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NIH Toolbox Standing Balance Test (SBT)
Availability
Please visit this website for more information about this instrument:NIH Toolbox Website
Classification
Supplemental: Sport-Related Concussion (SRC), Acute Hospitalized, Concussion/Mild TBI, Epidemiology, Moderate/Severe TBI: Rehabilitation Traumatic Brain Injury (TBI)
Short Description of Instrument
The NIH Toolbox Standing Balance Test (SBT) is a measure developed to assess static standing balance for ages 3–85 years. It involves the participant assuming and maintaining up to five poses for 50 seconds each. The sequence of poses is: eyes open on a solid surface, eyes closed on solid surface, eyes open on foam surface, eyes closed on foam surface, and eyes open in tandem stance on solid surface. Detailed stopping rules are in place to ensure participant safety with these progressively demanding poses. Postural sway is recorded for each pose using an accelerometer that the participant wears at waist level. This test takes approximately seven minutes to administer and is recommended for ages 3–85.
 
Sport-Related Concussion Specific:
 
Advantages: The NIH toolbox spans a wide age range and has been tested in a few studies with concussions and shown to have good reliability.  It has been able to differentiate between individuals with and without vestibular disorders and it is low in cost. The BAM has already been used for classifying sport concussion. Previous studies have shown accelerometer data are reliable and provide additional information about postural stability compared to only force platform data (Heebner et al., 2014).
 
Limitations: Needs normative data to spend the age; it is not clear what normal and abnormal sway is in the context of concussion. It needs to be validated with different age groups. BAM showed to be less sensitive compared to the balance error scoring system (BESS) (Furman et al., 2013).  
 
Scoring
Please visit this website for more information about scoring and interpretation of the SBT: NIH Toolbox Scoring and Interpretation Guide
References
Furman GR, Lin CC, Bellanca JL, Marchetti GF, Collins MW, Whitney SL. Comparison of the balance accelerometer measure and balance error scoring system in adolescent concussions in sports. Am J Sports Med. 2013;41(6):1404–1410.
 
Heebner NR, Akins JS, Lephart SM, Sell TC. Reliability and validity of an accelerometry based measure of static and dynamic postural stability in healthy and active individuals. Gait Posture. 2015;41(2):535–539.
 
King LA, Horak FB, Mancini M, Pierce D, Priest KC, Chesnutt J, Sullivan P, Chapman JC. Instrumenting the balance error scoring system for use with patients reporting persistent balance problems after mild traumatic brain injury. Arch Phys Med Rehabil. 2014;95(2):353–359.
 
Moe-Nilssen R, Helbostad JL. Trunk accelerometry as a measure of balance control during quiet standing. Gait Posture. 2002;16(1):60–68.
 
Moe-Nilssen R. Test-retest reliability of trunk accelerometry during standing and walking. Arch Phys Med Rehabil. 1998;79(11):1377–1385.
 
Reuben DB, Magasi S, McCreath HE, Bohannon RW, Wang YC, Bubela DJ, Rymer WZ, Beaumont J, Rine RM, Lai JS, Gershon RC. Motor assessment using the NIH Toolbox. Neurology. 2013;80(11 Suppl 3):S65–S75.
 
Rine RM, Schubert MC, Whitney SL, Roberts D, Redfern MS, Musolino MC, Roche JL, Steed DP, Corbin B, Lin CC, Marchetti GF, Beaumont J, Carey JP, Shepard NP, Jacobson GP, Wrisley DM, Hoffman HJ, Furman G, Slotkin J. Vestibular function assessment using the NIH Toolbox. Neurology. 2013;80(11 Suppl 3):S25–S31.
 
Rine RM, Roberts D, Corbin BA, McKean-Cowdin R, Varma R, Beaumont J, Slotkin J, Schubert MC. New portable tool to screen vestibular and visual function--National Institutes of Health Toolbox initiative. J Rehabil Res Dev. 2012;49(2):209–220.
 
Shumway-Cook A, Horak FB. Assessing the influence of sensory interaction of balance. Suggestion from the field. Phys Ther. 1986;66(10):1548–1550.
 
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