Examining for Race-Associated Differences on Sway Medical System Balance and Cognitive Tests Used for Sport-Related Concussion

Katie L Stephenson¹Julia Maietta²Nathan E. Cook³Lamont E Cavanagh⁴Heidi VanRavenhorst-Bell⁵Marc Norman⁶Alicia M D Kissinger-Knox⁷Grant L Iverson^2*

• ¹University of New England, Portland, Oregon, United States
• ²Harvard Medical School, Boston, United States
• ³University of Rhode Island, Kingston, Rhode Island, United States
• ⁴School of Community Medicine, University of Oklahoma, Tulsa, Oklahoma, United States
• ⁵Wichita State University, Wichita, Kansas, United States
• ⁶University of California, San Diego, La Jolla, California, United States
• ⁷Spaulding Rehabilitation Hospital, Boston, Massachusetts, United States

Background: Race associated differences and disparities in test scores, such as on neuropsychological measures, can complicate the interpretation of these test scores in student athletes following a concussion. It is unknown if there are race associated differences on the Sway Medical System, a battery that includes balance and cognitive tests for use in concussion management. Purpose: To determine if there are race-associated differences in Sway Medical System balance and cognitive module scores among athletes undergoing preseason baseline testing. Method: Athletes between 12 and 22 years old were administered the Sway Medical System balance and cognitive test modules during preseason baseline testing. Individuals with a past medical history of ADHD or concussion within the past 6 months were excluded from the study. Athletes (N=27,776) who self-identified as 'Black or African American' or 'White' were compared on Balance, Reaction Time, Inspection Time, Impulse Control, and Memory Module scores using Mann-Whitney U tests, and statistical tests were stratified by age and sex. Results: The race-associated differences (effect sizes) between Black and White athletes ranged from extremely small (negligible) to small across all ages for both sexes on Balance, Reaction Time, Inspection Time, and Impulse Control scores. For the Memory Module, the effect sizes ranged from small to medium across all ages for both sexes. White boys/men had higher Memory scores than Black boys/men (Hedges' g=-.18 to -.60). White girls/women had higher Memory scores than Black girls/women (g=-.13 to -.39).The race-associated differences between Black and White student-athletes on Sway Medical System balance and cognitive module scores are generally negligible. The reasons for modest race-associated differences on Memory scores are unknown and future research to examine the possible role or influence of social risk factors and psychosocial factors on module scores is recommended.