Now showing 1 - 10 of 23
  • Publication
    Wearable sensing and mobile devices: the future of post-concussion monitoring?
    In the past decade, concussion has received large amounts of attention in public, medical and research circles. While our understanding of the nature and management of concussion has greatly improved, there are still major limitations which need to be addressed surrounding the identification of the injury, determining when an individual is safe to return to normal activity, and what factors may contribute to the development of post-concussion syndrome (PCS).The current model of concussion management involves a triage evaluation in the acute stage of injury, focusing on the classic signs and symptoms of concussion. Next, the clinician attempts to evaluate key components of cerebral function through clinical symptom evaluation, and traditional assessments of motor and neurocognitive function [1]. The development of the sports concussion assessment tool (SCAT) saw a massive leap forward in the strategies employed in the management of concussion, as it acknowledged the multifactorial nature of concussion, and provided a standardised means for clinicians to assess the many domains of cerebral function [2]. While these methods have demonstrated some promise in the acute stage, they are not designed for serial monitoring (particularly in instances where PCS develops) [3], and provide us with very little clinically relevant information that can assist clinicians in the return to learn/ sport/ performance process.
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  • Publication
    Quantifying Y Balance Test performance with multiple and single inertial sensors
    A growing body of evidence has highlighted that inertial sensor data can increase the sensitivity and clinical utility of the Y Balance Test, a commonly used clinical dynamic balance assessment. While early work has demonstrated the value of a single lumbar worn inertial sensor in quantifying dynamic balance control, no research has investigated if alternative (shank) or combined (lumbar and shank) sensor mounting locations may improve the assessments discriminant capabilities. Determining the optimal sensor set-up is crucial to ensuring minimal cost and maximal utility for clinical users The aim of this cross-sectional study was to investigate if single or multiple inertial sensors, mounted on the lumbar spine and/or shank could differentiate young (18-40 years [n = 41]) and middle-aged (40-65 years [n = 42]) adults, based on dynamic balance performance. Random-forest classification highlighted that a single lumbar sensor could classify age-related differences in performance with an accuracy of 79% (sensitivity = 81%; specificity = 78%). The amalgamation of shank and lumbar data did not significantly improve the classification performance (accuracy = 73-77%; sensitivity = 71-76%; specificity = 73-78%). Jerk magnitude root-mean-square consistently demonstrated predictor importance across the three reach directions: posteromedial (rank 1), anterior (rank 3) and posterolateral (rank 6).
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  • Publication
    Investigating the effects of maximal anaerobic fatigue on dynamic postural control using the Y-Balance Test
    ObjectivesThe Y Balance Test is one of the most commonly used dynamic balance assessments, providing an insight into the integration of the sensorimotor subsystems. In recent times, there has been an increase in interest surrounding its use in various clinical populations demonstrating alterations in motor function. Therefore, it is important to examine the effect physiological influences such as fatigue play in dynamic postural control, and establish a timeframe for its recovery.DesignDescriptive laboratory study.MethodsTwenty male and female (age 23.75 4.79 years, height 174.12 8.45 cm, mass 69.32 8.76 kg) partaking in competitive sport, completed the Y Balance Test protocol at 0, 10 and 20 min, prior to a modified 60 s Wingate fatiguing protocol. Post-fatigue assessments were then completed at 0, 10 and 20 min post-fatiguing intervention.ResultsIntraclass correlation coefficients demonstrated excellent intra-session reliability (0.9760.982) across the three pre-fatigue YBT tests. Post-hoc paired sample t-tests demonstrated that all three reach directions demonstrated statistically significant differences between pre-fatigue and the first post-fatigue measurement (anterior; p = 0.019, posteromedial; p = 0.019 & posterolateral; p = 0.003). The anterior reach direction returned to pre-fatigue levels within 10 min (p = 0.632). The posteromedial reach direction returned to pre-fatigue levels within 20 min (p = 0.236), while the posterolateral direction maintained a statistically significant difference at 20 min (p = 0.023).ConclusionsMaximal anaerobic fatigue has a negative effect on normalised Y balance test scores in all three directions. Following the fatiguing protocol, dynamic postural control returns to pre-fatigue levels for the anterior (<10 min), posteromedial (<20 min) and posterolateral (>20 min).
      879Scopus© Citations 33
  • Publication
    Investigating normal day to day variations of postural control in a healthy young population using Wii balance boards
    The quantification of postural control (PC) provides the opportunity to understand the function and integration of the sensorimotor subsystem. The increased availability of portable sensing technology, such as Wii Balance Boards (WBB), has afforded the capacity to capture data pertaining to motor function, outside of the laboratory and clinical setting. However, prior to its use in long-term monitoring, it is crucial to understand natural daily PC variation. Twenty-four young adults conducted repeated static PC assessments over 20 consecutive weekdays, using WBBs. 16/24 participants (eyes open) and 11/24 participants (eyes closed) exhibited statistically significant differences (p <0.05) between their initial ‘once-off’ measure and their daily measures of PC. This study showed that variations in PC exist in a healthy population, a once-off measure may not be representative of true performance and this inherent variation should be considered when implementing long-term monitoring protocols.
    Scopus© Citations 1  425
  • Publication
    Challenging Concussed Athletes: The Future of Balance Assessment in Concussion
    The assessment and management of sports-related concussion has become a contentious issue in the field of sports medicine. The current consensus in concussion evaluation involves the use of a subjective examination, supported by multifactorial assessment batteries designed to target the various components of cerebral function. Balance assessment forms an important component of this multifactorial assessment, as it can provide an insight into the function of the sensorimotor subsystems post-concussion. In recent times, there has been a call to develop objective clinical assessments that can aid in the assessment and monitoring of concussion. However, traditional static balance assessments are derived from neurologically impaired populations, are subjective in nature, do not adequately challenge high functioning athletes and may not be capable of detecting subtle balance disturbances following a concussive event. In this review, we provide an overview of the importance of assessing motor function following a concussion, and the challenges facing clinicians in its assessment and monitoring. Additionally, we discuss the limitations of the current clinical methods employed in balance assessment, the role of technology in improving the objectivity of traditional assessments, and the potential role inexpensive portable technology may play in providing objective measures of more challenging dynamic tasks.
    Scopus© Citations 22  279
  • Publication
    Athletes with a concussion history in the last two years have impairments in dynamic balance performance
    The purpose of this study was to determine if National Collegiate Athletics Association Division 1 American Football and Ice Hockey athletes with a history of concussion have impaired dynamic balance control when compared to healthy control athletes. This cross‐sectional observational study recruited 146 athletes; 90 control athletes and 56 athletes with a history of concussion. Athletes were tested during a pre‐season evaluation using the inertial‐sensor instrumented Y Balance Test. Independent variables were normalized reach distance, gyroscope magnitude sample entropy, and jerk magnitude root mean square. Kruskal‐Wallis H test and Dunn‐Bonferroni analysis demonstrated that individuals with a concussion history within the last 2 years have statistically significantly lower jerk magnitude root mean square in the posteromedial (Z = 23.22, P = .015) and posterolateral (Z = 24.64, P = .010) reach directions, when compared to the control group. There was no significant difference between those who sustained a concussion longer than two years ago and the control group for the posteromedial (Z = −1.25; P = .889) and posterolateral (Z = 6.44; P = .469) directions. These findings show that athletes with a concussion history within the last two years possess dynamic balance deficits, when compared to healthy control athletes. Conversely, athletes whose injury occurred greater than 2 years ago possessed comparable performance to the healthy controls. This suggests that sensorimotor control deficits may persist beyond clinical recovery, for up to 2 years. Therefore, clinicians should integrate balance training interventions into the return‐to‐play process to accelerate sensorimotor recovery and mitigate the risk of future injury.
    Scopus© Citations 9  428
  • Publication
    Association of dynamic balance with sports related concussion: a prospective cohort study
    Background: Concussion is one of the most common sports-related injuries, with little understood about the modifiable and non-modifiable risk factors. Researchers have yet to evaluate the association between modifiable sensorimotor function variables and concussive injury. Purpose: To investigate the association between dynamic balance performance, a discrete measure of sensorimotor function, and concussive injuries. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 109 elite male rugby union players were baseline tested in dynamic balance performance while wearing an inertial sensor and prospectively followed during the 2016-2017 rugby union season. The sample entropy of the inertial sensor gyroscope magnitude signal was derived to provide a discrete measure of dynamic balance performance. Logistic regression modeling was then used to investigate the association among the novel digital biomarker of balance performance, known risk factors of concussion (concussion history, age, and playing position), and subsequent concussive injury. Results: Participant demographic data (mean 6 SD) were as follows: age, 22.6 6 3.6 years; height, 185 6 6.5 cm; weight, 98.9 612.5 kg; body mass index, 28.9 6 2.9 kg/m2; and leg length, 98.8 6 5.5 cm. Of the 109 players, 44 (40.3%) had a history of concussion, while 21 (19.3%) sustained a concussion during the follow-up period. The receiver operating characteristic analysis for the anterior sample entropy demonstrated a statistically significant area under the curve (0.64; 95% CI, 0.52-0.76; P \ .05), with the cutoff score of anterior sample entropy 1.2, which maximized the sensitivity (76.2%) and specificity (53.4%) for identifying individuals who subsequently sustained a concussion. Players with suboptimal balance performance at baseline were at a 2.81-greater odds (95% CI, 1.02-7.74) of sustaining a concussion during the rugby union season than were those with optimal balance performance, even when controlling for concussion history. Conclusion: Rugby union players who possess poorer dynamic balance performance, as measured by a wearable inertial sensor during the Y balance test, have a 3-times-higher relative risk of sustaining a sports-related concussion, even when controlling for history of concussion. These findings have important implications for research and clinical practice, as it identifies a potential modifiable risk factor. Further research is required to investigate this association in a large cohort consisting of males and females across a range of sports.
    Scopus© Citations 24  624
  • Publication
    Reliability, Validity and Utility of Inertial Sensor Systems for Postural Control Assessment in Sport Science and Medicine Applications: A Systematic Review
    Background Recent advances in mobile sensing and computing technology have provided a means to objectively and unobtrusively quantify postural control. This has resulted in the rapid development and evaluation of a series of wearable inertial sensor-based assessments. However, the validity, reliability and clinical utility of such systems is not fully understood. Objectives This systematic review aims to synthesise and evaluate studies that have investigated the ability of wearable inertial sensor systems to validly and reliably quantify postural control performance in sports science and medicine applications. Methods A systematic search strategy utilising the PRISMA guidelines was employed to identify eligible articles through ScienceDirect, Embase and PubMed databases. In total, 47 articles met the inclusion criteria and were evaluated and qualitatively synthesised under two main headings: measurement validity and measurement reliability. Furthermore, studies that investigated the utility of these systems in clinical populations were summarised and discussed. Results After duplicate removal, 4374 articles were identified with the search strategy, with 47 papers included in the final review. In total, 28 studies investigated validity in healthy populations, and 15 studies investigated validity in clinical populations; 13 investigated the measurement reliability of these sensor-based systems. Conclusions The application of wearable inertial sensors for sports science and medicine postural control applications is an evolving field. To date, research has primarily focused on evaluating the validity and reliability of a heterogeneous set of assessment protocols, in a laboratory environment. While researchers have begun to investigate their utility in clinical use cases such as concussion and musculoskeletal injury, most studies have leveraged small sample sizes, are of low quality and use a variety of descriptive variables, assessment protocols and sensor-mounting locations. Future research should evaluate the clinical utility of these systems in large high-quality prospective cohort studies to establish the role they may play in injury risk identification, diagnosis and management. This systematic review was registered with the International Prospective Register of Systematic Reviews on 10 August 2018 (PROSPERO registration: CRD42018106363): https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=106363.
    Scopus© Citations 51  1344
  • Publication
    Inertial Sensor Technology Can Capture Changes in Dynamic Balance Control during the Y Balance Test
    Introduction: The Y Balance Test (YBT) is one of the most commonly utilised clinical dynamicbalance assessments. Research has demonstrated the utility of the YBT in identifying balancedeficits in individuals following lower limb injury. However, quantifying dynamic balancebased on reach distances alone fails to provide potentially important information related tothe quality of movement control and choice of movement strategy during the reaching action.The addition of an inertial sensor to capture more detailed motion data may allow for the inexpensive,accessible quantification of dynamic balance control during the YBT reach excursions.As such, the aim of this study was to compare baseline and fatigued dynamic balancecontrol, using reach distances and 95EV (95% ellipsoid volume), and evaluate the ability of95EV to capture alterations in dynamic balance control, which are not detected by YBT reachdistances. Methods: As part of this descriptive laboratory study, 15 healthy participants completedrepeated YBTs at 20, 10, and 0 min prior to and following a modified 60-s Wingate testthat was used to introduce a short-term reduction in dynamic balance capability. Dynamicbalance was assessed using the standard normalised reach distance method, while dynamicbalance control during the reach attempts was simultaneously measured by means of the95EV derived from an inertial sensor, worn at the level of the 4th lumbar vertebra. Results:Intraclass correlation coefficients for the inertial sensor-derived measures ranged from 0.76to 0.92, demonstrating strong intrasession test-retest reliability. Statistically significant altera-tions (p < 0.05) in both reach distance and the inertial sensor-derived 95EV measure wereobserved immediately post-fatigue. However, reach distance deficits returned to baseline levelswithin 10 min, while 95EV remained significantly increased (p < 0.05) beyond 20 min forall 3 reach distances. Conclusion: These findings demonstrate the ability of an inertial sensorderivedmeasure to quantify alterations in dynamic balance control, which are not capturedby traditional reach distances alone. This suggests that the addition of an inertial sensor tothe YBT may provide clinicians and researchers with an accessible means to capture subtlealterations in motor function in the clinical setting.
    Scopus© Citations 19  298
  • Publication
    Capturing concussion related changes in dynamic balance using the quantified Y Balance Test - a case series of six elite rugby union players
    This paper investigates design considerations and challenges of integrating on-chip antennas in nanoscale CMOS technology at millimeter-wave (mm-wave) to achieve a compact front-end receiver for 5G communication systems. Solutions to overcome these challenges are offered and realized in digital 28-nm CMOS. A monolithic on-chip antenna is designed and optimized in the presence of rigorous metal density rules and other back-end-of-the-line (BEoL) challenges of the nanoscale technology. The proposed antenna structure further exploits ground metallization on a PCB board acting as a reflector to increase its radiation efficiency and power gain by 37.3% and 9.8 dB, respectively, while decreasing the silicon area up to 30% compared to the previous works. The antenna is directly matched to a two-stage low noise amplifier (LNA) in a synergetic way as to give rise to an active integrated antenna (AIA) in order to avoid additional matching or interconnect losses. The LNA is followed by a double-balanced folded Gilbert cell mixer, which produces a lower intermediate frequency (IF) such that no probing is required for measurements. The measured total gain of the AIA is 14 dBi. Its total core area is 0.83 mm 2 while the total chip area, including the pad frame, is 1.55 × 0.85 mm 2.
    Scopus© Citations 5  756