Feasibility and Reliability of a Novel Game-Based Test of Neurological Function in Youth: The Equilibrium Test Battery

Heather A Shepherd; Cody R van Rassel; Amanda M Black; Robert F Graham; Keith Owen Yeates; Carolyn A Emery; Kathryn J Schneider

Feasibility and Reliability of a Novel Game-Based Test of Neurological Function in Youth: The Equilibrium Test Battery

Int J Sports Phys Ther. 2022 Apr 1;17(3):378-389. eCollection 2022.

Authors

Heather A Shepherd¹, Cody R van Rassel², Amanda M Black¹, Robert F Graham³, Keith Owen Yeates⁴, Carolyn A Emery⁵, Kathryn J Schneider⁶

Affiliations

¹ Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
² Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
³ Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
⁴ Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada; Department of Psychology, University of Calgary, Calgary, AB, Canada.
⁵ Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Community Health Sciences, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁶ Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada; Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Evidence Sport and Spine, Calgary, AB, Canada.

PMID: 35391865
PMCID: PMC8975567

Abstract

Background: An estimated 11% of Canadian adolescents will sustain a sport-related concussion each year. However, diagnostic tools to detect and monitor concussive outcomes are limited.

Purpose: To evaluate the feasibility and test-retest reliability of the Highmark Interactive Equilibrium (HIEQ) test battery in uninjured adolescents.

Study design: Observational study with repeated measurements.

Methods: Participants completed the HIEQ test battery, a game-based platform on an iPad application, that assesses balance, cognitive function, and visual function, for up to 15 consecutive school days in a group classroom setting. Feasibility for use of the HIEQ was evaluated by (1) recruitment rates; (2) retention rates; (3) test completion without assistance; and (4) adverse events. Test-retest reliability was examined using Bland Altman 95% limits of agreement and intraclass correlation coefficients comparing the first and second and second and third obtained scores. Reliability across multiple baseline assessments was also analyzed using intraclass correlations for the second to sixth and seventh to eleventh obtained scores.

Results: Fifty-five uninjured high school students (31 females and 24 males, mean age = 16.24 [1.09]) from three high schools participated in the study. Three participants (5%) completed all 15 days of testing, and 73% completed at least 10 of 15 test days. No adverse events were reported. Although the test was feasible, all subtests showed wide limits of agreement from first to second and from second to third testing occasions. Results indicate poor-to-moderate reliability (<0.50 to 0.75) across those intervals, as well as across the second to sixth and seventh to eleventh testing occasions.

Conclusion: The HIEQ is feasible in high school students; however, performance was characterized by wide limits of agreement and poor-to-moderate reliability across test occasions. Future evaluation of the HIEQ in visual and auditory distraction free individual testing settings is warranted.

Level of evidence: Level 3.

Keywords: adolescents; assessment; concussion; digital technology; feasibility.

Grants and funding

We acknowledge funding through Highmark Innovations Inc. (Toronto, Canada) for the support of this project and the studentship of HAS.