“The Clinical Advantage” Balance Assessment For Concussion .
“The Clinical Advantage” Balance Assessment forConcussion ManagementConsistent with NCAA and NATA Guidelines“At a minimum, the baseline assessment shouldconsist of the use of a symptoms checklist andstandardized cognitive and balance assessment.” 1– 2013 -14 NCAA Sports Medicine Handbook“Formal cognitive and postural-stability testingis recommended to assist in determining injuryseverity and readiness to return to play (RTP).” 2– NATA Position Statement on Sport-Related ConcussionLeader in objective Balance Assessment for Concussion Management
Balance Assessment for Concussion ManagementAs research continues to demonstrate the potential long-term impact of concussion in sports,the importance of objective assessment in the management of concussion has become vital.Biodex Balance Assessment is used by high schools, college and professional sports teams asan integral part of their concussion management programs. Programs that bring togetherbest practices of cognitive testing and a graded symptoms checklist in combination withobjective data provided by Biodex technology.Biodex Balance Assessment for Concussion Management adds the objective neurophysicalcomponent that gives clinicians the ability to quantify the elements of balance before andafter an injury occurs. Using the Clinical Test of Sensory Integration of Balance (CTSIB),Biodex Balance devices can independently test all three sensory feedback systems (visual,vestibular and somatosensory).The objective data generated by either the Balance System SD or the portable BioSway provides a baseline against which postinjury performance can be compared. In addition,test results from a healthy population of student-athletes are stored on the system for generalnormative data comparison.Detailed test and progress reports track recovery and provide the medical team withquantitative data to help with the return-to-play decision.““Objective balance assessment is recognized as partof ‘best practice’ for concussion assessmentand management.” 3– International Symposium on Concussion, Consensus StatementAll test results and training sessions canbe stored and printed. Comparison tonormative data helps communicate need,progress and outcome.Baseline Testing for Concussion ManagementPreseason tests are performed on athletes to establish an individual athlete’spreinjury performance levels.The proper management of concussion should include baseline ofthe following: Balance Assessment Cognitive Assessment Graded Symptoms ChecklistThe NCAA and NATA have identified these as the threeessential assessment pillars.When combined, these baseline tests can provide a comparison point forcognitive function and objectively quantified balance for athletes. In the case of a suspected concussion, it is thesebaseline tests to which postinjury assessments are compared, providing the objective data necessary to track recovery.2
Objective Documentationto normative data of a healthy student-athlete populationstored on the system. Reports can be forwarded to doctors,coaches, parents, or athletes to provide quantitative data thatsubstantiates return-to-play decisions.Data from objective measures of postural stability is a crucialcomponent in determining severity of injury and postinjuryrecovery. Featuring extensive comparative reporting capabilities,both the Biodex Balance System SD and the portable BioSwaycompare preseason baseline and postinjury balance assessmentDemonstrate need, progress and outcomes of balance testsTest results of a preinjury baseline assessment usingthe Balance System SD’s integrated ClinicalTest of Sensory Integration of Balance (CTSIB).Postinjury test results show increased postural sway withgreater variance from normative data.The objective measure from posturalstability/balance testing provides clinicianswith an important additional piece of theconcussion puzzle and assists them indetermining readiness for return-to-play.4Progress report shows baseline data, initial postinjuryassessment and change over time, providing crucial datafor postinjury return-to-play decisions.Arrows graphically represent increased postural swayin relation to normative mean postinjury.Put athletes back in play with confidence.Based on Science. Backed by Studies.Premier multi-joint system for objective testing. Isolate muscle-performance data for:Knee Hamstring Shoulder Hip Ankle Wrist Elbow Forearm Lumbarwww.biodex.com/s43
Measuring BalanceResearch shows that athletes often demonstrate decreasedstability post-concussion.5 The postural stability deficitcan best be explained by a sensory interaction problemthat prevents concussed athletes from accurately using andexchanging sensory information from the visual, vestibular,and somatosensory systems.5 Difficulty in postural swaycontrol can persist even after signs and symptoms ofconcussion subside.6 More simply stated, the athlete mayappear asymptomatic and even pass a computerized cognitivetest. However, the lingering effects of a balance disturbancefrom head trauma would otherwise go undetected without abalance assessment.In fact, research has shown that balance assessment, incombination with cognitive testing and a graded symptomschecklist, increases overall sensitivity to greater than 90%.7Concussion should be approached through a multifaceted assessment, and each componentof the assessment process should focus on distinct aspects of an athlete’s function.7““A decreased ability to maintain balance is one of the hallmark signs of concussion.” 8– Broglio SP, Guskiewicz KM,Concussion in Sport: The Sideline Assessment, Sports Health.Clinical Test of Sensory Integration of Balance (CTSIB)The Biodex default four condition CTSIB test quantifies postural sway under the following sensory conditions:Eyes Open,Firm SurfaceProvides a baseline. Information available by all three sensory inputs: Somatosensory, visualand vestibular.Eyes Closed,Firm SurfaceVisual not available; somatosensory and vestibular are available. If the athlete performs poorly,the vestibular or somatosensory may be compromised, with an increase in visual dependency.Eyes Open,Unstable SurfaceSomatosensory compromised; visual and vestibular are available. If the athlete performedpoorly, visual or vestibular may be compromised, with an increase in somatosensorydependency.Eyes Closed,Unstable SurfaceVisual not available; somatosensory compromised, only vestibular available. Concussedathletes are most likely to present problems in this condition. If performance is reducedbeyond normal or baseline readings, the vestibular system may be disrupted.The Clinical Test of Sensory Integration of Balance (CTSIB)is the accepted standardized assessment that identifies andtracks disturbances in balance and the three associatedsensory systems.Combined with today’s technological advances, the CTSIBprovides the sports medicine community with a more accurateand objective assessment tool for evaluating postural stability.4
Testing BalanceBiodex Balance Assessment is conducted using eitherthe versatile Balance System SD or portable BioSway.The Balance System SD is a sophisticated measuring andtraining device for static and dynamic balance testing andtraining. The BioSway is a portable balance device, with astatic-only platform.The CTSIB can be performed on either Biodex balancedevice, designed to systematically test the sensory selectionprocess by compromising available somatosensory, visualand vestibular senses while measuring an athlete’s ability tominimize postural sway.The Sway Index is an objective quantification of posturalsway and is measured during the CTSIB. The test provides ageneralized assessment of how well an athlete can integratevarious senses with respect to balance, and compensate whenone or more of those senses are compromised. A higher SwayIndex indicates a reduction in the athlete’s ability to remainsteady during the test.The Balance System SD and BioSway include a preconfiguredBioSway(Static)four condition CTSIB test and a modified version of theBalance Error Scoring System (BESS) test of posturalstability, both popular for concussion managment.9 Both tests can easily be customized toinclude up to six conditions. In addition, the software features the ability to create customsensory integration balance tests, allowing for the creation of entirely new protocols.Balance System SD(Static and Dynamic)Peer PerspectiveBalance assessment gets thumbs up from High School Athletic DirectorScott Stein is the athletic director and head football coach at SunValley High School. “The baseline testing that we’ve done in thelast couple of years has been excellent for us as athletic directors andcoaches in understanding our kids. The new information that we’regetting – from concussion screening to the equipment that they’rewearing – allows us to get more involved in protecting the lives ofthe student-athletes that are playing sports for us,” said Stein.““The Balance testingfor concussion is abig part of understandingwhen a student-athlete cancome back to play safely.”“The Balance testing for concussion is a big part of understanding when a student-athlete can come back to play safely. It’scome all the way down from professional sports and is now at the high school level. In Union County, balance testing isgoing to be a big part of keeping our kids safe and healthy.”Scott Stein, Athletic DirectorSun Valley High School, NC5
Marketing Support MaterialsAvailable exclusively to our customers using Balance Assessment in support of a concussionmanagement program, Biodex provides an assortment of marketing materials to attractathletes, parents, community sports teams, school coaches and athletic directors, as wellas referring pediatricians. Materials can be customized to reflect your facility and used tobroadcast the role of Balance Assessment in the management of concussion.Materials include:Sample letters to coaches and athletic directors, pediatricians or referring physicians and tothe parents of local team athletes.Tri-fold brochure, customized with your facility contact information, to usein the waiting room, as a follow up to letters, or sent to anyone that wouldbenefit by learning about your program.Sample press release for local newspapers to help promote balanceassessment, position your facility as a premier center for concussionmanagement and to draw media attention.Clinical Brief, providing the physician with a technical understanding ofthe Clinical Test of Sensory Integration of Balance, the value of measuringpostural sway and the underlying objective technology.Clinical Voucher, customized with your facility contact information, to sendto partnering physicians directing athletes to your facility for baseline testing.Ads for local print publications designed to drive student-athletes to yourfacility for a baseline balance assessment and to position your facility as a leaderin the community.Concussion Posters to display in your own facility or with partneringphysicians, alerting patients to your Balance Assessment Program.Scroll Sign Graphic assists facilities to create signage that can be used atcommunity events, school functions and educational forums in order to generateinterest and build a relationship for future physical therapy requirements.Resource CenterTo learn more about balanceassessment for concussionmanagement, accessguidelines, tips andresearch, visit ourResource Center.www.biodex.com/resource/concussion6FACILITY LETTERHEADMARKETING SUPPORT – SAMPLE PRESS RELEASEFor Immediate Release:Concussion.When is it Safe for Sports Again?[Facility Name Here] has the answers through testing to keep kids healthy(Town, State)—(Month, Day, Year)—[Facility Name Here] now offers BiodexBalance Assessment as part of a Concussion Management Program. Balance testing is akey component of best practices for concussion management and is endorsed as such byauthorities treating this growing concern among school-aged children. Biodex BalanceAssessment, available at [office/facilities], is used by leading hospitals,rehabilitationFACILITYLETTERHEADcenters and national sports teams throughout the U.S.MARKETING SUPPORT – SAMPLE LETTER TO:LocalPhysicians / PediatriciansThe Centers for Disease Control (CDC) estimate up to 3 millionsports-relatedRemove theguesswork enrollyour patient in aconcussions occur annually in the U.S., with school-agedchildrenmaking up themajority of cases. Athletes returning to play prematurelyat a higher riskof injuryBiodexareConcussionManagementProgramand a second concussion. The rate of reoccurrence is just as concerning and can beDearmore damaging.parentsaddedassurance whenmanaginga child’sconcussion! In addition to a medical diagnosis,[Facility Name Here] would Givelike totake thisopportunityto enrollathletesin a Concussion[Facility Name Here] is excited to extend the resources of our new Concussion Management Program toManagement Program which includesa simple baseline test of balance, an important firstsupport and manage head injuries in conjunction with your office protocols.step in the event of an injury in the future. The test takes only minutes, yet in the event ofa concussion, provides acility Name Here] now offers a Biodex Concussion Management Program and we would like theevaluation and rehabilitation. Shoulda concussionoccurathletesretestedand testresultsopportunityto enroll yourpatientswith area simplebaselineof balance and cognitive assessment. Inare compared to the baseline toanageinjury,patientsare retested andcomparedto baseline as well as compared to age- andgender-specific normative data. All data is stored per athlete with the ability to generate HIPAAcompliant reporting.the risks can be great, including reoccurrence and possible lasting effects. Each concussion is different,Biodex Balance Assessment for Concussion Management, along with guidance provided byThe test takesminutesbut processwill provide[Facility Name Here] can dramaticallyaidonlyin thehealingand valuableprovideinformationpost-injuryin the event a patient sustains aconcussion.school baselineathletes engagedin contact sportsare isexperiencing concussions at an alarmingtesting to the benefit of the patient.UsingHighthe initialtest, a comparisonreportrate. TheCentersfor DiseaseControl (CDC)estimate toup school,to 3 million sports-related concussions arecreated for the patient’s physicianto helpdeterminethe readinessof returninghappening in the U.S. with school-aged children making up the majority of these cases. The rate ofsports and other activities. is inreoccurrence is just as concerning.the recovery process through the testing of balance and motor control while assessing anydizziness issues.When a concussion protocol is followed, kids usually recover within a week or two. Without a protocol,too is eachpatient’s aboutrecovery.HavingAbout [Facility Name Here]:so ty. and data-driven support is essential for thosedifficult return-to-play decisions.About Biodex Medical Systems, Inc.: Biodex has been providing customers withWeexcellenceask that wheninnovative products and servicefor consideringmore than a60Concussionyears withManagementinnovationsProgram for your patient athletes, youconsider [Facility Name Here]. We invite you to visit our facility and understand the benefits of thedesigned to solve clinical problems and improve lives. www.biodex.comprogram first hand. Please call to schedule an evaluation.M A RKETIN G SU G G E STION offer FREE voucher s fo r basel ine testing to the patients of localpediatr icians, al lowing them to distr ibute to thei r patients. It makes them look good, gives patientssomething tangible and valuable, bui lds an athlete base in you r p ractice.Sincerely,P.S. - The Biodex Concussion Management Program is used by local and professional sports teamsthroughout the U.S.Concussion Management P rogramMa rketing Support
Balance TechnologyBeyond AssessmentBalance System SDThe Balance System SD and BioSway are powerfulrehabilitation tools. Both devices not only provide abalance assessment program for concussion management,but also offer multiple rehabilitation training protocolsthat can be used across a broad scope of athleticpopulations for general orthopedic and neuromuscularrehabilitation and athletic conditioning.Features static and dynamic balance testing and training.The Balance System SD not only serves your concussionmanagement needs, but standardized athlete knee injuryscreening tests, plus six interactive training modesto provide valuable and effective proprioceptive andneuromuscular training.950-440 Balance System SD, 15.6″ Display,115 VACIncludes: Printer, printer stand, andCTSIB Indexed Pad.Export models available.Test/training modes include: CTSIB BESS Postural Stability Fall Risk Bilateral Comparison Limits of Stability Percent Weight Bearing Motor Control Weight Shift Random Control Maze ControlOptional950-306 Step Stool, Balance System SDBioSwayFor therapists in the clinic or on the go, the portableBioSway utilizes a static platform for balance assessmentfor concussion management. It features a lightweightinstrumented platform, intuitive navigation, 15.6″,touchscreen display, standardized testing, interactivetraining, plus a hard shell travel case.950-460 BioSway 15.6″ Display with TabletopStand and Case, 115/230 VAC 50/60 HzIncludes: Instrumented platform, CTSIBIndexed Pad, tabletop stand/wall mountbracket, AC adapter for 100/240 VACinput, and two blindfolds.Optional950-465 Adjustable Height Stand for 15.6″ Display950-464 HP Office Jet Printer(compact portable printer)950-467 HP InkJet Printer (full size color printer)950-466 Printer StandCTSIB Indexed Pad for the Balance System SD (left) and BioSway (right)provide consistent surface for unstable test conditions.DISCLAIMER: The information provided is not intended to be a substitute for professional medical advice but as a guideline to assessing athletes followinga concussion. Always seek the care of a physician or other qualified healthcare provider with any questions or concerns you may have about a medicalcondition. If there is any question/concern about the athlete’s status then recommend not returning to play.References1. 2011-12 NCAA Sports Medicine Handbook, National Collegiate Athletic Association, July 20112. Guskiewicz, KM, et al (2004). National Athletic Trainers’ Association Position Statement: Management of Sport-RelatedConcussion Journal of Athletic Training 2004;39(3):280–2973. McCrory P, Meeuwisse W, Johnston K, Dvorak J, Aubry M, Molloy M, et al. Consensus statement on concussion in sport the 3rdInternational Conference on concussion in sport, held in Zurich, November 2008. J Clin Neurosci. 2009;16:755–63.4. Guskiewicz KM. Balance assessment in the management of sports-related concussion. Clin Sports Med 30 (2011) 89-102.5. Guskiewicz, KM, et al, Postural Stability and Neuropsychological Deficits After Concussion in Collegiate Athletes (Journal ofAthletic Training 2001;36(3):263–2736. Valovich McLeod T, The Value of Various Assessment Techniques in Detecting the Effects of Concussion on Cognition,Symptoms, and Postural Control. Journal of Athletic Training 2009;44(6):663–6657. Broglio SP, Macciocchi SN, Ferrara MS. Sensitivity of the concussion assessment battery. Neurosurgery. 2007;60:1050-1057;discussion 1057-1058.8. Broglio SP, Guskiewicz KM, Concussion in Sport: The Sideline Assessment. Sports Health. 2009; 1:3619. Finnoff, JT, et al (2009). Intrarater and Interrater Reliability of the Balance Error Scoring System (BESS). PM&R, Volume 1, Issue 1, January 20097
Balance Assessment forConcussion Managementwww.biodex.com/concussionBiodexBiodex Medical Systems, Inc.20 Ramsey Road, Shirley, New York, 11967-4704, Tel: 800-224-6339 (Int’l 631-924-9000), Fax: 631-924-9241, Email: info@biodex.com, www.biodex.comFN: 19-160 4/19
Biodex Balance Assessment is conducted using either the versatile Balance System SD or portable BioSway. The Balance System SD is a sophisticated measuring and training device for static and dynamic balance testing and training. The BioSway is a portable balance device, with a static-only platform. The CTS
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