Are cost-effective technologies feasible to measure gait in older adults? A systematic review of evidence-based literature

Evaluation and Rehabilitation after Adult Lumbar Spine Surgery

Purpose: With an increase in the proportion of elderly patients, the global burden of spinal disease is on the rise. This is gradually expected to increase the number of surgical procedures all over the world in the near future. As we know, rehabilitation following spine surgery is critical for optimal recovery. However, the current literature lacks consensus regarding the appropriate post-operative rehabilitation protocol. The purpose of this review is to evaluate the optimal protocol for rehabilitation after lumbar spine surgery in adults. Materials and Methods: The goals of rehabilitation after lumbar spine surgery are to improve physical and psychosocial function and may include multiple modalities such as physical therapy, cognitive behavioral therapy, specialized instruments, and instructions to be followed during activities of daily living. In recent years, not only are a greater number of spine surgeries being performed, but various different techniques of lumbar spine surgery and spinal fusion have also emerged. (1) Our review summarizes post-operative rehabilitation under the following headings-1. Historical aspects, 2. Subjective functional outcomes, and (3) Actual rehabilitation measures, including balance. Results: Physical therapy programs need to be patient-specific and surgery-specific, such that they consider patient-reported outcome measures and take into consideration the technique of spinal fusion used and the muscle groups involved in these surgeries. By doing so, it is possible to assess the level of functional impairment and then specifically target the strengthening of those muscle groups affected by surgery whilst also improving impaired balance and allowing a return to daily activities. Conclusions: Rehabilitation is a multi-faceted journey to restore mobility, function, and quality of life. The current rehabilitation practice focuses on muscle strengthening, but the importance of spinal balance is less elaborated. We thus equally emphasize muscle strengthening and balance improvement post-lumbar spine surgery.

Validity and Reliability of Dynamic and Functional Balance Tests in People Aged 19-54: A Systematic Review

Evaluating an impairment in an individual's capacity to maintain, achieve, or restore balance suggests a deficiency in postural control. For effective identification of individuals at risk for falls, balance assessment should exhibit reliability, validity, and ease of use. This systematic review concentrated on dynamic and functional balance assessment methods and their validity in healthy adults aged 19-54. The objective was to clarify the tools that health professionals can utilize to assess balance in this healthy population.

Methods

A systematic literature search conducted in August 2019 yielded nine articles meeting predefined selection criteria. Inclusion criteria required studies featuring healthy adult participants aged 19-54, published in English, and focusing on dynamic and functional balance testing. Exclusion criteria excluded studies involving participants with chronic diseases or musculoskeletal disorders, systematic reviews, professional athletes, and those lacking specific participant age information. The quality of the studies was evaluated using a modified PEDro scale.

Results

This review analyzed ten distinct postural balance tests. The Star Excursion Balance Test and Y-Balance Test exhibited moderate to high reliability, establishing them as dependable measures of dynamic balance. The Nintendo Wii Balance Board, Clever Balance Board, and Posturomed device also displayed excellent reliability for assessing dynamic postural balance. Comparing one-arm and two-arm functional reach tests, the one-arm reach test emerged as a more suitable option for evaluating dynamic balance among young adults. Moreover, an investigation comparing three dynamic balance tests (one-leg jump landing, Posturomed device, and stimulated forward fall) revealed a low correlation among these tests, indicating a measurement of different balance constructs.

Discussion

In conclusion, the Y-Balance Test stands out as the most practical dynamic balance assessment for clinical use, characterized by a standardized protocol, good repeatability, affordability, and ease of application. The Nintendo Wii Balance Board also presents itself as a cost-effective and reliable tool for dynamic balance evaluation in clinical settings. It is crucial to recognize that these tests appraise discrete postural skills, preventing direct comparisons between test outcomes. This review equips healthcare professionals with valuable insights into optimal balance assessment methods for the healthy, 19 to 54 aged population.

Levels of evidence

Level 3.

Use of a Triaxial Accelerometer to Measure Changes in Gait Sway and Related Motor Function after Corrective Spinal Fusion Surgery for Adult Spinal Deformity

Background: Adult spinal deformity is a complex condition that causes lower back pain, causing spinal imbalance and discomfort in activities of daily life. After corrective spinal surgery, patients' gait and balance abilities might not revert to normalcy and they might be at increased risk of falling. Therefore, early evaluation of such a risk is imperative to prevent further complications such as a fall, or even worse, fractures in post-surgery ASD patients. However, there has been no report of an investigation of such early changes in gait sway before and after ASD surgery. This is a prospective to investigate changes in gait sway before and following ASD surgery, using accelerometers, and also to examine motor function related to postoperative gait sway. Methods: Twenty patients were included who underwent corrective surgery as treatment for ASD, from October 2019 to January 2023. Measurement parameters included a 10 m walking test and the timed up-and-go test (TUG), gait sway was evaluated using accelerometers (root mean square; RMS), and hip flexion and knee extension muscle strength were tested. RMS included RMS vertical: RMSV; RMS anterior posterior: RMSAP; RMS medial lateral: RMSML. The radiographic spinopelvic parameters were also evaluated preoperatively and postoperatively. p < 0.05 was noted as remarkably significant. Results: Preoperative and postoperative RMSV were 1.07 ± 0.6 and 1.31 ± 0.8, respectively (p < 0.05). RMSML significantly decreased from 0.33 ± 0.2 to 0.19 ± 0.1 postoperatively (p < 0.01). However, RMSAP did not change postoperatively (0.20 ± 0.2 vs. 0.14 ± 0.1, p > 0.05). Patients' one-month postoperative hip flexor muscle strength became significantly weaker (0.16 ± 0.04 vs. 0.10 ± 0.03 kgf/kg, p = 0.002), but TUG was maintained (11.6 ± 4.2 vs. 11.7 s, p = 0.305). RMSV was negatively correlated with quadriceps muscle strength and positively with TUG. RMSAP was negatively correlated with quadriceps muscle strength. All spinopelvic parameters became normal range after surgery. Conclusions: After corrective spinal fusion for ASD patients, the gait pattern improved significantly. Iliopsoas (hip flexor) and quadriceps femoris (knee extensor) muscles may play important roles for gait anterolateral and vertical swing, respectively.

Characteristics and Range of Reviews About Technologies for Aging in Place: Scoping Review of Reviews

BACKGROUND

It is a contemporary and global challenge that the increasing number of older people requiring care will surpass the available caregivers. Solutions are needed to help older people maintain their health, prevent disability, and delay or avoid dependency on others. Technology can enable older people to age in place while maintaining their dignity and quality of life. Literature reviews on this topic have become important tools for researchers, practitioners, policy makers, and decision makers who need to navigate and access the extensive available evidence. Due to the large number and diversity of existing reviews, there is a need for a review of reviews that provides an overview of the range and characteristics of the evidence on technology for aging in place.

OBJECTIVE

This study aimed to explore the characteristics and the range of evidence on technologies for aging in place by conducting a scoping review of reviews and presenting an evidence map that researchers, policy makers, and practitioners may use to identify gaps and reviews of interest.

METHODS

The review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Literature searches were conducted in Web of Science, PubMed, and Scopus using a search string that consisted of the terms "older people" and "technology for ageing in place," with alternate terms using Boolean operators and truncation, adapted to the rules for each database.

RESULTS

A total of 5447 studies were screened, with 344 studies included after full-text screening. The number of reviews on this topic has increased dramatically over time, and the literature is scattered across a variety of journals. Vocabularies and approaches used to describe technology, populations, and problems are highly heterogeneous. We have identified 3 principal ways that reviews have dealt with populations, 5 strategies that the reviews draw on to conceptualize technology, and 4 principal types of problems that they have dealt with. These may be understood as methods that can inform future reviews on this topic. The relationships among populations, technologies, and problems studied in the reviews are presented in an evidence map that includes pertinent gaps.

CONCLUSIONS

Redundancies and unexploited synergies between bodies of evidence on technology for aging in place are highly likely. These results can be used to decrease this risk if they are used to inform the design of future reviews on this topic. There is a need for an examination of the current state of the art in knowledge on technology for aging in place in low- and middle-income countries, especially in Africa.

Accelerometry applications and methods to assess standing balance in older adults and mobility-limited patient populations: a narrative review

Accelerometers provide an opportunity to expand standing balance assessments outside of the laboratory. The purpose of this narrative review is to show that accelerometers are accurate, objective, and accessible tools for balance assessment. Accelerometry has been validated against current gold standard technology, such as optical motion capture systems and force plates. Many studies have been conducted to show how accelerometers can be useful for clinical examinations. Recent studies have begun to apply classification algorithms to accelerometry balance measures to discriminate populations at risk for falls. In addition to healthy older adults, accelerometry can monitor balance in patient populations such as Parkinson's disease, multiple sclerosis, and traumatic brain injury. The lack of software packages or easy-to-use applications have hindered the shift into the clinical space. Lack of consensus on outcome metrics has also slowed the clinical adoption of accelerometer-based balance assessments. Future studies should focus on metrics that are most helpful to evaluate balance in specific populations and protocols that are clinically efficacious.

Foot characteristics of the daily-life gait in postmenopausal females with distal radius fractures: a cross-sectional study

BACKGROUND

Gait decline in older adults is related to falling risk, some of which contribute to injurious falls requiring medical attention or restriction of activity of daily living. Among injurious falls, distal radius fracture (DRF) is a common initial fragility fracture associated with the subsequent fracture risk in postmenopausal females. The recent invention of an inertial measurement unit (IMU) facilitates the assessment of free-living gait; however, little is known about the daily gait characteristics related to the risk of subsequent fractures. We hypothesized that females with DRF might have early changes in foot kinematics in daily gait. The aim of this study was to evaluate the daily-life gait characteristics related to the risk of falls and fracture.

METHODS

In this cross-sectional study, we recruited 27 postmenopausal females with DRF as their first fragility fracture and 28 age-matched females without a history of fragility fractures. The participants underwent daily gait assessments for several weeks using in-shoe IMU sensors. Eight gait parameters and each coefficient of variance were calculated. Some physical tests, such as hand grip strength and Timed Up and Go tests, were performed to check the baseline functional ability.

RESULTS

The fracture group showed lower foot angles of dorsiflexion and plantarflexion in the swing phase. The receiver operating characteristic curve analyses revealed that a total foot movement angle (TFMA) < 99.0 degrees was the risk of subsequent fracture.

CONCLUSIONS

We extracted the daily-life gait characteristics of patients with DRF using in-shoe IMU sensors. A lower foot angle in the swing phase, TFMA, may be associated with the risk of subsequent fractures, which may be effective in evaluating future fracture risk. Further studies to predict and prevent subsequent fractures from daily-life gait are warranted.

The Movement Deviation Profile Can Differentiate Faller and Non-Faller Older Adults

BACKGROUND

The World Health Organization considers falls the second leading cause of death by accidental injury worldwide and one of the most frequent complications in older adults during activities of daily living. Several tasks related to fall risk have been individually assessed describing kinematic changes in older adults. The study proposal was to identify which functional task differentiates faller and non-faller older adults using the movement deviation profile (MDP).

METHODS

This cross-sectional study recruited 68 older adults aged ≥60 years by convenience sampling. Older adults were divided into 2 groups: with and without a history of falls (34 older adults in each group). The MDP analyzed the 3-dimensional angular kinematics data of tasks (ie, gait, walking turn, stair ascent and descent, sit-to-stand, and stand-to-sit), and the Z score of the mean MDP identified which task presented the greatest difference between fallers and non-fallers. A multivariate analysis with Bonferroni post hoc verified the interaction between groups considering angular kinematic data and the cycle time of the task. Statistical significance was set at 5% (p < .05).

RESULTS

Z score of the MDPmean showed an interaction between groups (λ = 0.67, F = 5.085, p < .0001). Fallers differed significantly from non-fallers in all tasks and the greatest difference was in stair descent (Z score = 0.89). The time to complete each task was not different between groups.

CONCLUSIONS

The MDP distinguished older adult fallers from non-fallers. The stair descent task should be highlighted because it presented the greatest difference between groups.

Quantified analysis of facial movement: A reference for clinical applications

Most techniques for evaluating unilateral impairments in facial movement yield subjective measurements. The objective of the present study was to define a reference dataset and develop a visualization tool for clinical assessments. In this prospective study, a motion capture system was used to quantify facial movements in 30 healthy adults and 2 patients. We analyzed the displacements of 105 reflective markers placed on the participant's face during five movements (M1-M5). For each marker, the primary endpoint was the maximum amplitude of displacement from the static position (M0) in an analysis of variance. The measurement precision was 0.1 mm. Significant displacements of markers were identified for M1-M5, and displacement patterns were defined. The patients and age-matched healthy participants were compared with regard to the amplitude of displacement. We created a new type of radar plot to visually represent the diagnosis and facilitate effective communication between medical professionals. In proof-of-concept experiments, we collected quantitative data on patients with facial palsy and created a patient-specific radar plot. Our new protocol for clinical facial motion capture ("quantified analysis of facial movement," QAFM) was accurate and should thus facilitate the long-term clinical follow-up of patients with facial palsy. To take account of the limitations affecting the comparison with the healthy side, we created a dataset of healthy facial movements; our method might therefore be applicable to other conditions in which movements on one or both sides of the face are impaired. The patient-specific radar plot enables clinicians to read and understand the results rapidly.

The Validity and Reliability of a New Intelligent Three-Dimensional Gait Analysis System in Healthy Subjects and Patients with Post-Stroke

Odonate is a new, intelligent three-dimensional gait analysis system based on binocular depth cameras and neural networks, but its accuracy has not been validated. Twenty-six healthy subjects and sixteen patients with post-stroke were recruited to investigate the validity and reliability of Odonate for gait analysis and examine its ability to discriminate abnormal gait patterns. The repeatability tests of different raters and different days showed great consistency. Compared with the results measured by Vicon, gait velocity, cadence, step length, cycle time, and sagittal hip and knee joint angles measured by Odonate showed high consistency, while the consistency of the gait phase division and the sagittal ankle joint angle was slightly lower. In addition, the stages with statistical differences between healthy subjects and patients during a gait cycle measured by the two systems were consistent. In conclusion, Odonate has excellent inter/intra-rater reliability, and has strong validity in measuring some spatiotemporal parameters and the sagittal joint angles, except the gait phase division and the ankle joint angle. Odonate is comparable to Vicon in its ability to identify abnormal gait patterns in patients with post-stroke. Therefore, Odonate has the potential to provide accessible and objective measurements for clinical gait assessment.

Evidence and User Considerations of Home Health Monitoring for Older Adults: Scoping Review

BACKGROUND

Home health monitoring shows promise in improving health outcomes; however, navigating the literature remains challenging given the breadth of evidence. There is a need to summarize the effectiveness of monitoring across health domains and identify gaps in the literature. In addition, ethical and user-centered frameworks are important to maximize the acceptability of health monitoring technologies.

OBJECTIVE

This review aimed to summarize the clinical evidence on home-based health monitoring through a scoping review and outline ethical and user concerns and discuss the challenges of the current user-oriented conceptual frameworks.

METHODS

A total of 2 literature reviews were conducted. We conducted a scoping review of systematic reviews in Scopus, MEDLINE, Embase, and CINAHL in July 2021. We included reviews examining the effectiveness of home-based health monitoring in older adults. The exclusion criteria included reviews with no clinical outcomes and lack of monitoring interventions (mobile health, telephone, video interventions, virtual reality, and robots). We conducted a quality assessment using the Assessment of Multiple Systematic Reviews (AMSTAR-2). We organized the outcomes by disease and summarized the type of outcomes as positive, inconclusive, or negative. Second, we conducted a literature review including both systematic reviews and original articles to identify ethical concerns and user-centered frameworks for smart home technology. The search was halted after saturation of the basic themes presented.

RESULTS

The scoping review found 822 systematic reviews, of which 94 (11%) were included and of those, 23 (24%) were of medium or high quality. Of these 23 studies, monitoring for heart failure or chronic obstructive pulmonary disease reduced exacerbations (4/7, 57%) and hospitalizations (5/6, 83%); improved hemoglobin A1c (1/2, 50%); improved safety for older adults at home and detected changing cognitive status (2/3, 66%) reviews; and improved physical activity, motor control in stroke, and pain in arthritis in (3/3, 100%) rehabilitation studies. The second literature review on ethics and user-centered frameworks found 19 papers focused on ethical concerns, with privacy (12/19, 63%), autonomy (12/19, 63%), and control (10/19, 53%) being the most common. An additional 7 user-centered frameworks were studied.

CONCLUSIONS

Home health monitoring can improve health outcomes in heart failure, chronic obstructive pulmonary disease, and diabetes and increase physical activity, although review quality and consistency were limited. Long-term generalized monitoring has the least amount of evidence and requires further study. The concept of trade-offs between technology usefulness and acceptability is critical to consider, as older adults have a hierarchy of concerns. Implementing user-oriented frameworks can allow long-term and larger studies to be conducted to improve the evidence base for monitoring and increase the receptiveness of clinicians, policy makers, and end users.

Impact of walking states, self-reported daily walking amount and age on the gait of older adults measured with a smart-phone app: a pilot study

BACKGROUND

Smartphones provide a cost-effective avenue for gait assessment among older adults in the community. The purpose of this study is to explore the impact of walking state, self-reported daily walking amount, and age on gait quality, using a smartphone application.

METHODS

One hundred older adult individuals from North China, aged 73.0 ± 7.7 years, voluntarily participated in this study. They performed three walking tests: normal walking, fast walking, and visually impaired walking. Three-dimensional acceleration data for gait were obtained using the smartphone app Pocket Gait. This study used multivariate analysis of variance (MANOVA) to explore the effects of the walking state, self-reported daily walking amount, and age on the step frequency, root mean square (RMS) acceleration, step time variability, regularity, and symmetry.

RESULTS

The walking state, self-reported daily walking amount, and age had statistically significant effects on gait quality. Compared with normal walking, the step frequency, RMS acceleration, variability, and regularity were greater in the fast-walking state, and simulated visually impaired walking did not significantly affect gait quality. Relatively older individuals had a significant decline in gait quality compared to (relatively) younger older adult individuals. Compared with older adults who walked less than 1 km a day, older adults who walked more had better gait quality.

CONCLUSIONS

The walking state, self-reported daily walking amount, and age have a significant effect on the gait quality of older adults. Walking with pigmented sunglasses can be used as a training intervention to improve gait performance. Older adult people who walk less than 1 km/day have worse gait quality compared with their counterparts.

Detecting Fall Risk and Frailty in Elders with Inertial Motion Sensors: A Survey of Significant Gait Parameters

In the elderly, geriatric problems such as the risk of fall or frailty are a challenge for society. Patients with frailty present difficulties in walking and higher fall risk. The use of sensors for gait analysis allows the detection of objective parameters related to these pathologies and to make an early diagnosis. Inertial Measurement Units (IMUs) are wearables that, due to their accuracy, portability, and low price, are an excellent option to analyze human gait parameters in health-monitoring applications. Many relevant gait parameters (e.g., step time, walking speed) are used to assess motor, or even cognitive, health problems in the elderly, but we perceived that there is not a full consensus on which parameters are the most significant to estimate the risk of fall and the frailty state. In this work, we analyzed the different IMU-based gait parameters proposed in the literature to assess frailty state (robust, prefrail, or frail) or fall risk. The aim was to collect the most significant gait parameters, measured from inertial sensors, able to discriminate between patient groups and to highlight those parameters that are not relevant or for which there is controversy among the examined works. For this purpose, a literature review of the studies published in recent years was carried out; apart from 10 previous relevant reviews using inertial and other sensing technologies, a total of 22 specific studies giving statistical significance values were analyzed. The results showed that the most significant parameters are double-support time, gait speed, stride time, step time, and the number of steps/day or walking percentage/day, for frailty diagnosis. In the case of fall risk detection, parameters related to trunk stability or movements are the most relevant. Although these results are important, the total number of works found was limited and most of them performed the significance statistics on subsets of all possible gait parameters; this fact highlights the need for new frailty studies using a more complete set of gait parameters.

App-based strength and balance self-test in older adults: an exploratory study from a user perspective

Objectives

Falls are a common problem, especially in the older population. The number of older adults aged over 65 years is increasing globally, leading to a major challenge in providing effective fall prevention interventions to older adults requiring such interventions. This study aimed to explore the usability of an app-based strength and balance self-tests in a small sample of four older adults. This study is a side product of another project.

Results

The results from this study indicated that self-test of strength and balance by using a smartphone application is a challenge for older adults. Basic test measures, such as start and stop and counts of sit-to-stand, were difficult to self-administer. However, from a user perspective, the possibility of independently performing these measures was considered important and needed to be further developed and evaluated in future studies.

Clinical assessment of gait and functional mobility in Italian healthy and cognitively impaired older persons using wearable inertial sensors

AIM

The main purpose of the present study was to verify the feasibility of wearable inertial sensors (IMUs) in a clinical setting to screen gait and functional mobility in Italian older persons. In particular, we intended to verify the capability of IMUs to discriminate individuals with and without cognitive impairments and assess the existence of significant correlations between mobility parameters extracted by processing trunk accelerations and cognitive status.

METHODS

This is a cross-sectional study performed on 213 adults aged over 65 years (mean age 77.0 ± 5.4; 62% female) who underwent cognitive assessment (through Addenbrooke's Cognitive Examination Revised, ACE-R) instrumental gait analysis and the Timed Up and Go (TUG) test carried out using a wearable IMU located in the lower back.

RESULTS

Individuals with cognitive impairments exhibit a peculiar gait pattern, characterized by significant reduction of speed (- 34% vs. healthy individuals), stride length (- 28%), cadence (- 9%), and increase in double support duration (+ 11%). Slight, but significant changes in stance and swing phase duration were also detected. Poorer performances in presence of cognitive impairment were observed in terms of functional mobility as overall and sub-phase TUG times resulted significantly higher with respect to healthy individuals (overall time, + 38%, sub-phases times ranging from + 22 to + 34%), although with some difference associated with age. The severity of mobility alterations was found moderately to strongly correlated with the ACE-R score (Spearman's rho = 0.58 vs. gait speed, 0.54 vs. stride length, 0.66 vs. overall TUG time).

CONCLUSION

The findings obtained in the present study suggest that wearable IMUs appear to be an effective solution for the clinical assessment of mobility parameters of older persons screened for cognitive impairments within a clinical setting. They may represent a useful tool for the clinician in verifying the effectiveness of interventions to alleviate the impact of mobility limitations on daily life in cognitively impaired individuals.

Kinect V2-Based Gait Analysis for Children with Cerebral Palsy: Validity and Reliability of Spatial Margin of Stability and Spatiotemporal Variables

Children with cerebral palsy (CP) have high risks of falling. It is necessary to evaluate gait stability for children with CP. In comparison to traditional motion capture techniques, the Kinect has the potential to be utilised as a cost-effective gait stability assessment tool, ensuring frequent and uninterrupted gait monitoring. To evaluate the validity and reliability of this measurement, in this study, ten children with CP performed two testing sessions, of which gait data were recorded by a Kinect V2 sensor and a referential Motion Analysis system. The margin of stability (MOS) and gait spatiotemporal metrics were examined. For the spatiotemporal parameters, intraclass correlation coefficient (ICC_2,k) values were from 0.83 to 0.99 between two devices and from 0.78 to 0.88 between two testing sessions. For the MOS outcomes, ICC_2,k values ranged from 0.42 to 0.99 between two devices and 0.28 to 0.69 between two test sessions. The Kinect V2 was able to provide valid and reliable spatiotemporal gait parameters, and it could also offer accurate outcome measures for the minimum MOS. The reliability of the Kinect V2 when assessing time-specific MOS variables was limited. The Kinect V2 shows the potential to be used as a cost-effective tool for CP gait stability assessment.

Development of a dynamic fall risk profile in elderly nursing home residents: A free field gait analysis based study

Falls in nursing home residents are associated with a significant individual and socioeconomic burden of disease. To trigger and tailor individual intervention programs, solid early detection measures of residents at risk are needed. Aim of this study was thus to test the capability of a free field gait analysis insole to determine its usefulness in determining fall risk. In an observational study gait data of 22 nursing home residents over the age of 75 years was collected over one week with a measuring insole. Clinical scores were performed at baseline (POMA; DGI, TUG). For 6 months before and after the insole measurement, the fall events per resident were recorded. Correlation analysis as well as receiver operating characteristic curve analysis were performed. The average resident age was 88.2 years (range 78-99), 15 had at least one fall event. There was no significant correlation between clinical assessment and fall risk. Moderate correlations between different temporospatial parameters and fall risk were seen. Pressure distribution during gait was markedly changed in fallers. Differences between fallers and non-fallers as well as cut off values for increased fall risk in the ROC analysis could be determined. The introduced measurement protocol suggests that patients at risk for falling can be detected without any additional office visits. Based on the introduced protocol in a limited patient setting, further large scale studies should now determine the effect of prevention measures triggered by gait analysis, the specific risk reduction and the associated personal and socioeconomic advantages.

Reliability of a New Test of Balance Function in Healthy and Concussion Populations

Providing quantitative measures of balance and posture is a valuable aid in clinical assessment and in recent years several devices have been introduced that have demonstrated the accurate measure of balance via deviation of center of mass utilizing software algorithms and mobile devices. The purpose of this study was to assess the accuracy of EQ Balance against the Sway^TM Balance System (Sway), another balance device that is currently established as an accurate measure of balance, and to evaluate the test-retest reliability of EQ Balance. Seventy individuals presenting to a sports medicine and concussion clinic volunteered to participate in the assessment of balance utilizing Sway and EQ Balance simultaneously. The group included 25 males and 45 females (mean age: 37.8 ± 14.8, range: 13-65) with and without concussion or other neurological conditions (39 concussed vs. 31 non-neurologically injured, or healthy). Twenty-six of the concussed participants were balance-impaired. Participants performed five postures while holding the mobile device against their chest. Participants held a device holder that secured two devices: one iPhone 6 with EQ Balance and a second iPhone 6 with Sway Balance. The average balance score on all five stances was recorded as the "average balance score". Average balance scores were in statistical agreement between the two methods across the entire group, and for sub-groups according to the Deming regression (p < 0.01). The intra-class correlation (ICC) for the cohort was 0.87 (p < 0.001). Across the cohort, EQ Balance measured significantly worse balance scores in the balance-impaired group, comprised of participants with brain injury who failed a clinical balance screening test, compared to the group without clinically-determined balance impairment (this group includes healthy and some concussed patients). EQ Balance demonstrated safety, as it was considered safe to perform independently (i.e., without an observer) in those with impaired balance, and high test- retest reliability in the healthy and concussed patient population. Statistical agreement was established between the two measures of EQ Balance and Sway Balance for the average balance score across all five stances. The ICC analysis demonstrates strong consistency of the task output between test sessions. Given these results, EQ Balance demonstrates strength as a new balance assessment tool to accurately measure balance performance as part of a unique and novel gamified application in healthy and neurologically injured populations.