESS scoring. Optimal concussion management should use objective age- and sex-specific values in the evaluation of postural stability. The normative values of the CC-PSI may be used in the absence of a baseline BESS evaluation to aid clinical decision making.
尽管平衡错误评分系统（BESS）在评估脑震荡方面得到了广泛应用，但它因其基于错误的评分而受到批评，这种评分容易受到地板效应和天花板效应以及大量的评分者间变异性的影响。一种生物力学结果，克利夫兰诊所姿势稳定性指数（CC-PSI），已被开发作为主观 BESS 评分的替代方法。CC-PSI 使用移动设备内的惯性传感器数据来提供 BESS 期间姿势摆动的客观测量。本项目旨在确定年龄和性别对 CC-PSI 的影响，并报告健康、活跃的儿童、青少年和年轻人的正常参考值。
一项包含 6762 名运动员的横断面样本完成了 BESS 测试。参与者根据每个性别的三个年龄组进行分层。这些组包括以下内容：青少年（年龄 5-13 岁），男性（n = 360），女性（n = 246）；高中生（年龄 14-18 岁），男性（n = 3743），女性（n = 1673）；大学生（年龄 19-23 岁），男性（n = 497），女性（n = 243）。为每个参与者确定百分位排名，以描述在 BESS 站位期间 COM 在中-侧、前-后和躯干旋转方向相对于整个队列的运动。
总体而言，青少年的姿势稳定性比高中生和大学生运动员差。具体来说，与高中和大学生男性运动员相比，青年男性运动员的 CC-PSI 明显更差（P < 0.001）。与青年和高中生队列中的男性相比，女性的得分明显更好（P < 0.01）。
CC-PSI 提供了一种定量的、客观的姿势稳定性测量方法，克服了传统 BESS 评分相关的局限性。最佳的脑震荡管理应该在评估姿势稳定性时使用针对年龄和性别的具体的客观值。CC-PSI 的正常参考值可在缺乏基线 BESS 评估的情况下使用，以帮助临床决策。
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