The Functional Assessment of Balance in Concussion (FAB-C) Battery

• Author / Creator

  El Manaseer, Thaer

• Background: Current evidence suggests that athletes may be susceptible to subsequent injury after returning to play following a sport-related concussion (SRC). It is hypothesized that this increased risk may be due in part to residual postural control deficits that are not detectable with common clinical measures of postural control.
  Objective: To develop and perform a preliminary evaluation of a new clinical postural control battery to inform return-to-play decisions following SRC called the Functional Assessment of Balance in Concussion (FAB-C).
  Methods: A stepwise process was used to develop the FAB-C. Initially, components of postural control that could potentially be impacted by an SRC were identified through a systematic review and theoretical conceptualizations of postural control (studies one and two). Next, the FAB-C was compiled by including existing clinical tests that assessed potentially impacted components of postural control. New clinical tests were developed when none existed. The agreement (i.e., intraclass correlation coefficient or Kappa coefficients and 95%CI), and precision (i.e., standard error of measurement and minimal detectable change at 95% confidence level) of the individual clinical tests that comprise the FAB-C were then assess in a sample of uninjured active participants (studies three and four). Finally, the feasibility (i.e., battery completion, FAB-C components correlation, adverse events, cost and administration time) and construct validity [i.e., differences (mean and standard deviation, median and range or proportion and 95% CI) in FAB-C outcomes between uninjured participants and participants who had recently returned to play following an SRC) of the FAB-C were examined (study five).
  Results: A SRC can impact postural control by dysregulating sensory integration, control of dynamics (i.e., increased medial-lateral center-of-mass displacement and decreased gait velocity), and movement strategies (i.e., reaction time). Deficits in these components can only be thoroughly assessed under single-task, dual-task, and sport-specific testing paradigms. Three clinical tests (Balance Error Scoring System, Tandem Gait Test, and Clinical Reaction Time) assessed under single- and dual-task conditions, and a fourth fit-for-purpose Sport-Related Postural Control Test were included in the FAB-C. Depending on the clinical test of interest, ICC estimates ranged from 0.24 to 0.99, and kappa coefficients varied between 0.03 and 0.90. ICC estimates for most of the single-task tests, all dual-task tests, and the Sport-Related Postural Control Test were ≥0.7. The Balance Error Scoring System, Tandem Gait Test, and Clinical Reaction Time demonstrated higher precision under the dual-task testing condition compared to the single-task task testing condition. With respect to feasibility, 100% of uninjured participants and 86% of participants who had recently returned to play following an SRC were able to complete the FAB-C. Between component correlation coefficients were <0.7. No adverse effects were reported. FAB-C cost was less than $100CAD with a median administration time of 49 (44-60) minutes. A greater percentage of uninjured participants passed individual FAB-C components (range 52%-82%) compared to participants who had recently returned to play following an SRC (range 17-66%).
  Conclusion: The FAB-C is a novel clinical assessment tool that aims to target different components of postural control that may be affected following SRC. Although promising, the FAB-C requires further evaluation before widespread use in clinical settings. FAB-C may provide clinicians with a practical framework around which to diagnose and treat postural control deficits after SRC.

• Subjects / Keywords

  • Postural control
  • Sport
  • Concussion

• Graduation date

  Fall 2020

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/r3-v242-m427

• License

  Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.