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Balance Error Scoring System (BESS)
Balance Error Scoring System (BESS)
| Availability |
Please visit this website for more information about the instrument: Balance Error Scoring System (BESS)
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| Classification |
Core: Sport-Related Concussion (SRC) Acute (time of injury until 72 hours)
Supplemental: Sport-Related Concussion (SRC) Subacute (after 72 hours to 3 months) and Persistent/Chronic (3 months and greater post concussion), and Traumatic Brain Injury (TBI)
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| Short Description of Instrument |
In the Balance Error Scoring System (BESS), three stances all held with eyes closed—double-leg stance with hands on hips and feet together, single-leg stance using the non-dominant foot and a heel-toe stance with the non-dominant foot in the rear—are held for 20 seconds each on a firm surface. The number of balance errors is recorded for each trial. Balance errors include moving the hands off the iliac crests, opening the eyes, step stumble or fall, abduction or flexion of the hip beyond 30°, lifting the forefoot or heel off the testing surface, and remaining out of the proper testing position for greater than 5 seconds.
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| Scoring |
The BESS is calculated by adding on error point for each error during the three 20-second tests. A maximum of 10 errors can be counted for any single condition. If the individual is unable to maintain the testing procedure for a minimum of 5 seconds, from start, the highest possible score of 10 is assigned for that testing condition.
A standard testing protocol is administered and the test can be completed in under 10 minutes.
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| Rationale/Justification |
The test may be administered to children or adults and in military or civilian populations.
The BESS is inexpensive, easy to administer, and has been used extensively to assess athletes' balance on the playing field after injury.
Age Range: 13 to 40
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| References |
Concussion in Sports Group (2013). SCAT3TM Sport Concussion Assessment Tool - 3rd edition. Accessed: 2015 March 23. Available at: http://bjsm.bmj.com/content/47/5/259.full.pdf.
Echemendia RJ, Bruce JM, Meeuwisse W, Hutchison MG, Comper P, Aubry M. Can visible signs predict concussion diagnosis in the National Hockey League? Br J Sports Med. 2017 Apr 4. pii: bjsports-2016-097090. doi: 10.1136/bjsports-2016-097090.
Furman GR, Lin CC, Bellanca JL, Marchetti GF, Collins MW, Whitney SL. Comparison of the balance accelerometer measure and balance error scoring system in adolescent concussions in sports. Am J Sports Med. 2013;41(6):1404-1410.
Guskiewicz KM. Postural stability assessment following concussion: one piece of the puzzle. Clin J Sport Med. 2001;11(3):182-189.
Guskiewicz KM. Balance assessment in the management of sport-related concussion. Clin Sports Med. 2011;30(1):89-102, ix.
Guskiewicz KM, Ross SE, Marshall SW. Postural Stability and Neuropsychological Deficits After Concussion in Collegiate Athletes. J Athl Train. 2001;36(3):263-273.
Hunt TN, Ferrara MS, Bornstein RA, Baumgartner TA. The reliability of the modified Balance Error Scoring System. Clin J Sport Med. 2009;19(6):471-475.
Iverson GL, Koehle MS. Normative data for the modified balance error scoring system in adults. Brain Inj. 2013;27(5):596-599.
McCrory P, Meeuwisse W, Aubry M, Cantu B, Dvorak J, Echemendia RJ, Engebretsen L, Johnston K, Kutcher JS, Raftery M, Sills A; SchneiderK, Tator CH, Benson BW, Davis GA, Ellenbogen RG, Guskiewicz KM, Herring SA, Iverson G, Jordan BD, Kissick J, McCrea M, McIntosh AS, Maddocks DL, Makdissi M, Purcell L, Putukian M, Turner M, Schneider K, Tator CH. Consensus statement on concussion in sport--the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Clin J Sport Med. 2013;23(2):89-117.
National Football League (2009). NFL Sideline Concussion Assessment Tool. Accessed: 2015 March 23. Available at: http://nflps.org/wp-content/uploads/2012/08/NFL_SIDELINE_TOOL-POST_INJURY_Final.pdf.
Riemann BL, Guskiewicz KM. Effects of mild head injury on postural stability as measured through clinical balance testing. J Athl Train. 2000;35(1):19-25.
Riemann BL, Guskiewicz KM, Shields EW. Relationship between clinical and forceplate measures of postural stability. J Sport Rehabil. 1999;8(2):71-82.
Document last updated July 2019
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| Recommended Instrument for |
SRC and TBI
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