Balance Error Scoring System Performance Research Articles

Balance Error Scoring System in the assessment of chronic ankle stability: A systematic review and meta-analysis.

Chronic ankle instability (CAI) is a common musculoskeletal injury associated with static balance deficits. The Balance Error Scoring System (BESS) is commonly used to assess static balance in individuals with CAI. However, the sensitivity of BESS in detecting balance deficits in CAI is unknown. This study compared BESS performance between people with CAI and controls and investigated which stances most effectively identified balance deficits in individuals with CAI. Seven electronic databases (Web of Science, CINAHL, Embase, PubMed, Scopus, SPORTDiscus, and Cochrane Library) were searched from July 13, 2023, to September 10, 2023, using the ankle instability and balance related terms as keywords to search original studies and perform a systematic review. Studies that compared BESS scores between individuals with CAI and healthy controls were systematically identified. Extracted data included study characteristics, participant demographics, and assessment details. The risk of bias was assessed using the Newcastle-Ottawa Scale. The standardized mean difference (SMD) and 95% confidence interval (CI) were used as effect sizes to compare groups for the BESS components used to assess CAI. Six studies met the eligibility criteria. The double-leg foam stance yielded an SMD of -0.02 (95% CI: -0.32 to 0.29), with an I2 value of 3.5%. Significant differences between groups were noted in the single foam (SMD = 0.89; 95% CI: 0.33-1.45; I2 = 78.3%) and single firm (SMD = 0.62; 95% CI: 0.14-1.10; I2 = 72.1%) performances, although both demonstrated high heterogeneity. Conversely, the tandem foam (SMD = 0.77; 95% CI: 0.51-1.02; I2 = 0.0%) and tandem firm (SMD = 0.38; 95% CI: 0.11-0.68; I2 = 23.8%) performances showed small to moderate between-group differences with considerably lower heterogeneity. This review indicates that tandem stances on foam and firm surfaces in the BESS are reliable indicators of static balance deficits in individuals with CAI.

Balance Error Scoring System Performance Differences in Figure Skaters Based on Discipline.

Balance and postural stability are required of figure skaters throughout on-ice performance. Spinning, jumping, and landing each rely on this skill set to maintain control while skaters manage changing demands for each skating discipline. The aim of this study was to compare balance error scoring system (BESS) performance in figure skaters between disciplines and determine if age was related to BESS performance. Cross-sectional study. Three hundred and fifty-eight figure skaters (age: 15.4±3.3 years, 213 females, 145 males) of multiple disciplines completed the BESS during the United States Figure Skating's Standardized Testing of Athleticism to Recognize Skaters (S.T.A.R.S.) combine. Errors during each condition of the BESS were recorded by trained evaluators. A 3x6 ANOVA was used to determine BESS differences based on skating discipline. Spearman's rho (ρ) correlation coefficients were calculated for relationships between BESS errors and age. Ice dancers had more errors than singles and pairs for bipedal foam (p<0.001) but had fewer errors than single skaters for single leg foam (p=0.002). Tandem on a firm surface also showed an increase in errors for ice dancers and pairs skaters compared to singles (p<0.001). There were significant weak negative relationships noted between age and bipedal foam and single leg firm conditions (ρ=-0.14, -0.23, p<0.05). Figure skaters of different disciplines have varying levels of static postural stability. Assessing postural stability in figure skaters can provide insight to improve performance and may identify skaters at risk of injury. 3©The Author(s).

Motor vehicle crash concussion mechanism displays a greater total number of symptoms and greater affective symptom severity but no neurocognitive differences compared with sport-related concussion mechanism

Previous research among adolescents has shown differences in symptoms and neurocognitive performance between sport-related (SRC) and motor vehicle crash (MVC) concussion mechanisms. Limited research has focused on young adults. The purpose of our study was to compare symptoms, balance, and neurocognitive performance between SRC and MVC mechanisms in young adults. Forty-three (58.1% female, age = 25.5 ± 3.2 years, days since concussion = 12.8 ± 12.7) and 26 (76.9% female, age = 24.1 ± 5.6 years, days since concussion = 12.6 ± 8.3) individuals with an SRC and MVC mechanism, respectively, participated. Primary outcome measures included the total number, severity, cluster (disorientation, migraine, lethargy, and affective) of post-concussion symptoms endorsed, Balance Error Scoring System (BESS), and CNS Vital Signs scores. Clusters are subgroups of symptoms used for targeted rehabilitation. We used independent t-tests and Mann–Whitney U tests to compare symptoms, BESS, and neurocognitive performance. Cliff’s Delta effect size was interpreted as negligible (<0.15), small (0.15–0.33), medium (0.34–0.47), and large (≥0.48). There were no group differences for any demographic factors or preexisting conditions (p-range = 0.112–0.991). Participants with an MVC mechanism reported a greater number of total post-concussion symptoms (p = 0.025, Cliff’s Delta = 0.32) and a more severe affective symptom cluster (p = 0.010, Cliff’s Delta = 0.37). There were no group differences for BESS or neurocognitive performance after correcting for multiple comparisons. The MVC mechanism resulted in a greater total symptom burden relative to the SRC mechanism. Medical practitioners and individuals experiencing a concussion should know that concussions are heterogeneous within and across various mechanisms.

Footwear Type and Testing Environment Do Not Affect Baseline Modified Balance Error Scoring System Performance Among Middle School Athletes.

Limited evidence exists to demonstrate the effect of extrinsic factors, such as footwear worn or the testing environment, on performance of the modified balance error scoring system (mBESS) in the middle school age (10-14y) population. Therefore, the purpose of our study was to investigate the effect of footwear types and testing environments on performance of the mBESS by middle school athletes. Cross-sectional. In total, 2667 middle school athletes (55.9% boys and 44.1% girls; age = 12.3 [0.94]y) were administered the mBESS while wearing their self-selected footwear (barefoot, cleats, or shoes) either indoors (basketball court) or outdoors (football field or track). The number of errors committed (range = 0-10) during the double-leg, single-leg, and tandem stances of the mBESS were summed to calculate a total score (range = 0-30). Kruskal-Wallis tests were used to assess for differences among the footwear groups for each mBESS stance and the total score. Mann-Whitney U tests with calculated nonparametric effect sizes (r) were used to assess for differences between the footwear groups and testing environments when appropriate. There were significant differences for the number of committed errors among the footwear groups in the single-leg (P < .001) and tandem (P < .001) stances of the mBESS and mBESS total scores (P < .001). Significantly fewer errors (better) were committed while wearing shoes compared with other footwear in the single-leg and tandem stances of the mBESS (Ps ≤ .032, r = .07-.13). Participants assessed indoors committed significantly fewer errors than those assessed outdoors in each stance of the mBESS (Ps ≤ .022, r = .04-.14). Lower (better) mBESS total scores were observed for participants while wearing shoes (Ps ≤ .002, r = .10-.15) or assessed indoors (P = .001, r = .14). Although our data suggest that the type of footwear worn and the testing environment have a significant effect on mBESS scores of middle school athletes, the magnitudes of these differences are negligible.

Age is associated with postural control performance following youth concussion.

To examine the effect of age on postural control outcomes among patients being seen during their initial post-concussion clinical visit. Youth patients were seen≤14 days post-concussion, and completed a series of postural control evaluations: tandem gait, Romberg, and Balance Error Scoring System (BESS) tests. We included 109 children 8-12 years of age (24% female, evaluated median = 7 [interquartile range = 4-10] days post-injury) and 353 adolescents aged 13-18 years (36% female, evaluated median = 7 [4-10] days post-injury). There was a higher proportion of children who demonstrated abnormal tandem gait relative to adolescents (26% vs. 11%; p < 0.001). They also made more BESS errors in single (median = 5 [2-10] vs. 4 [2-6] errors) and tandem (median = 3 [1-6] vs. 2 [0-4]) firm stances. After covariate adjustment, children demonstrated worse tandem gait (adjusted odds ratio = 3.05, 95% CI = 1.68-5.53) and more firm surface BESS errors (double stance β=0.51, 95% CI = 0.22-0.80; single stance β= 1.18, 95% CI = 0.42-1.95; tandem stance β= 0.98, 95% CI = 0.28-1.68) than adolescents. Tandem gait and BESS performance following concussion differ in children compared to adolescents who present within 2 weeks of injury. Clinicians assessing and managing concussion should recognize age differences in postural control performance when assessing those with concussion.

Performance on auditory, vestibular, and visual tests is stable across two seasons of youth tackle football

ABSTRACTObjective: Few studies have tracked neurologic function in youth football players longitudinally. This study aimed to determine whether changes in tests of auditory, vestibular, and/or visual functions are evident after participation in one or two seasons of youth tackle football.Study Design: Prospective cohort study.Subjects and Methods: Before their 2017 and/or 2018 seasons, male tackle football players (ages 7–14 yrs) completed three tests that tend to exhibit acute disruptions following a concussion: (1) the FFR (frequency-following response), aphysiologic test of auditory function, (2) the BESS (Balance Error Scoring System), a test of vestibular function, and (3) the King-Devick, a test of oculomotor function. We planned to repeat these on all subjects at the end of each season.Results: Performance on neurosensory tests was stable, with no changes observed in FFR or King-Devick and a slight improvement observed in BESS performance across each season. Performance was also stable over two years for the subjects who participated both years. Across-season test-retest reliability correlations were high.Conclusions: In the absence of concussion, young athletes’ performance on the FFR, King-Devick, and BESS is stable across one or two seasons of youth tackle football.

No Differences in Tandem Gait Performance Between Males and Females Acutely Post-Concussion

ObjectiveTo examine sex differences in TG performance among collegiate student-athletes acutely post-concussion relative to pre-injury performance.BackgroundPostural control impairments are common following concussion and traditionally assessed using the Balance Error Scoring System (BESS). Tandem gait (TG) has successfully identified impairments in postural control acutely post-concussion that were undetected by the BESS; thus, TG may be a more robust postural control assessment following concussion. While sex differences in BESS performance after concussion have been explored, there is no literature regarding sex differences in post-concussion TG.Design/MethodsForty-eight concussed collegiate student-athletes (30 females) and twenty-five healthy controls (13 females) completed TG tests during pre-season and again acutely post-concussion. Participants walked heel-to-toe down a 3-meter line, turned, and returned as quickly as possible, completing four single-task (ST) and dual-task (DT) TG trials. During DT trials, they simultaneously answered mini-mental style questions. The best ST and DT times were recorded. A 2 × 2 (group*sex) ANOVA was used to examine TG change between pre-injury and post-injury tests (positive value = slower/worsening; negative value = faster/improving).ResultsThe change in TG time from pre-injury to post-injury was significantly higher for the concussion group relative to the control group during both ST (Concussion: 1.6 ± 2.6 seconds, Controls: −1.1 ± 0.8 seconds, p &lt; 0.001) and DT (Concussion: 2.0 ± 3.8 seconds, Controls: −0.9 ± 1.7 seconds, p &lt; 0.001) TG. There were no significant interactions (ST: p = 0.17, DT: p = 0.23) or main effects for sex (ST: p = 0.63, DT: p = 0.91).ConclusionsThere were no sex-specific differences in TG performance acutely post-concussion. However, all concussed participants, regardless of sex, performed significantly worse on TG than male and female controls after injury relative to baseline, while controls did not demonstrate such a change. These results suggest that TG can appropriately identify postural control impairments following concussion; however, there do not appear to be differences in performance between males and females.

How Accurate are Concussed College Athlete’s Self-reported Balance Problems?

Abstract Purpose The Balance Error Scoring System (BESS) has been determined to be a reliable and valid measure of balance performance (Bell et al., 2011). Previous research indicates self-reported balance difficulties and postural stability are positively correlated (Broglio et al., 2009). Furthermore, athletes exhibit an increase in errors on the BESS following a concussion (McCrea et al., 2004). Methods 68 collegiate athletes (age 18-23; M=19.62, SD=1.44) received baseline, post-concussion, and follow-up evaluations. Balance performance was measured via the BESS on the Sports Concussion Assessment Tool-5th edition (SCAT5), while symptom reporting was measured by the SCAT5 and ImPACT neurocognitive testing. Results Multiple simple linear regressions were conducted, suggesting that changes in BESS performance from baseline to post-trauma significantly predicted self-report of “balance problems” at post-trauma on ImPACT (F(1, 66)=11.94, p=.001; R2=.15) and SCAT5 (F(1, 66)=5.73, p=.02; R2=.08). While baseline BESS errors were significantly correlated with post-trauma BESS errors (r=.29, p=.02), BESS errors at post-trauma did not significantly predict self-reporting of balance problems on either assessment. Conclusion Results suggest that self-reported balance difficulties following a concussion are an indicator of change in intraindividual balance performance, but not post-trauma balance performance alone. Furthermore, it provides clinical context as the individuals’ perception of change may be greater, impacting the likelihood of self-reporting of balance problems at post-trauma. These results support the clinical utility of examining pre- and post-injury changes in balance by including balance measurements in pre-participation baseline testing.

B-44 An Examination of Balance Measurements in Predicting Post-Concussion Neurocognitive Dysfunction

Abstract Objective Previous research indicates that athletes experiencing concussions demonstrate acute balance deficits (Guskiewicz, 2011). Although it is hypothesized that balance performance is related to neurocognitive function in athletes experiencing a concussion (Guskiewicz, Ross, &amp; Marshall, 2001; Broglio, Sosnoff, Ferrara, 2009), limited research exists regarding the clinical utility of baseline measures. Method 68 collegiate athletes (ages 18-23; M = 19.62, SD = 1.44) were evaluated using the Balance error scoring system (BESS) and ImPACT at baseline and post-concussion. Multiple linear regressions were used to determine how BESS performance change across evaluations predicted post-concussion neurocognitive dysfunction compared to post-concussion performance alone. Results BESS performance changes from baseline to post-concussion significantly predicted post-concussion Verbal Memory (R² = .06, p = .05), Visual Memory (R² = .135, p = .002), Visual-Motor Speed (R² = .146, p = .001), Reaction Time (R² = .156, p = .001), and Total Symptom Scores (R² = .112, p = .005); while post-concussion BESS scores predicted Visual Memory (R² = .138, p = .002), Visual-Motor Speed (R² = .137, p = .002), and Reaction Time (R² = .145, p = .001). Therefore, assessing change in BESS performance is a more comprehensive predictor of neurocognitive dysfunction than solely post-concussion BESS performance. Conclusions Changes in BESS performance from baseline to post-concussion was found to be a more comprehensive predictor of neurocognitive dysfunction than post-concussion BESS scores alone. Therefore, our results support the clinical utility of evaluating balance at pre-participation to better understand neurocognitive risk factors.

Level of Agreement Between Human-Rated and Instrumented Balance Error Scoring System Scores

Clinicians have used the Balance Error Scoring System (BESS) to quantify postural control for concussion management. However, the reliability of the human rated BESS has varied prompting the development of instrumented BESSs. A cross-sectional design was used to determine the level of agreement (LOA) between human rated and instrumented BESS scores. Sixty participants completed the BESS on video. An instrumented mat was used to quantify BESS errors while a live human rater simultaneously scored the BESS. A second human rated BESS performance via video. Bland-Altman LOA analyses evaluated agreement between scoring methods (Mat-Human, Mat-Video, Video-Live) for each stance. Mean biases between scores, for each stance, with 95% confidence intervals (95%CIs) were calculated. Agreement between scoring methods was not assessed for the Firm-Double-Limb stance because very few errors were recorded. Agreement between both human raters and the mat was poor based on mean bias estimates > ± 1 and/or wide 95%CIs for all stances including BESS-Total. Agreement between the human raters was better, having displayed consistently smaller mean bias estimates and tighter 95%CIs for all stances and BESS Total. As a result, human rated and instrumented BESS scores may not be comparable. One method should be used to measure BESS errors for consistency.

POST-CONCUSSIVE CHANGES IN BALANCE AND POSTURAL STABILITY MEASURED WITH CANESENSE™ AND THE BALANCE ERROR SCORING SYSTEM (BESS) IN DIVISION I COLLEGIATE FOOTBALL PLAYERS: A CASE SERIES

Impairments in postural stability have been identified following sports-related concussion. CaneSense™ is a recently developed mobile lower limb motion capture system and mobile application for movement assessment which provides an objective measure of postural stability. One of the components within CaneSense™ is the Post-Concussive Excursion Index (PCEI), a measure of postural stability expressed as a percentage of symmetry between lower limbs. The purpose of this case series is to examine pre- and post-concussion differences using two separate measures, CaneSense™, and a known test, the Balance Error Scoring System (BESS), in Division I collegiate football players. A convenience sample of eight football players diagnosed with a concussion, were the subjects in this case series. All subjects underwent baseline testing prior to the start of pre-season camp consisting of the single limb stance (SLS) test with CaneSense™ and the BESS test. Twenty-four to 72 hours following their concussion, SLS with CaneSense™ test and the BESS test, were administered. Segmental excursions for the thigh and shank segments for each lower limb were combined into the Post-Concussion Excursion Profile (PCEP), which represents each segment's maximum excursion in the medial-lateral and anterior-posterior direction. The PCEI is a single metric generated to quantify differences within subjects by comparing the PCEP value between lower limbs during SLS where 100% suggests absolute symmetry. The PCEI value decreased significantly post-concussion (41.43 ± 15.53% vs. 87.41 ± 6.05%, p < 0.001) demonstrating a 52.6% decrease in inter-limb symmetry when compared to baseline values. There was an unanticipated 36.36% improvement in composite BESS performance post-concussion (10.5 ± 4.87 errors vs. 16.5 ± 8.49 errors, p = 0.10). Differences in inter-limb postural stability were found in subjects post-concussion. By assessing postural stability in both lower limbs individually, using the PCEI, impairments were detected that otherwise would have likely gone undiagnosed using the BESS test alone. Therapy, Level 4.

Reference values for the Balance Error Scoring System as measured by the Tekscan MobileMat™ in a physically active population

ABSTRACTObjectives: The Balance Error Scoring System (BESS) is commonly used to measure postural stability; however, it has demonstrated inconsistent reliability values when administered by humans. The Tekscan MobileMat™ was developed to automate the assessment of BESS errors and eliminate rater subjectivity. The objective of this study was to report reference values for the BESS, as measured by the MobileMat™, and examine the effect of sex, concussion history, and competitive sport level on BESS performance.Methods: Four hundred and forty participants performed the BESS on the MobileMat™. Participants were asked to maintain each stance with their eyes closed for 20 s. The MobileMat™ was used to quantify the number of errors.Results: Concussion history (p = 0.279–0.979) and competitive sport level (p = 0.422–0.979) did not affect BESS performance. Males performed significantly better than females for the single-limb foam stance (p = 0.032). No sex differences were detected for the other BESS stances or BESS total score (p = 0.067–0.744).Conclusions: Previously reported reference values in collegiate athletes and adolescents were slightly higher thus highlighting the value in establishing population norms and in developing new technologies to objectively quantify BESS performance. Furthermore, sex, concussion history, and competitive sport level do not appear to influence BESS performance as measured by the MobileMat™.

A Normative Dataset of the Balance Error Scoring System in Children Aged Between 5 and 14.

Pediatric head injuries occur commonly and are being reported in increasing numbers. Balance testing is a key component in the evaluation of suspected concussion, and the balance error scoring system (BESS) is likely the most well-known and widely used measure. To date, normative BESS scores for adults have been reported but not for children. Normative data for BESS scores and modified BESS scores were created in a cohort of healthy children. Potential variables were analyzed as predictors of BESS performance. Local elementary and junior high schools. A total of 373 healthy children between the ages of 5 and 14. The BESS was performed on all children. Gender, body mass index percentile, previous concussions, athletic participation, age, and the parental opinion of child's balance ability were examined as factors associated with the BESS score. BESS scores. Normative data are reported, stratified by age groups of 5 to 7 years, 8 to 10 years, and 11 to 14 years of age, for both BESS and modified BESS. Median BESS scores are 23 for children aged 5 to 7, 18 for children aged 8 to 10, and 16 for children aged 11 to 14. Median modified BESS scores are 8 for children age 5 to 7, 5 for children age 8 to 10, and 4 for children age 11 to 14. Increasing age and positive parental opinion regarding their child's balance ability were independently correlated with decreasing BESS scores (P < 0.01). The normative data on BESS scores for healthy children reported here provide age-stratified reference values for suspected balance alterations.

Reference values for the balance error scoring system in adolescents

Objectives: Adolescents with mild traumatic brain injury (i.e. concussion) may experience postural stability impairments. The Balance Error Scoring System (BESS) is widely used in assessment of postural stability after concussion. Despite its common use in adolescents, the BESS lacks reference values in adolescents, limiting its clinical utility. The objective of this study is to report the reference values for the BESS in adolescents and to examine the effect of gender on the BESS scores.Methods: One hundred and ninety-one high school adolescents between the ages of 14–18 (M = 16.1, SD = 1.1) years of age completed the BESS. The effects of gender, age, body mass and height on the performance of BESS were examined. Additionally, the reported reference values for the BESS were stratified by gender.Results: Female participants demonstrated better performance on five of the six BESS conditions as well as the total error score (p < 0.001). No relationships were observed between age and body mass to the BESS scores.Conclusions: The effects of gender on the BESS performance support the gender-specific reference values reported in this study. These reference values provide benchmarks for clinicians when interpreting the BESS in the absence of individual baseline scores.

Balance Error Scoring System Performance in Children and Adolescents With No History of Concussion.

Background:The Balance Error Scoring System (BESS) is a useful means of measuring postural stability, which frequently exhibits deficits after a concussion. However, it has limited applicability for children since there is insufficient normative data available for the BESS in the pediatric population. The purposes of this study were to report scores for the BESS in children 10 to 17 years old with no history of concussion and to identify whether BESS score is correlated with age, sex, sports participation, height, weight, or body mass index.Hypothesis:Baseline BESS scores will be related to age and sports participation.Study Design:Descriptive laboratory study.Level of Evidence:Level 3.Methods:One examiner recruited 100 participants 10 to 17 years old over a period of 4 months; performed all of the BESS tests; surveyed participants regarding age, sex, and sports participation; recorded participants’ heights and weights; and calculated body mass indices. Intrarater reliability was measured. The main outcome measures were total, firm, and foam surface BESS scores. We assessed data for normality using the Shapiro-Wilk test and used the Spearman rank test to determine whether BESS scores correlated with sex, age, sports participation, height, weight, or body mass index.Results:There was no correlation between the BESS firm surface (5.37 ± 4.4), BESS foam surface (12.28 ± 4.43), or total surface scores (17.64 ± 7.52) and age, anthropometrics, or sports participation. Male and female subjects had similar scores except in the 10- to 13-year-old age group on the foam surface, where girls performed better than boys (10.42 ± 4.53 vs 13.07 ± 4.23; P = 0.02).Conclusion:Baseline BESS scores in children aged 10 to 17 years were normally distributed and were not related to age, sex, height, weight, body mass index, or sports participation.Clinical Relevance:These results provide a reference for clinicians using BESS to evaluate and manage children and teens with concussions.

Balance Error Scoring System Performance Changes After a Competitive Athletic Season

To evaluate the change in Balance Error Scoring System (BESS) performance after an athletic season. A prospective longitudinal group study. University biomechanics research laboratory. A total of 58 college-aged females (23 soccer student-athletes, 16 volleyball student-athletes, and 19 recreationally active healthy college students) participated in the study. The BESS test was administered on 2 occasions 90 days apart. For the student-athletes, the first test (PRE) was administered before the start of their athletic season and the second test (POST) was administered immediately after the season. For the recreationally active college students, the PRE test was at the beginning of the academic semester and the POST test exactly 90 days thereafter. Total BESS score at PRE and POST was compared with a 3 × 2 repeated measures analysis of variance. The overall change score and absolute value change score were also calculated and compared with a 1-sample t test to an expected change of zero errors. There was no group by time interaction; however, there was a main effect for time. There was a significant improvement (P = 0.003) between PRE (9.00 ± 2.97 errors) and POST (7.92 ± 2.78 errors) BESS performance. There were significant differences for both the overall change score (1.08 errors) and the absolute value change score (2.00 errors). A clinically and statistically significant difference in BESS performance was identified after a 90-day intercollegiate athletic season.

Normative Data for the Balance Error Scoring System in Adults

Background. The balance error scoring system (BESS) is a brief, easily administered test of static balance. The purpose of this study is to develop normative data for this test. Study Design. Cross-sectional, descriptive, and cohort design. Methods. The sample was drawn from a population of clients taking part in a comprehensive preventive health screen at a multidisciplinary healthcare center. Community-dwelling adults aged 20–69 (N = 1, 236) were administered the BESS within the context of a fitness evaluation. They did not have significant medical, neurological, or lower extremity problems that might have an adverse effect on balance. Results. There was a significant positive correlation between BESS scores and age (r = .34). BESS performance was similar for participants between the ages of 20 and 49 and significantly declined between ages 50 and 69. Men performed slightly better than women on the BESS. Women who were overweight performed significantly more poorly on the test compared to women who were not overweight (P < .0001; Cohen's d = .62). The BESS normative data are stratified by age and sex. Conclusions. These normative data provide a frame of reference for interpreting BESS performance in adults who sustain traumatic brain injuries and adults with diverse neurological or vestibular problems.

Normative data for the balance error scoring system: Implications for brain injury evaluations

Primary objective: Patients who sustain traumatic brain injuries can experience temporary or permanent deficits in static or dynamic balance. The Balance Error Scoring System (BESS) is a brief, easily-administered test of static balance that recently has been recommended for use with military personnel who do not recover rapidly from a mild traumatic brain injury. However, the test lacks normative reference values for healthy adults, which greatly limits its clinical usefulness. The purpose of this study is to provide normative data for healthy men and women across the lifespan.Methods: Community-dwelling adults (n= 589) between the ages of 20–69 (M= 49.75, SD = 10.81) were administered the BESS. They did not have significant medical, neurological or lower extremity problems that might have an adverse effect on balance.Results: There was no relation between BESS and height and a very small correlation between BESS and weight. There was a small correlation between BESS and waist girth and body mass index. BESS performance was similar in men and women. BESS scores were consistent across the age groups until the 50s, when they worsened. Normative reference values stratified by age groups are presented.Conclusions: These normative data provide a frame of reference for interpreting BESS performance in civilians and military personnel who sustain traumatic brain injuries and adults with diverse neurological problems.