Balance Error Scoring System Test Research Articles

Accuracy to identify young adults with chronic ankle instability using a virtual reality - Balance error scoring system: A cross-sectional study

IntroductionThe Balance Error Scoring System (BESS) assesses the ability to control postural stability by performing 3 different stances on two-type surfaces during closed eyes. Virtual reality technology combined with the BESS test (VR-BESS) may be used to disrupt visual inputs instead of closing the eyes, which may improve the sensitivity of diagnosing patients with chronic ankle instability (CAI). ObjectiveThis study aimed to evaluate the accuracy to identify individuals with CAI of the VR-BESS test comparing with the original BESS test. MethodsThe BESS and VR-BESS tests were administered to 68 young adults (34 participants with CAI and 34 without CAI). Frontal and lateral video views were used to measure the participant's performance errors. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was computed to determine the diagnostic test's overall accuracy. ResultsThe total score of the BESS test and the VR-BESS test were statistically significant in comparison to the AUC of no discrimination at 0.5, with AUC values of 0.63 and 0.64, respectively. The cut-off scores for the BESS and VR-BESS tests were 12 and 15, respectively. There was no significant difference between the ROC curves of the BESS and the VR-BESS test for identifying individuals with CAI. ConclusionThe BESS and VR-BESS tests may be utilized interchangeably to identify individuals with CAI.

Reliability of the Balance Error Scoring System test is maintained during remote administration.

This study investigates if scores on the Balance Error Scoring System (BESS) are affected when administered remotely. Participants included 26 undergraduate students, aged 19-32 (mean: 21.85±2.95). Each participant received the BESS test remotely and in person, and scores on each were compared. To minimize potential practice effects, participants were randomly assigned to two equal sized groups to take the BESS remotely first or in person first. The mean difference between scores for the remote and in-person assessments was 0.711 (95% CI: 0.708-2.131). There was no significant difference between scores (p=0.312)indicating the BESS maintains reliability when administered remotely. Administration of the BESS remotely was possible without any significant challenges.

Inertial Sensor-Based Assessment of Static Balance in Athletes with Chronic Ankle Instability.

The Balance Error Scoring System (BESS), a subjective examiner-based assessment, is often employed to assess postural balance in individuals with chronic ankle instability (CAI); however, inertial sensors may enhance the detection of balance deficits. This study aimed to compare the BESS results between the CAI and healthy groups using conventional BESS scores and inertial sensor data. The BESS test (six conditions: double-leg, single-leg, and tandem stances on firm and foam surfaces, respectively) was performed for the CAI (n = 16) and healthy control (n = 16) groups with inertial sensors mounted on the sacrum and anterior shank. The BESS score was calculated visually by the examiner by counting postural sway as an error based on the recorded video. The root mean square for resultant acceleration (RMSacc) in the anteroposterior, mediolateral, and vertical directions was calculated from each inertial sensor affixed to the sacral and shank surfaces during the BESS test. The mixed-effects analysis of variance and unpaired t-test were used to assess the effects of group and condition on the BESS scores and RMSacc. No significant between-group differences were found in the RMSacc of the sacral and shank surfaces, and the BESS scores (P > 0.05), except for the total BESS score in the foam condition (CAI: 14.4 ± 3.7, control: 11.7 ± 3.4; P = 0.039). Significant main effects of the conditions were found with respect to the BESS scores and RMSacc for the sacral and anterior shank (P < 0.05). The BESS test with inertial sensors can detect differences in the BESS conditions for athletes with CAI. However, our method could not detect any differences between the CAI and healthy groups.

Countermovement jump, handgrip, and balance performance change during euhydration, mild-dehydration, rehydration, and ad libitum drinking

Background/ObjectivesTo examine the effects of euhydration, mild-dehydration, rehydration, and ad libitum drinking on countermovement jump (CMJ), handgrip strength, and performance of balance error scoring system test (BESS). MethodsEighteen healthy male subjects (mean[M]±standard deviation[SD]; age, 23±3y; body mass, 80.1 ± 9.7 kg; height, 175.8 ± 5.7 cm) participated in this study. Participants reported to the laboratory to perform CMJ, handgrip strength, and BESS with different hydration statuses (euhydrated, EUH; when they initially sensed thirst, THIRST; dehydrated, DEH; following 30 minutes of rehydration, REH; and following 24-h ad libitum drinking, AD). ResultsCMJ at EUH (M±SD; 54.6 ± 3.0 cm) was significantly higher than DEH (52.8 ± 3.0 cm, p = 0.027) and REH (52.6 ± 2.8 cm, p < 0.001). However, there was no difference between DEH and REH (p = 0.643). CMJ at THIRST (54.9 ± 3.0 cm, p = 0.004) was higher than REH. Also, AD (53.8 ± 2.8 cm, p = 0.027) was higher than REH. In left handgrip strength, THIRST (48.6 ± 9.5 kg) was higher than EUH (46.7 ± 10.1 kg, p = 0.018), DEH (45.8 ± 10.0 kg, p = 0.013), REH (46.1 ± 9.5 kg, p = 0.004), and AD (47.1 ± 9.7 kg, p = 0.05). Additionally, in the single-leg stance on a foam pad, more BESS errors were found at THIRST (6 ± 2) compared to EUH (5 ± 2, p = 0.007) and AD (5 ± 2, p = 0.002). ConclusionThe findings of this study were: ∼2% of mild dehydration induced by 24-h fluid restriction decreased lower body power measured by CMJ, acute rehydration did not restore the loss of lower body power induced by dehydration, and ∼0.5–0.9% of dehydration did not decrease lower body power.

Functional Balance Tests for Patients with Multiple Sclerosis: A Review Study

Background: Knowledge of the functional balance tests for the patients with Multiple Sclerosis (PwMS) may provide useful and accurate information about the balance function of these patients under different situations. Objectives: This study aims to review the functional balance tests for PwMS. Materials and Methods: This is a systematic review. The search was conducted in PubMed, Scopus, LILACS, CINAHL, CENTRAL, Web of Science, PEDro, and Google Scholar databases on relevant studies published until November 2021. Results: Twenty-five articles and 25 different tests were found to evaluate the functional balance of PwMS. It was found that the studies used 6 tests to assess the static balance, 13 tests to assess dynamic balance, and 6 multi-item tests to assess functional balance in PwMS. Single-leg stance test, balance error scoring system test and steady stance test is a test battery for static balance; six-spot step test, timed up and go test, and figure-of-8 hop test are better for dynamic balance, and the balance evaluation systems test is a better multiitem test to assess the balance of PwMS by examining the postural control components. Conclusion: Single-limb standing test, balance error scoring system (BESS) test and steady stance test provide accurate data on static balance; six spot step test, Timed Get up and go test and figure-of-8 hop test provide valuable data on the dynamic balance and Balance Evaluation Systems Test (BESTest) is a valid test to assess the balance of PwMS from the perspective of the review of posture control components.

Evidence to Eliminate Double-Leg Conditions From the Modified Balance Error Scoring System and Balance Error Scoring System.

The purpose of our study was to assess the differences between the Balance Error Scoring System (BESS), modified BESS (mBESS), and both measures with the double-leg (DL) stances removed [BESS-revised (BESS-R) and mBESS-revised (mBESS-R)] among healthy and concussed collegiate student-athletes. Retrospective, repeated-measures cohort study. Clinical. Healthy and concussed collegiate athletes (baseline n = 622, postinjury n = 41) from 12 National Collegiate Athletic Association Division I sports cheer and dance at a single university. Balance Error Scoring System, mBESS, BESS-R, and mBESS-R test versions from baseline and postinjury testing. The mBESS and BESS and their revised versions with DL stances removed (mBESS-R and BESS-R) scores were compared at baseline. Baseline and postinjury scores for all 4 BESS variations and the 6 BESS conditions were compared for those who sustained a concussion. The BESS and BESS-R were statistically different at baseline for the entire sample (99.6% confidence interval 0.32, 0.38, P > 0.0001). None of the other comparisons were significantly different ( P > 0.004). Although our results do suggest statistically significant differences between the BESS and BESS-R test versions, they do not represent clinically meaningful differences. The greatest mean difference between all test versions was <1 error; therefore, these BESS versions may not be specific enough to identify balance deficits at baseline or postinjury. Elimination of the time intensive DL measures in the revised BESS variations may be a more clinically practical alternative.

Contributions of PCSS, BESS, Tandem Gait, and Romberg Test for Identifying Balance Deficits in Pediatric Concussions.

Balance deficits are common after concussions in pediatric patients. This study evaluates 3 clinical tools for identifying postconcussion balance deficits in a pediatric population: (1) Post-Concussion Symptom Scale (PCSS); (2) Balance Error Scoring System (BESS); and (3) physical examination measures of balance: tandem gait (TG) and Romberg test. Data were collected in a tertiary care outpatient pediatric sports medicine clinic. English-speaking patients aged 8 to 17 years who presented to a tertiary care hospital-based pediatric sports medicine clinic and diagnosed with concussion between August 2014 and February 2018 were invited to participate. A total of 614 patients were screened and/or approached during the inclusion period and 500 were enrolled. Of those enrolled, 423 patients had complete data collected and analyzed. This is a cross-sectional, observational data set from a longitudinal, prospective study. Data extracted from patients' electronic medical records included physical examination, PCSS, and BESS scores from their initial visit. Descriptive statistics were calculated for the outcome measures. A logistic regression was performed to evaluate significant contributors to abnormal BESS score (≥25). There were 423 patients (56.7% female; 14.7 ± 2.01 years old) included in the study. Overall, we identified 336 patients (79.4%) with balance difficulties. Of the 336 with balance difficulties, 284 (84.5%) reported "balance problems" and/or "dizziness" on PCSS, 153 (45.5%) had abnormal BESS scores (≥25), and 100 (29.8%) had an abnormality on either TG or Romberg test. Balance difficulties were identified in close to 80% of children with concussions. Using PCSS and BESS along with physical examination measures, TG and Romberg test, identified more patients with balance deficits than using TG and Romberg test alone.

Normative Data for the Balance Error Scoring System in Iranian Adults.

The Balance Error Scoring System (BESS), originally designed to diagnose and assess athletes with concussion syndrome, is now widely used to evaluate postural stability. To interpret balance status, a normative database can be a reliable source. However, different anthropometric characteristics and sociocultural backgrounds across populations hinder the application of previously developed databases in different populations. The present study was designed to develop a normative data set for the general population of healthy Iranian adults according to their age groups and to study the correlation between BESS scores and the participants' sex, height, weight, and body mass index. A cross-sectional study. A total of 1051 community-dwelling adults aged 20-69years not suffering from balance disorders, dizziness, or other neurological or musculoskeletal diseases were recruited and stratified into 5 different age groups by decade. The BESS tests were composed of single-leg, double-leg, and tandem stances, each on a rigid surface and a foam pad. The individuals maintained each position for 20seconds with eyes closed. The assessor recorded the total number of errors as the individuals' BESS score (range: 0-60). Significant but weak correlations were found between BESS score and height (r = -.13, P < .001) and between BESS score and body mass index (r = .11, P < .001), and the difference between sexes in BESS score was statistically significant in the 50- to 59-year-old (P = .021) and 60- to 69-year-old (P < .001) groups. The BESS scores were significantly different between all age groups (P < .05), except between the 20- to 29-year-old and 30- to 39-year-old groups (P = 1.000) and between the 40- to 49-year-old and 50- to 59-year-old groups (P = .086). This study provided a normative database for different age groups of asymptomatic Iranian adults. The BESS score had weak correlations with height and body mass index and no correlation with weight, and significant differences were found between sexes in 50- to 69-year-old individuals. This study emphasizes the importance of obtaining specific normative data for different populations.

The Immediate Effects Of Abdominal And Core Exercise On Balance For College-age Dancers

Balance is defined as the ability to maintain a stable position while remaining steady. Balance is extremely important to dancers to help prevent injury and to maximize aesthetic and athletic performance. While other studies support the improvement of balance among dancers following a core exercise training program, the effects immediately following one core exercise session are less clear. PURPOSE: The purpose of this study was to examine the immediate effects of a core and abdominal exercise program on balance for dancers, with the hypothesis that a core exercise program would cause an immediate improvement in balance for college-aged dancers. METHODS: Eighteen female collegiate dancers (19.83 ± 1.58 years, 7-18 years of dance experience) completed two sets of eight exercises, engaging the upper and lower abdominal, obliques, gluteals, and erector spinae muscles. Two static balance tests, the Balance Error Scoring System (BESS) test and the Stork Balance Standing test, and two dynamic balance tests, the Y Balance test and the Pirouette test, were conducted prior to and after the core exercises. RESULTS: The core exercise program significantly improved balance results for the Y Balance Test composite score (86.0 ± 6.3% pre vs 88.4 ± 5.3% post, p<0.05) and the BESS Test (22.7 ± 8.0 errors pre vs 16.1 ± 7.0 errors post, p<0.05). There were no significant differences between pre and post intervention scores of the Stork Balance Standing test or the Pirouette test. CONCLUSIONS: Including core exercises in a dancer’s warm-up before practices and performances may have an acute positive effect on balance for dancers, which could translate to improvements in performance. It is unclear if a core exercise program can acutely improve dance skill-specific balance, such as during pirouettes.

A-16 The Clinical Utility of a Novel Dual-Task Assessment for Sport-Related Concussion in Collegiate Athletes

Abstract Objective To compare the clinical utility of a novel dual-task assessment for sport-related concussion (SRC) to other commonly-used clinical measures in collegiate athletes. Method Participants consisted of 38 collegiate athletes (19 concussed and 19 matched comparisons, 53% male, age = 20.0 ± 1.34 years, height = 178.2 ± 12.12 cm, mass = 83.4 ± 21.89 kg). Participants were administered the dual-task assessment, Balance Error Scoring System (BESS), Standardized Assessment of Concussion (SAC), and tandem gait (TG) test within 48 hours (T1), at 5 days (T2), and when symptom-free (T3) following a diagnosed SRC. The novel dual-task assessment consisted of concurrent administration of the SAC and TG. The ImPACT and Sensory Organization Test (SOT) were administered at T3 in alignment with the university’s concussion management policy. Sensitivity, specificity, and diagnostic accuracy using receiver operator curve analyses were calculated for each measure for T1-T3 using previously established interpretation guidelines. Results For sensitivity, a range of values were observed from T1-T3 for the dual-task (88%–37%), BESS (47%–47%), SAC (53%–26%), TG test (53%–11%). Similarly, a range of specificity values were observed for the dual-task (58%–84%), BESS (84%–63%), SAC (79%–84%), and TG test (95%–100%) from T1-T3. At T3, the ImPACT and SOT were observed to have a sensitivity of 32% and 100% and specificity of 16% and 100%, respectively. A range of diagnostic accuracy values were observed from T1-T3 for the dual-task (84%–62%), BESS (59%–50%), SAC (64%–56%), TG test (82%–71%), ImPACT (T3 = 66%), and SOT (T3 = 50%). Conclusions The dual-task assessment had comparable or higher diagnostic accuracy as other commonly-used clinical measures of SRC throughout clinical recovery in collegiate athletes.

Static balance ability of persons with visual impairment on firm and foam surfaces

The Balance Error Scoring System (BESS) is an easily administered test of short duration static In daily activities including sports, people with low vision (partially sighted) or partial blindness and visual impairment face difficulty while balancing their body in static positions. The purpose of this study is to test and stability of people with low vision or partially sightedness (PS) and full blindness (FB) using BESS test. The BESS was used to measure the error in the range from 0 for excellent balance and 10 for very poor balance. A total of 106 volunteers participated in the study that included 43 PS (mean age = 17.5y, SD = 3.2y) and 63 FB (mean age = 20y, SD = 3.4y) volunteers. The test for the BESS was taken for Non-Dominant Leg (NDL) and Dominant Leg (DL). Descriptive statistics and non-parametric tests were carried out. The study revealed that all the combinations of correlation between Firm Surface (FS) and Foam Surface (FOS) were statistically significant at p<.05. Test of age, height, and weight of the PS and FB group indicated significant differences between the groups in these variables. Surface firmness is less effective in evaluating for persons with visual impairments.

Using Variance to Explore the Diagnostic Utility of Baseline Concussion Testing.

The Graded Symptom Checklist (GSC), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and King-Devick Test (KDT) are considered important components of concussion assessment. Whether baseline testing improves the diagnostic utility of these tests remains unclear. We performed an observational cohort study to investigate the within-subject and between-subjects variability of these tests over repeated assessments during two football seasons to examine whether baseline testing reduces variability in test performance. Thirty-five male collegiate football players completed weekly clinical concussion assessments over two seasons. Within-subject (week-to-week) and between-subjects (player-to-player) variability for each test were compared using a bootstrap analysis. Within-subject and between-subjects proportions of overall variance for each test score were calculated. Mixed-model analyses were used to quantify practice effects resulting from repeated testing. For the GSC and BESS, within-subject and between-subjects variability did not significantly differ. For the KDT, the proportion of within-subject variance (20.2%) was significantly less than the between-subjects variance (79.8%). For SAC, however, the proportion of within-subject variance (66.8%) was significantly greater than the between-subjects variance (33.8%). A small, but significant, practice effect was observed for the BESS and KDT tests. When athletes are evaluated during a football season for concussion using the GSC, SAC, and BESS, comparing their scores to baseline performance is likely no more beneficial than comparing them to normative population data for identifying neurological changes associated with concussion. For the KDT, comparison to baseline testing is likely beneficial because of significantly higher between-subjects variability.

QUANTITATIVE ANALYSIS OF THE RESULTS OBTAINED BY THE FUNCTIONAL TESTING WITH THE SWAYTM BALANCE APPLICATION IN RELATION TO NORMS FOR APPROPRIATE GENDER AND AGE

The Balance Error Scoring System (BESS) is a common balance test relying on assessment tools such as the SwayTM Balance application for IOS mobile, encompassing the tri-axial accelerometers and movement sensors to measure bodily sway. Given that age and gender are important factors when using this methodology, suitable normative score sets were determined. The main aim of this study was a quantitative analysis of the ability of healthy, 21-year-old participants of both genders to maintain postural balance using the aforementioned normative values. The postural balance scoring was done by the co-application of the modified BESS test and SwayTM Balance software during a protocol organized in three-week double-scoring sessions. In order to assess the participants’ age- and gender-dependent abilities, the average balance score medians were contextualized with the appropriate normative values. All of the participants showed average results, with scores ameliorating during the procedure, and the female participants showed generally better results than the males. Focusing solely on the first-session scores revealed, however, that men had scored at the low average cut-off point, while women scored below average age- and sex-dependent cut-off points. However, in the last session both genders scored deeply within the average. This study showed average abilities of the studied participants according to the normative values, as well as a generally better performance of the women compared to the men, but it has also pointed out that, due to subject adaptation, the chosen combination of protocol and technology is of limited usefulness for balance assessment in the general population, indicating the need for protocol adjustments in future studies.

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.

Fat-Free Mass and the Balance Error Scoring System Predict an Appropriate Maximal Load in the Unilateral Farmer's Walk.

This study quantified and compared unilateral farmer’s walk (UFW) performance in recreationally active males and females, and determined if additional variables allowed for the prediction of a maximal safe load. Anthropometric (height, body weight (BW), body mass index, body fat percentage, fat-free mass (FFM), and fat mass), muscular endurance (maximal duration side bridge), and balance (Balance Error Scoring System (BESS)) tests were completed. Participants performed a series of 20 s UFW trials (non-dominant side) at a cadence of 66 beats/min. The initial load was 10% of BW and increased by 10% per trial until deviations in spinal alignment or compromised gait patterns were noted, and the series was terminated. The highest load carried before technical failure was recorded. Descriptive and comparative statistics and a stepwise linear regression analysis were utilized to determine relationships between UFW performance and anthropometric, muscular endurance, and balance tests. Males (N = 25) were significantly taller (177.3 ± 6.7 vs. 164.7 ± 7.2 cm, p < 0.05), heavier (81.7 ± 7.0 vs. 62.0 ± 9.4 kg, p < 0.05), and leaner (14.4 ± 4.4 vs. 22.4 ± 4.8%, p < 0.05) than females (N = 26). Further, males had a higher amount of FFM (p < 0.05) than females. The males (52.2 ± 9.0, 64% BW) carried a higher average UFW load than the females (32.5 ± 7.1 kg, 53% BW, p < 0.05). FFM was strongly predictive of UFW load (load = −9.88876 + 0.88679 × (FFM); r2 = 0.774, p < 0.0001). The addition of the BESS test further increased the accuracy of the prediction equation (r2 = 0.800, p < 0.0001). There are differences in UFW performance ability between males and females. As our method does not account for all potential confounding variables, the use of these equations should be combined with technique analysis and participant feedback to ensure an appropriate workload.

Cleveland Clinic Postural Stability Index Norms for the Balance Error Scoring System.

Despite the widespread utilization of the Balance Error Scoring System (BESS) in the evaluation of concussion, it has been criticized for its error-based scoring that is susceptible to floor and ceiling effects and substantial inter-rater variability. A biomechanical outcome, Cleveland Clinic Postural Stability Index (CC-PSI), has been developed as an alternative to subjective BESS scoring. The CC-PSI uses inertial sensor data within a mobile device to provide an objective measure of postural sway during the BESS. This project aimed to determine the effect of age and sex on the CC-PSI and report normative values for healthy, active children, adolescents, and young adults. A cross-sectional sample of 6762 student-athletes completed BESS testing. Participants were stratified according to three age groups for each sex. The groups included the following: youth (age, 5-13 yr), males (n = 360), females (n = 246); high school (age, 14-18 yr), males (n = 3743), females (n = 1673); and college (age, 19-23 yr), males (n = 497), females (n = 243). Percentile rankings were determined for each participant to characterize movement of COM in the medial-lateral, anterior-posterior, and trunk rotation directions relative to the entire cohort during the BESS stances. Overall, postural stability was worse in youth compared with high school and collegiate athletes. Specifically, the CC-PSI was significantly worse in youth male athletes compared with high school and collegiate male athletes (P < 0.001). Females exhibited significantly better scores compared with males in youth and high school cohorts (P < 0.01). The CC-PSI provides a quantitative, objective measure of postural stability, overcoming the limitations associated with conventional BESS scoring. Optimal concussion management should use objective age- and sex-specific values in the evaluation of postural stability. The normative values of the CC-PSI may be used in the absence of a baseline BESS evaluation to aid clinical decision making.

Efficacy of Tandem Gait to Identify Impaired Postural Control after Concussion.

The purpose was to evaluate tandem gait (TG), Balance Error Scoring System (BESS), and modified Balance Error Scoring System (mBESS) performance acutely after concussion in collegiate student-athletes. In addition, we sought to evaluate the psychometric properties of TG, including minimal detectable change (MDC), sensitivity, and specificity. Seventy-six National Collegiate Athletic Association student-athletes performed TG and BESS tests: 38 acutely after concussion and 38 controls. Participants were tested at baseline (time 1) and again acutely after concussion, or the following year for controls (time 2). Ten controls, tested simultaneously by two researchers, established a TG interrater minimal detectable change. A 2 × 2 mixed-design ANOVA compared each outcome variable. An receiver operating characteristic curve analysis was used to evaluate sensitivity, specificity, and area under the curve (AUC). There was a significant interaction (F = 8.757, P = 0.004) for TG whereby the concussion group was slower after concussion (10.59 ± 1.53 vs 11.80 ± 2.67 s), whereas there was no difference for controls (10.13 ± 1.72 vs 9.93 ± 1.85 s). There was no significant interaction for BESS (F = 0.235, P = 0.630) or mBESS (F = 0.007, P = 0.935). TG had a sensitivity of 0.632, a specificity of 0.605, and an AUC of 0.704. BESS had a sensitivity of 0.447, a specificity of 0.500, and an AUC of 0.508. mBESS had a sensitivity of 0.474, a specificity of 0.632, and an AUC of 0.535. Participants completed TG significantly slower after concussion, whereas no change across time was detected for controls. In contrast, BESS and mBESS performances were similar at both testing times in both groups. Our AUC analysis was acceptable for TG, but a failure for both BESS and mBESS; thus, TG may be a useful alternative for clinicians conducting postconcussion postural control assessments.

Smartphone virtual reality to increase clinical balance assessment responsiveness

ObjectiveTo determine if a low cost smartphone based, clinically applicable virtual reality (VR) modification to the standard Balance Error Scoring System (BESS) can challenge postural stability beyond the traditional BESS. DesignCross-sectional study. SettingUniversity research laboratory. Participants28 adults (mean age 23.36 ± 2.38 years, mean height 1.74 m ± 0.13, mean weight 77.95 kg ± 16.63). Main outcome measuresBESS postural control errors and center of pressure (CoP) velocity were recorded during the BESS test and a VR modified BESS (VR-BESS). The VR-BESS used a headset and phone to display a rollercoaster ride to induce a visual and vestibular challenge to postural stability. ResultsThe VR-BESS significantly increased total errors (20.93 vs. 11.42, p < 0.05) and CoP velocity summed across all stances and surfaces (52.96 cm/s vs. 37.73 cm/s, p < 0.05) beyond the traditional BESS. ConclusionThe VR-BESS provides a standardized, and effective way to increase postural stability challenge in the clinical setting. The VR-BESS can use any smartphone technology to induce postural stability deficits that may otherwise normalize with traditional testing. Thus, providing a unique relatively inexpensive and simple to operate clinical assessment tool and∖or training stimulus.

Integration of a Complex Balance Task into a Concussion Management Protocol Specific to Dancers

Mechanisms for concussions in dance include drops from lifting, falls from stage sets, and contact with the floor or fellow dancers that happen during class, rehearsal, or performances. Despite the recent awareness of sports-related concussions, there are gaps in knowledge regarding dance-specific concussions and what a “return to dance” protocol should look like for dancers. Although dance is not a high-impact sport like football or rugby, concussions still occur and can be calamitous for a collegiate and professional dancer’s career. Balance tests, standard in concussion management protocols, are useful tools for evaluating the motor domain of balance functioning and are considered reliable and valid assessments of athletes suffering from concussions. PURPOSE: Develop and investigate a complex balance task to integrate into a concussion management protocol specific to dancers. METHODS: 31 participants, pre-professional dancers (n=12) and recreational dancers (n=19), completed an multipart evaluation to assess static and dynamic balance. They were tested using the Balance Error Scoring System (BESS) test which assessed static balance through performing 3 stances on surfaces (ground and Airex Balance Pad). The modified Dance BESS (DBESS) test assessed static and dynamic balance of the participants through performing 10 dance movements on 3 surfaces (ground, Airex Balance Pad and foam balance beam). Participants were monitored and scored for errors on each balance test. RESULTS: Pre- professional dancers and recreational dancers were not significantly different for static balance on the BESS and DBESS (p>0.05). There was significant difference between the pre-professional dancers and recreational dancers (p<0.05) for the dynamic balance conditions in the Dance BESS. CONCLUSIONS: More skilled dancers show greater differences with dynamic balance conditions. Thus, creation of more dynamic balance tasks would be useful for baseline and post concussion testing and aid in the overall tracking during the concussion rehabilitation period for dancers.

Simple Low-Cost Virtual Reality to Improve the Responsiveness of Clinical Balance Assessment

Concussions commonly affect postural stability, which incorporates the visual, vestibular, and somatosensory system. Postural stability post-concussion is commonly quantified via the Balance Error Scoring System (BESS). However, the BESS may not sufficiently challenge postural stability in an athletic population allowing potential deficits to go unquantified. Virtual reality (VR) devices may be capable of providing an increased visual-vestibular integration challenge to improve BESS responsiveness. PURPOSE: Determine if a low cost and clinically applicable VR modification to the standard BESS can provide a superior challenge to postural stability than the traditional BESS. METHODS: Twenty-eight adults (mean age 23.36 ± 2.38 years, mean height 1.74 m ± 0.13, mean weight 77.95 kg ± 16.63) were recruited. All individuals performed the standard BESS test and a VR modified BESS (VR-BESS) on a force plate. All participants completed a familiarization session to practice the traditional BESS and VR-BESS. Participants then performed two trials of the traditional BESS or VR-BESS in a counter-balanced randomized order. The VR-BESS used a headset (Google Cardboard) and phone (LG V10) to display a rollercoaster ride (FIBRUM) to induce a visual and vestibular challenge to postural stability. BESS postural control errors and center of pressure (CoP) velocity were averaged for the two trials and used for analyses. Separate repeated measures ANOVAs were conducted for the BESS errors and CoP velocity. Post hoc testing was conducted for the condition by stance by surface interaction with an alpha level set at p<0.05 with a Bonferroni correction for multiple comparison analyses. RESULTS: The overall repeated measures ANOVA was significant for BESS errors (F(2,26)=6.37, p=.003) and CoP velocity (F(2,26)=5.19, p=.008).The VR-BESS significantly increased total errors (20.93 vs. 11.42, p<0.05) and CoP velocity summed across all stances and surfaces (52.96 cm/s vs. 37.73 cm/s, p<0.05) beyond the traditional BESS. CONCLUSION: VR-BESS provides a standardized, efficient, and effective way to challenge postural stability to a greater extent than the traditional BESS. With technology quickly advancing and becoming less expensive, this modification may be immediately incorporated into balance training and assessment.