Daniel Goble

Oakland University, Exercise Science, Faculty Member

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Biomechanist, neuroscientist, and software developer. Researcher of balance and proprioception. Founder of http://www.balancetrackingsystems.com .
Phone: 619-594-7272
Address: San Diego State University
School of Exercise and Nutritional Sciences
5500 Campanile Drive
San Diego, CA
92182-7251

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Papers by Daniel Goble

Estimating Huntington’s Disease (HD) Onset Using a Low-Cost Balance Assessment (P4.061)

Neurology, Apr 8, 2014

OBJECTIVE: To enhance estimates of Huntington’s disease (HD) onset (i.e. phenoconversion) using a... more OBJECTIVE: To enhance estimates of Huntington’s disease (HD) onset (i.e. phenoconversion) using a simple and practical body sway assessment device (i.e. Wii Balance Board). BACKGROUND: HD is a progressive neurodegenerative disorder with motor, cognitive and psychiatric symptoms that typically emerge in the fourth or fifth decades. Predicting when phenoconversion will occur is a critical factor for management of pre-manifest HD (preHD). Using state of the art balance testing (i.e. Neurocom Balance Master), Salomoncyzk and colleagues (2010) demonstrated balance difficulties in preHD subjects who were close to disease onset. Unfortunately, the clinical implementation of this equipment is both difficult and impractical. METHODS: In the present study we performed a brief balance assessment on 16 subjects with HD (mean age=54, mean CAG=43.1, mean UHDRS Total Motor=28.6), 15 subjects with preHD (mean age=46.4, mean CAG=41.9, mean UHDRS Total Motor=5.1), and 19 normal controls. PreHD was further separated into those individuals estimated to be far from onset (i.e. >5 years; n=7) and those estimated to be near to onset (i.e. within 5 years; n=8) by the Aylward equation. Body sway was assessed using a low-cost Wii balance board and user-friendly software run on a laptop. The balance test consisted of 12, 10-second static balance trials that included combinations of eyes open/closed and standing on a stable versus unstable (i.e. foam) surface. RESULTS: There were statistically significant differences in body sway (i.e. worse balance) in individuals with HD relative to controls in all conditions (p=0.006 - p=0.000); in addition, there was increased body sway for the near premanifest HD group in the task where eyes were open while standing on an unstable surface (p<0.05, Cohen’s D=0.74). CONCLUSION: Increased body sway, easily evaluated using a brief balance assessment, may serve as an important functional measure of gait disability in early HD, and an important marker of disease onset in those preHD who are near to conversion. Study supported by: UCSD HDSA CoE, NIH P50 AG 005131 Disclosure: Dr. Herndon has nothing to disclose. Dr. Corey-Bloom has received research support from Janssen Pharmaceutica, Siena, Prana, HSG, and CHDI. Dr. Scholl has nothing to disclose. Dr. Burt has nothing to disclose. Dr. Huynh has nothing to disclose. Dr. Goble has nothing to disclose.

Using a Wii Balance Board to Measure Disease Onset in Huntington’s disease (P5.288)

Neurology, Apr 6, 2015

OBJECTIVE: To enhance estimates of Huntington’s disease (HD) onset using a simple and practical b... more OBJECTIVE: To enhance estimates of Huntington’s disease (HD) onset using a simple and practical body sway assessment device (i.e. Wii Balance Board). BACKGROUND: HD is a progressive neurodegenerative disorder with motor, cognitive, and psychiatric symptoms that typically emerge in the fourth or fifth decades. Balance assessments may be useful for predicting disease onset and progression, but studies are limited. DESIGN/METHODS: We assessed total body sway (TBS) on 59 HD gene carriers and 28 normal controls (NC) employing a Wii balance board and laptop software. Gene carriers were stratified on the basis of the UHDRS Total Functional Capacity (TFC) and Penny Burden of Pathology (BOP) score as early pre-manifest, transitional, or later HD. Subjects were administered a balance test consisting of 12, 10-second static balance trials that included combinations of eyes open or closed while standing on a stable versus unstable (i.e. foam) surface. A one-way analysis of covariance (ANCOVA) with Tukey post-hoc comparisons was used in each condition to compare TBS. Correlations were assessed in transitional and later HD subjects using Pearson’s r. RESULTS: Subjects were well matched with regard to age and education. The Later HD subjects (n=25) showed more statistically significant TBS relative to controls in all conditions (p<0.001) as did transitional subjects (p=.001-.03). TBS correlated most strongly with measures of motor ability (r=.423 to .662) and total functional capacity (r=-.313 to -.611) as opposed to cognition (r=-.081 to -.302). CONCLUSIONS: Increased body sway, easily evaluated using a brief balance assessment, may serve as an important functional marker in patients with, and during the transition to, HD. Further studies will be needed to confirm and extend these findings. Study Supported by: UCSD Huntington9s Disease Society of America Center of Excellence and the UCSD Shiley-Marcos Alheimer9s Disease Research Center NIH P50 AG005131 Disclosure: Dr. Herndon has nothing to disclose. Dr. Corey-Bloom9s husband holds stock and/or stock options in Alkermes. Dr. Corey-Bloom has received research support from PRANA, Omeros, Teva, HSG, and CHDI. Dr. Lam has nothing to disclose. Dr. Gilbert has nothing to disclose. Dr. Goble has nothing to disclose.

Upper Limb Asymmetries in the Utilization of Movement-related Sensory Feedback

2.5-Mean (+/-SEM) group differences in constant error for proprioceptive (left panel) and visual ... more 2.5-Mean (+/-SEM) group differences in constant error for proprioceptive (left panel) and visual (right panel) target matching tasks. 2.6-Ensemble averaged velocity profiles during target matching for a representative subject in each experimental condition. 49 2.7-Mean (+/-SEM) group differences in the peak velocity of matching movements made to proprioceptive (top panel) and visual (bottom panel) targets. 50 2.8-Mean (+/-SEM) group differences in the percent time to peak velocity of matching movements made to proprioceptive (top panel) and visual (bottom panel) targets. 2.9-Mean (+/-SEM) group differences in the smoothness of matching movements made to proprioceptive (top panel) and visual (bottom panel) targets. 3.1-Experimental setup for velocity matching task. vii 3.2-Ensemble averaged velocity profiles for a representative subject in each experimental condition. 74 3.3-Mean (+/-SEM) average acceleration errors. 3.4-Comparison of average acceleration error for the preferred versus non-preferred arm matching in the ipsilateral remembered task. 3.5-Mean (+/-SEM) peak velocity errors. 78 3.6-Mean (+/-SEM) average deceleration errors. 3.7-Mean (+/-SEM) area under the curve errors. 4.1-Experimental setup for dynamic position matching. 4.2-Representative data for 30 deg dynamic position matching in the ipsilateral remembered and contralateral remembered conditions. 4.3-Mean (+/-SEM) absolute errors in dynamic position matching for 10, 20 and 30 deg targets in the ipsilateral remembered (left panel) and contralateral remembered (right panel) tasks. 101 4.4-Mean (+/-SEM) constant errors in dynamic position matching for 10, 20 and 30 deg targets in the ipsilateral remembered (left panel) and contralateral remembered (right panel) tasks. 102 4.5-Mean (+/-SEM) variable errors in dynamic position matching for 10, 20 and 30 deg targets in the ipsilateral remembered (left panel) and contralateral remembered (right panel) tasks. 104 4.6-The effect of target determination speed on dynamic position matching error. 5.1-Summary of overall arm differences demonstrated during the visual and proprioceptive target matching tasks utilized in this dissertation. 5.2-Sample tasks demonstrating preferred right arm dependence on visual feedback and non-preferred arm reliance on proprioception.

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An Initial Evaluation of the Btracks Balance Plate and Sports Balance Software for Concussion Diagnosis

PubMed, Apr 1, 2016

Background: As recently dictated by the American Medical Society, balance testing is an important... more Background: As recently dictated by the American Medical Society, balance testing is an important component in the clinical evaluation of concussion. Despite this, previous research on the efficacy of balance testing for concussion diagnosis suggests low sensitivity (∼30%), based primarily on the popular Balance Error Scoring System (BESS). The Balance Tracking System (BTrackS, Balance Tracking Systems Inc., San Diego, CA, USA) consists of a force plate (BTrackS Balance Plate) and software (BTrackS Sport Balance) which can quickly (<2 min) perform concussion balance testing with gold standard accuracy. Purpose: The present study aimed to determine the sensitivity of the BTrackS Balance Plate and Sports Balance Software for concussion diagnosis. Study design: Cross-Sectional Study. Methods: Preseason baseline balance testing of 519 healthy Division I college athletes playing sports with a relatively high risk for concussions was performed with the BTrackS Balance Test. Testing was administered by certified athletic training staff using the BTrackS Balance Plate and Sport Balance software. Of the baselined athletes, 25 later experienced a concussion during the ensuing sport season. Post-injury balance testing was performed on these concussed athletes within 48 of injury and the sensitivity of the BTrackS Balance Plate and Sport Balance software was estimated based on the number of athletes showing a balance decline according to the criteria specified in the Sport Balance software. This criteria is based on the minimal detectable change statistic with a 90% confidence level (i.e. 90% specificity). Results: Of 25 athletes who experienced concussions, 16 had balance declines relative to baseline testing results according to the BTrackS Sport Balance software criteria. This corresponds to an estimated concussion sensitivity of 64%, which is twice as great as that reported previously for the BESS. Conclusions: The BTrackS Balance Plate and Sport Balance software has the greatest concussion sensitivity of any balance testing instrument reported to date. Level of evidence: Level 2 (Individual cross sectional diagnostic study).

Normative Data for the BTrackS Balance Test of Postural Sway: Results from 16,357 Community-Dwelling Individuals Who Were 5 to 100 Years Old

Physical therapy, May 17, 2018

Background. Postural sway is routinely assessed because increased postural sway is associated wit... more Background. Postural sway is routinely assessed because increased postural sway is associated with poorer performance of activities of daily living, higher rates of residential care, and increased risk of falling. Force plate technology is one of the most sensitive and objective means of assessing postural sway in the clinic. Objective. The aim of this study was to provide the first set of normative data for the BTrackS Balance Test (BBT) of postural sway. Design. The design was descriptive and population based. Methods. BBT results from 16,357 community-dwelling individuals who were 5 to 100 years old were accumulated and assessed for effects of age, sex, height, and weight. Percentile rankings were calculated for significant groupings. Results. BBT results were dependent on age and sex but not height or weight. Therefore, percentile rankings were determined for male and female individuals in each age category, with no consideration of participant height or weight. Limitations. Data were collected by third-party practitioners with various backgrounds in more than 50 locations across the United States and Canada. There was an imbalance in the sample sizes for age and sex groupings. Conclusions. The findings of this study represent the largest normative dataset ever published for postural sway results. Normative data on the BBT can assist in determining abnormalities in postural sway, which have been linked to negative clinical outcomes.

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Motivating Instructions Provoke Large Increases In Volitional Postural Sway

Medicine and Science in Sports and Exercise, Sep 1, 2022

On the Nature of Clinical Evaluations With Low Sensitivity for Concussion-Related Balance Deficits

Journal of Sport Rehabilitation, May 1, 2018

Effects of Fatigue on the BTrackS Balance Test for Concussion Management

International Journal of Athletic Therapy and training, Jul 1, 2017

Fatigue has been shown to adversely affect balance results, as measured by the Balance Error Scor... more Fatigue has been shown to adversely affect balance results, as measured by the Balance Error Scoring System (BESS). The present study aimed to determine whether a new low-cost force plate for concussion balance assessment, the Balance Tracking System (BTrackS), is subject to similar fatigue effects. Significant fatigue effects were only evident immediately following a fatigue protocol (p &gt; .05), and were fully resolved within 5 min postfatigue. These results suggest that the BTrackS Balance Test (BBT) is more fatigue resistant than the BESS, and support use of the BBT as a potentially more reliable alternative to the BESS during immediate sideline balance testing.

Postural sway normative data across the adult lifespan: Results from 6280 individuals on the Balance Tracking System balance test

Geriatrics & Gerontology International, Jun 13, 2018

Postural sway measured using force plate technology is a known risk factor for falls in older adu... more Postural sway measured using force plate technology is a known risk factor for falls in older adults, but is currently underutilized due to the high cost and lack of portability issues associated with most force plate systems. The Balance Tracking System (BTrackS) is a new force plate that alleviates these barriers and has potential for widespread use. The present study provides important normative data for the BTrackS Balance Test of postural sway that improves its translational value to the field of gerontology. Methods: BTrackS Balance Test postural sway results were accumulated from 6280 community-dwelling individuals across the adult lifespan. Data were assessed for effects of age, sex and body size. Stratified percentile rankings were then calculated. Results: BTrackS Balance Test results were dependent on age and sex, but not body size. Percentile rankings were, therefore, determined across various age groups for men and women separately, with no consideration of participant body size. A novel interaction was found between the age and sex factors, suggesting enhanced postural sway ability for women that becomes more pronounced with older age. Conclusions: The results of the present study represent one of the largest sets of normative postural sway data ever published. These data translate directly into the field of gerontology as a tool for determining abnormalities in postural sway, which have been linked to various poor outcomes in older adults, such as high fall risk. Geriatr Gerontol Int 2018; ••: ••-••.

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A new screening tool for behavioral disturbances in HD: The Huntington’s Disease-Behavioral Questionnaire (HD-BQ) (P3.002)

Neurology, Apr 6, 2015

OBJECTIVE: To examine the usefulness of a new behavioral questionnaire for patients with, and at ... more OBJECTIVE: To examine the usefulness of a new behavioral questionnaire for patients with, and at risk for, Huntington’s disease. BACKGROUND: Behavioral changes, including apathy, depression, irritability, anxiety, and difficulty prioritizing and initiating activities, are characteristic features of HD. For families and caregivers, they are often the most distressing aspect of the disease. The assessment of these behavioral disturbances is therefore important. DESIGN/METHODS: The UCSD HD-BQ was administered to 54 HD, 24 at-risk gene positive (AR+), and 13 normal control (NC) subjects at our Center. The UCSD HD-BQ was also administered to 32 HD caregivers. We used Cronbach’s alpha analysis to examine the internal consistency of the HD-BQ components; One-Way ANOVA/Tukey Posthoc to compare groups on dependent variables; Pearson product-moment correlations to compare HD-BQ scores with other variables. RESULTS: The HD-BQ showed substantial internal consistency (Cronbach α = 0.94). It showed construct validity with high-very high correlations with other behavioral measures (PBA r=0.55-0.70; HADS r=0.73-0.90), and poor correlations with measures of cognitive functioning and motor impairment (r=-0.04-0.16 and 0.00, respectively). The HD-BQ discriminated between HD (mean 30.5), preHD (mean 21.7), and control subjects (mean 5.0) (p=0.000), with no floor or ceiling effects. When questionnaires were completed independently by 32 HD subject/caregiver pairs, there was a discrepancy in the perception of impairment between patients and their caregivers, with caregivers identifying more behavioral changes (mean difference=16.17 points). Items with the largest discrepancies included more indecision, difficulty shifting thoughts or activities, increased sensitivity, and less insight with regard to symptoms. CONCLUSIONS: The HD-BQ is a quick, reliable instrument for screening behavioral changes in patients with, and at risk for, HD. When possible, information regarding behavior should be corroborated by an informant since HD patients tend to underestimate their impairment. Study supported by: UCSD HDSA CoE and UCSD Shiley-Marcos ADRC NIH P50 AG 005131. Disclosure: Dr. Corey-Bloom9s husband holds stock and/or stock options in Alkermes. Dr. Corey-Bloom has received research support from PRANA, Omeros, Teva, HSG, and CHDI. Dr. Herndon has nothing to disclose. Dr. Lam has nothing to disclose. Dr. Goble has nothing to disclose. Dr. Gilbert has nothing to disclose.

The influence of horizontal walking velocity on the bilateral symmetry of normal ground reaction force parameters

Recommended Citation Recommended Citation Goble, Daniel James., "The influence of horizontal walk... more Recommended Citation Recommended Citation Goble, Daniel James., "The influence of horizontal walking velocity on the bilateral symmetry of normal ground reaction force parameters." (2002). Electronic Theses and Dissertations. 4058. https://scholar.uwindsor.ca/etd/4058 This online database contains the full-text of PhD dissertations and Masters' theses of University of Windsor students from 1954 forward. These documents are made available for personal study and research purposes only, in accordance with the Canadian Copyright Act and the Creative Commons license-CC BY-NC-ND (Attribution, Non-Commercial, No Derivative Works). Under this license, works must always be attributed to the copyright holder (original author), cannot be used for any commercial purposes, and may not be altered. Any other use would require the permission of the copyright holder. Students may inquire about withdrawing their dissertation and/or thesis from this database. For additional inquiries, please contact the repository administrator via email

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Modality of Practice Affects Balance Improvement While Learning to Move with a Knee Crutch

Medicine and Science in Sports and Exercise, Sep 1, 2022

Differences in body sway can be identified in Huntington's disease using a practical balance assessment device

Parkinsonism & Related Disorders, Oct 1, 2022

Postural control deficits in collegiate athletes following mild concussions within the first 48 hours

British Journal of Sports Medicine, May 25, 2017

Objective The purpose of this study was to determine the extent of postural control deficits acco... more Objective The purpose of this study was to determine the extent of postural control deficits accompanying concussions in Division I collegiate athletes within 48 hours of injury. Design Cross-sectional study. Setting University Athletic Training Department & Biomechanics Laboratory. Participants Preseason baseline balance testing of 519 healthy Division I college athletes was performed with the BTrackS Balance Test (San Diego, CA). Of the baselined athletes, 26 (18–23 years; 14 females) experienced a concussion during the ensuing sport season. Post-injury balance testing was performed on these concussed athletes within 48 hours of injury. Additionally, 20 healthy young adults (19–25 years; 10 females) were baselined on 2 sessions 7 days apart. Outcome measures All testing consisted of three 20s trials of quiet unperturbed standing with eyes closed; feet shoulder width apart and hands on the hips. We calculated total centre of pressure (COP), COP antero-posterior (AP), and COP medio-lateral (ML) sway displacements. A principle component analysis was used to calculate the 99% confidence intervals (CI) of the COP area. Main results There were no preseason baseline differences in any of the balance measures between athletes and controls. However, postural displacement in all directions (AP, ML, and Total) increased significantly in athletes post-injury. Furthermore, ~80% of the increase in COP excursions was accounted for by a ~7 fold increase in the COP area post-injury. Conclusions Our findings are indicative of a decrease in postural control and multisensory integration post-concussion. Future studies should investigate the long-term effects and recovery from concussions in athletes. Competing interests One author (Goble) holds an equity stake in the parent company for the BTrackS Balance Plate. This conflict of interest was strictly managed by San Diego State University through a mitigation plan that limits his involvement in all primary aspects of data collection and analysis. All other authors have no conflict of interest to declare.

Upward gaze direction increases center of pressure displacement and decreases squat stability

International Journal of Sports Science & Coaching, May 14, 2021

The purpose of this study was to quantify differences in barbell back squat stability as a functi... more The purpose of this study was to quantify differences in barbell back squat stability as a function of gaze direction. Sixteen female subjects who were experienced in barbell back squatting performed six sets of three squat repetitions, randomized according to three gaze directions (DOWN, STRAIGHT, and UP). Stability was determined based on the displacement of center of pressure (COP) during each squat repetition, measured using a low-cost, portable force plate. Multiple t-tests with statistical significance set at p &lt; 0.05 were conducted between gaze directions and revealed significant differences in stability between the DOWN versus UP conditions. Specifically, DOWN had the smallest COP displacement, with significantly larger COP displacement in the UP condition (p = 0.02). There were no significant differences when DOWN or UP was compared to STRAIGHT (p = 0.22 and p = 0.28 respectively). From a practical standpoint, these results suggest that having a downward gaze direction during barbell back squat will maximize stability and reduce the likelihood of injury.

BTrackS limits of stability test is a reliable assessment of volitional dynamic postural control

Gait & Posture, Jul 1, 2020

Background: Unconstrained limits of stability assessment reveals aspects of volitional postural s... more Background: Unconstrained limits of stability assessment reveals aspects of volitional postural sway control that are inaccessible by other means. Prior versions of this assessment include instructions to sway towards predefined targets, and may not capture the full capability of the individual. Research question: This study sought to establish the test-retest reliability of a novel limits of stability protocol. Methods: Volitional sway area was determined during unconstrained trials, where participants were instructed to explore their ability to sway towards the perimeter of their base of support. Visual feedback was provided via computer monitor. Forty healthy young adults (mean age = 20.2 ± 1.3, 15 males, 25 females) participated in this study. Trials were collected in three sessions, repeated at the same time of the same day, with one week between. Reliability was assessed using IntraClass Correlation Coefficients (ICC), considering the total area of sway as well as quadrant level area. Results: Reliability was moderate between the first and second session (0.583), and much higher 0.921) between the second and third session. The quadrant level reliability was poor to excellent (0.183−0.791), with similar trends between the three sessions. Significance: Ultimately, these results indicate that the novel limits of stability test is reliable. However, it is recommended that a practice trial be conducted prior to baseline establishment.

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Balance Testing for Patients With Type 2 Diabetes

Journal of Diabetes Science and Technology