Total Balance Error Scoring System Score Research Articles

Balance abilities in high dynamic-sport athletes with different maximal voluntary contraction

Background: Previous studies have shown that muscle force control during submaximal isometric contractions is associated with the ability of dynamic balance to a greater extent than static balance in healthy adults. However, the effect of maximal voluntary contraction (MVC) on balance abilities of athletes with high dynamicsport, which are most popular in Thailand, needs to be addressed. Objective: To determine static and balance abilities of high dynamic-sport athletes at different levels of MVC. Materials and methods: Three groups of high dynamic-sport athletes at different levels of maximal voluntary contraction (MVC), were voluntarily recruited using a sports matrix classification. Outcome measures comprised the Balance Error Scoring System (BESS) and the Star Excursion Balance Test (SEBT). Correlations between BESS and SEBT and confounding variables comprised of performance time of the Mcgill core endurance tests (Core), single-leg sit-to-stand (STS) test, and flexibility were investigated using Pearson’s correlation. After controlling for Core and STS, a factorial analysis of covariance (ANCOVA) was used to determine group differences in SEBT and BESS variables. Results: Athletes with high- and low- MVC had significantly different reaching distances in all SEBT directions (all, p<0.05). Significant differences between the high- and the moderate- MVC groups were observed in anterior and lateral directions (p<0.05). A significant difference between the moderate- and the low MVC groups was found in the medial direction (p<0.05). After controlling for Core and STS, the observed group differences disappeared, except in the posterolateral reaching distance between the high- and the low-MVC groups (p<0.05). A significant difference between the high- and the low-MVC groups was only observed in the total foam BESS scores with tandem stance (p<0.05) and then disappeared after adjusting for Core and STS (all, p>0.05). Conclusion: The observed differences in all SEBT directions among groups and the difference in the total BESS scores between the high- and the low- MVC, which were observed only in challenged conditions i.e., tandem-foam stance, suggested that dynamic, but not static balance performance of athletes with high dynamicsport appears to be associated with the magnitude of MVC. Core and STS, but not flexibility, are considered significant contributions to their balance performance.

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.

The Effects of Proprioceptive Training on Balance, Strength, Agility and Dribbling in Adolescent Male Soccer Players.

The aim of the study was to determine the effects of proprioceptive training (PT) on balance, strength, agility and dribbling in adolescent soccer players. In this research, we included an experimental (n = 48) and a control (n = 48) group (CG) with 14 years old players. The experimental group (EG) participated in an 8 week PT program, with four 30 min sessions per week. The experimental program included 12 bosu ball exercises to improve balance, stability and strength which were grouped into two subprograms: the first not using the soccer ball, the second subprogram using the soccer ball. The subprograms were implemented alternately during 16 proprioceptive training sessions, on two types of firm and foam surfaces. Pre- and post-tests included the static balance [Balance Error Scoring System (BESS)], vertical, horizontal, and lateral jumping, and the completion of agility (“arrowhead”) and dribbling (“short dribbling”) tests. Regarding the total BESS score, the CG has demonstrated progress between the pre- and the post-test, with 0.780 ± 0.895, fewer errors, while the EG had 5.828 ± 1.017 fewer errors. The difference between the two groups was of 5.148 fewer errors for the EG who had practiced the proposed program of proprioceptive training. The highest difference registered between the pre- and the post-test was at the test “single-leg forward jump with the right leg”, with a result of 1.083 ± 0.459 cm for the CG and of 3.916 ± 0. 761 cm for the EG. Through the analysis of average differences between the pre- and the post-tests, we observe that, regarding the “Agility right side test”, the EG has progressed with 0.382 s in comparison with the CG; regarding the “Agility left side test”, the EG has progressed with 0.233 s compared to the CG; regarding the “Agility right and left side test”, the EG has progressed with 0.196 s compared to the CG; in the “Short dribbling test”, the EG has progressed with 0.174 s compared to the CG. The highest progress was made at the “Agility right side test”, of 0.402 s for the EG, while the CG registered 0.120 s. Most of the results in all tests for both experimental groups show an effect size ranging from small to medium. The progress made by the experimental group in all tests was statistically significant, while in the control group the progress was mostly statistically insignificant for p < 0.05. The results suggest that a PT program performed at about 14 years of age could be successfully implemented in the training regime of soccer players to improve components of fitness along with dribbling skills. The results of the study revealed that sports training on the foam surfaces determined a superior progress of the development of proprioception compared to the increased training on the firm surfaces.

Differences in Corticoreticulospinal Tract Injuries According to Whiplash in Mild Traumatic Brain Injury Patients.

Background: This study investigated differences in postural control ability (PCA) and corticoreticulospinal tract (CRT) injury severity according to whiplash in patients with mild traumatic brain injury (mTBI).Methods: Thirty-one patients with mTBI and 21 healthy control subjects were recruited for this study. The balance error scoring system (BESS) was used for PCA assessment. Based on their whiplash history, the patients were classified into two groups: group A—mTBI with whiplash injury; group B—mTBI without whiplash injury. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), and tract volume (TV) values were estimated for the reconstructed CRTs in all subjects.Results: Significant differences were observed among the total BESS scores of patient groups A and B and the control group (p < 0.05). The patient group A BESS score was significantly higher than that of patient group B, and that of the patient group B was significantly higher than that of the control group. No significant differences were detected among the FA and ADC values of the CRTs of the two patient groups and the control group (p > 0.05). However, the TV values of the CRT did reveal significant differences; the TV of patient group A was significantly lower than those of patient group B and the control group, and that of patient group B was significantly lower than that of the control group (p < 0.05).Conclusions: We observed greater CRT injury severity and PCA impairment in mTBI patients with whiplash than in mTBI patients without whiplash. The results indicate that whiplash might lead to a greater level of severity in axonal injuries in mTBI patients.

Influence of biological maturity on static and dynamic postural control among male youth soccer players

BackgroundPeak height velocity has been reported to be associated with the phenomenon of adolescent awkwardness, a temporary disruption in motor skills, and an increase in injuries in some adolescents. To date, it is not entirely clear which motor abilities are deficient during the phase of rapid growth. Research questionWe hypothesized that static as well as dynamic postural control is influenced by biological maturation. MethodsThe study was conducted in a prospective, cross-sectional design. Maturity offset, a somatic indicator for biological maturation was captured for n = 99 male soccer players (13.7 ± 0.5 years). Static and dynamic balance were assessed by the Balance Error Scoring System (BESS) and the Y-Balance Test (YBT), respectively. Influences of biological maturation on balance performances have been analyzed by linear mixed models. ResultsLinear mixed model analyses revealed that biological maturation is significantly associated with the total BESS score (p = 0.022, b = 2.195) as well as the YBT anterior (right leg: p = 0.023, b = -0.022; left leg: p = 0.015, b = -0.024) and posteromedial reach directions (left leg: p = 0.02, b = -0.029). No significant associations were found for the other YBT distances. SignificanceBased on our results, maturation seems to have a considerable influence on postural control. It might be that deficits in balance performance contribute to the phenomenon of adolescent awkwardness and therefore lead to an increased injury risk during the adolescent growth spurt. To possibly prevent injuries in youth soccer, biological maturation should be taken into consideration in youth sport coaching.

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.

The Utility of the Balance Error Scoring System for Mild Brain Injury Assessments in Children and Adolescents

The Balance Error Scoring System (BESS) is widely recognized as an acceptable assessment of postural control for adult patients following a mild traumatic brain injury (mTBI) or concussion. However, the measurement properties of the BESS as a post-mTBI assessment test for younger patients are not well understood. The purpose of this study was to evaluate the utility of the BESS as a post-mTBI assessment test for children and adolescents aged 8 to 18 years through 2 investigations: (1) a retrospective medical records review of the relationship among age, BESS scores, and other common post-mTBI assessment tests; and (2) a prospective study comparing BESS scores for a cohort of children with a recent mTBI and BESS scores for a cohort of matched healthy peers. Age was found to be significantly correlated with several of the BESS measures and the total BESS score (P < 0.05). Significant differences were observed between the injured and healthy cohorts for 3 of the BESS measures and the total BESS score. However, the observed differences were not likely to be clinically meaningful. Cumulatively, evidence from the literature and the results of these studies indicate that the BESS may be limited for producing accurate assessments of younger athletes' post-mTBI postural control abilities. Future research recommendations include testing of modified versions of the BESS or other alternatives for post-mTBI postural control assessments with younger individuals.

Development and Validation of an Objective Balance Error Scoring System

Limited access to sophisticated technology and the unreliability of simple tools prevent accurate and reliable human standing balance assessments outside research laboratory settings. The goal of this study was to develop and validate a simple objective balance assessment tool that provides an accurate, reliable, and affordable alternative to currently available laboratory and clinical methods. Thirty healthy subjects were filmed performing the Balance Error Scoring System (BESS) while wearing inertial measurement units (IMU) measuring linear accelerations and angular velocities from seven locations of the body: forehead, sternum, waist, right and left wrist, and right and left shin. Each video was scored by four experienced BESS raters, whose mean scores were used to develop an algorithm computing objective BESS (oBESS) scores solely from IMU data. Interrater reliability and accuracy of oBESS scores were assessed using intraclass correlations (ICC). Raters displayed low variability in scoring (ICC3,1 = 0.91). The oBESS was able to produce scores with accurate fit to raters (ICC3,1 = 0.92) and predicted individual BESS scores (ICC3,1 = 0.90) using data from one IMU placed at the forehead. oBESS was unable to produce accurate scores (ICC3,1 = 0.68) when using IMU data from the subset of conditions (firm surface only) used in popular concussion identification protocols. The oBESS can reliably predict total BESS scores in healthy subjects. Pending further validation, oBESS could represent a valid tool to assess balance by offering an objective and reliable alternative to the current scoring methods of the BESS.

Sport and Team Differences on Baseline Measures of Sport-Related Concussion

With the advent of the National Collegiate Athletic Association's (NCAA's) mandating the presence and practice of concussion-management plans in collegiate athletic programs, institutions will consider potential approaches for concussion management, including both baseline and normative comparison approaches. To examine sport and team differences in baseline performance on a computer-based neurocognitive measure and 2 standard sideline measures of cognition and balance and to determine the potential effect of premorbid factors sex and height on baseline performance. Cross-sectional study. University laboratory. A total of 437 NCAA Division II student-athletes (males = 273, females = 164; age = 19.61 ± 1.64 years, height = 69.89 ± 4.04 inches [177.52 ± 10.26 cm]) were recruited during mandatory preseason testing conducted in a concussion-management program. The computerized Concussion Resolution Index (CRI), the Standardized Assessment of Concussion (Form A; SAC), and the Balance Error Scoring System (BESS). Players on the men's basketball team tended to perform worse on the baseline measures, whereas soccer players tended to perform better. We found a difference in total BESS scores between these sports (P = .002). We saw a difference between sports on the hard-surface portion of the BESS (F6,347 = 3.33, P = .003, ηp(2) = 0.05). No sport, team, or sex differences were found with SAC scores (P > .05). We noted differences between sports and teams in the CRI indices, with basketball, particularly the men's team, performing worse than soccer (P < .001) and softball/baseball (P = .03). When sex and height were considered as possible sources of variation in BESS and CRI team or sport differences, height was a covariate for the team (F1,385 = 5.109, P = .02, ηp(2) = 0.013) and sport (F1,326 = 11.212, P = .001, ηp(2) = 0.033) analyses, but the interaction of sex and sport on CRI indices was not significant in any test (P > .05). Given that differences in neurocognitive functioning and performance among sports and teams exist, the comparison of posttraumatic and baseline assessment may lead to more accurate diagnoses of concussion and safer return-to-participation decision making than the use of normative comparisons.

Negative Effects on Postural Control After Anterior Cruciate Ligament Reconstruction as Measured by the Balance Error Scoring System

Anterior cruciate ligament (ACL) reconstruction is the standard of care for individuals with ACL rupture. Balance deficits have been observed in patients with ACL reconstruction (ACLR) using advanced posturography, which is the current gold standard. It is unclear if postural-control deficits exist when assessed by the Balance Error Scoring System (BESS), which is a clinical assessment of balance. The purpose of this study is to determine if postural-control deficits are present in individuals with ACLR as measured by the BESS. Thirty participants were included in this study. Fifteen had a history of unilateral ACLR and were compared with 15 matched controls. The BESS consists of 3 stances (double-limb, single-limb, and tandem) on 2 surfaces (firm and foam). Participants begin in each stance with hands on their hips and eyes closed while trying to stand as still as possible for 20 s. Each participant performed 3 trials of each stance (18 total), and errors were assessed during each trial and summed to create a total score. We observed a significant group x stance interaction (P = .004) and a significant main effect for stance (P < .001). Post hoc analysis revealed that the ACLR group had worse balance on the single-leg foam stance than did controls. Finally, the reconstructed group had more errors when total BESS score was examined (P = .02). Balance deficits exist in individuals with ACLR as measured by the BESS. Total BESS score was different between groups. The only condition that differed between groups was the single-leg stance on the unstable foam surface.

Comparison of the Balance Accelerometer Measure and Balance Error Scoring System in Adolescent Concussions in Sports

Background: High-technology methods demonstrate that balance problems may persist up to 30 days after a concussion, whereas with low-technology methods such as the Balance Error Scoring System (BESS), performance becomes normal after only 3 days based on previously published studies in collegiate and high school athletes. Purpose: To compare the National Institutes of Health’s Balance Accelerometer Measure (BAM) with the BESS regarding the ability to detect differences in postural sway between adolescents with sports concussions and age-matched controls. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Forty-three patients with concussions and 27 control participants were tested with the standard BAM protocol, while sway was quantified using the normalized path length (mG/s) of pelvic accelerations in the anterior-posterior direction. The BESS was scored by experts using video recordings. Results: The BAM was not able to discriminate between healthy and concussed adolescents, whereas the BESS, especially the tandem stance conditions, was good at discriminating between healthy and concussed adolescents. A total BESS score of 21 or more errors optimally identified patients in the acute concussion group versus healthy participants at 60% sensitivity and 82% specificity. Conclusion: The BAM is not as effective as the BESS in identifying abnormal postural control in adolescents with sports concussions. The BESS, a simple and economical method of assessing postural control, was effective in discriminating between young adults with acute concussions and young healthy people, suggesting that the test has value in the assessment of acute concussions.

Systematic Review of the Balance Error Scoring System

Context:The Balance Error Scoring System (BESS) is commonly used by researchers and clinicians to evaluate balance.A growing number of studies are using the BESS as an outcome measure beyond the scope of its original purpose.Objective:To provide an objective systematic review of the reliability and validity of the BESS.Data Sources:PubMed and CINHAL were searched using Balance Error Scoring System from January 1999 through December 2010.Study Selection:Selection was based on establishment of the reliability and validity of the BESS. Research articles were selected if they established reliability or validity (criterion related or construct) of the BESS, were written in English, and used the BESS as an outcome measure. s were not considered.Results:Reliability of the total BESS score and individual stances ranged from poor to moderate to good, depending on the type of reliability assessed. The BESS has criterion-related validity with force plate measures; more difficult stances have higher agreement than do easier ones. The BESS is valid to detect balance deficits where large differences exist (concussion or fatigue). It may not be valid when differences are more subtle.Conclusions:Overall, the BESS has moderate to good reliability to assess static balance. Low levels of reliability have been reported by some authors. The BESS correlates with other measures of balance using testing devices. The BESS can detect balance deficits in participants with concussion and fatigue. BESS scores increase with age and with ankle instability and external ankle bracing. BESS scores improve after training.

Relationships between Balance and Functional Performance in Football Players

Relationships between Balance and Functional Performance in Football Players The aim of the present study was to examine the relationships between balance performance as measured by the Balance Error Scoring System and functional performance in football players. Twenty-two football players from University League Final Group in Turkey (age 23.05 ± 1.65 years, height 176.58 ± 6.99 cm, weight 68.80 ± 7.00 kg) volunteered to participate in the study. Postural performance was measured by the Balance Error Scoring System (BESS). For functional performance, standing broad jump, triple-hop, vertical jump, four-line sprint and three-corner run test were used. There was not a statistically significant relationship among the all BESS scores and triplehop in non-dominant leg, power, four-line sprint, and three-corner run performances (p&lt;0.05). Triple-hop in dominant leg performance correlated with foam surface, tandem leg and total BESS score (r = 0.755, p &lt; 0.01; r = 0.664, p &lt; 0.05; r = 0.713, p&lt; 0.01, respectively). Standing broad jump performance correlated with foam surface, tandem leg and total BESS score (r = 0.737, p &lt; 0.01; r = 0.692, p &lt; 0.05; r = 0.617, p&lt; 0.05, respectively). There was a statistically significant relationship among the single leg BESS score and vertical jumping performance (r = -0.596, p&lt;0.05). In conclusion, the activities requiring explosive power may reflect the ability of managing a balanced posture but the activities in which time period is longer may not.

Intrarater and Interrater Reliability of the Balance Error Scoring System (BESS)

The purpose of this study was to determine the intrarater and interrater reliability of the Balance Error Scoring System (BESS). A prospective observational study. Academic sports medicine center. Three scorers participated in this study. Three scorers experienced in using the BESS viewed a videotape depicting 30 consecutive individuals performing the BESS stance positions. The 3 scorers independently scored each of the 30 videotaped individuals using the BESS scoring criteria. A week later, the same 3 subjects viewed and scored the videotape again. The interrater and intrarater reliability of the BESS was determined using intraclass correlation coefficients (ICC), reported with 95% confidence intervals. The minimum detectible change was also determined. The interrater and intrarater reliability ICCs for the total BESS scores were 0.57 and 0.74, respectively. The interrater reliability ICCs for the 6 different stance positions were between 0.44 and 0.83, while the intrarater reliability ICCs were between 0.50 and 0.88. The interrater and intrarater minimum detectible change for the total BESS score were 9.4 and 7.3 points, respectively. This study suggests that certain subcategories of the BESS have sufficient reliability to be used in the evaluation of postural stability but that the total BESS score is not reliable. In addition, a change in score of greater than 9.4 (interrater) or 7.3 (intrarater) points is required before the change in postural stability can be attributed to the balancer rather than to the scorer.

Return of Postural Control to Baseline After Anaerobic and Aerobic Exercise Protocols

With regard to sideline concussion testing, the effect of fatigue associated with different types of exercise on postural control is unknown. To evaluate the effects of fatigue on postural control in healthy college-aged athletes performing anaerobic and aerobic exercise protocols and to establish an immediate recovery time course from each exercise protocol for postural control measures to return to baseline status. Counterbalanced, repeated measures. Research laboratory. Thirty-six collegiate athletes (18 males, 18 females; age = 19.00 +/- 1.01 years, height = 172.44 +/- 10.47 cm, mass = 69.72 +/- 12.84 kg). Participants completed 2 counterbalanced sessions within 7 days. Each session consisted of 1 exercise protocol followed by postexercise measures of postural control taken at 3-, 8-, 13-, and 18-minute time intervals. Baseline measures were established during the first session, before the specified exertion protocol was performed. Balance Error Scoring System (BESS) results, sway velocity, and elliptical sway area. We found a decrease in postural control after each exercise protocol for all dependent measures. An interaction was noted between exercise protocol and time for total BESS score (P = .002). For both exercise protocols, all measures of postural control returned to baseline within 13 minutes. Postural control was negatively affected after anaerobic and aerobic exercise protocols as measured by total BESS score, elliptical sway area, and sway velocity. The effect of exertion lasted up to 13 minutes after each exercise was completed. Certified athletic trainers and clinicians should be aware of these effects and their recovery time course when determining an appropriate time to administer sideline assessments of postural control after a suspected mild traumatic brain injury.

Postural Control Deficits in Participants with Functional Ankle Instability as Measured by the Balance Error Scoring System

To determine if postural control deficits are present in participants with functional ankle instability (FAI) as measured by the Balance Error Scoring System (BESS). We used a between-groups design to assess postural control. All testing was conducted in a university athletic training facility. Sixty collegiate Division I athletes were included in this study. Thirty participants had functional ankle instability and thirty participants had no history of ankle injuries. Postural control was measured using the BESS. The BESS test battery requires participants to stand unsupported on two different surfaces (firm and foam) in three different stances (double, single, and in tandem). Each condition lasted 20 seconds. The number of errors were calculated for each individual condition and then summed to produce a total BESS score. We found a significant group by condition interaction (F5,290 = 5.12, P < 0.001) and significant main effects for group (F1,58 = 16.01, P < 0.001) and condition (F5,290 = 228.88, P < 0.001). Post hoc analyses revealed that subjects with functional ankle instability scored more errors (poorer balance) on the single stancefirm condition (2.9 +/- 2.1 versus 1.6 +/- 1.3 errors), tandem stancefoam condition (4.3 +/- 2.4 versus 2.7 +/- 1.6 errors), single stancefoam condition (7.0+/-1.6 versus 5.6 +/- 1.8 errors), and total BESS score (15.7 +/- 6.0 versus 10.7 +/- 3.2). Postural control deficits were identified in participants with functional ankle instability using the BESS. These deficits could be a contributing factor to the repeated episodes of instability and giving way that often occurs following an inversion ankle sprain. These results suggest the BESS, traditionally used for monitoring recovery from mild head injury, may also be useful in screening athletes for postural deficits following lower extremity injury.