Reference values for the balance error scoring system in adolescents

Abstract

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.

Keywords:

• Concussion
• mTBI
• postural stability
• normative

Acknowledgements

We would like to thank Mitch Smelis, AT, ATC and Kirk Cabanilla AT, ATC for their assistance in participant recruitment for the study.

Declaration of interest

This project was funded by Dr. Ben F. Bryer Foundation Medical Research Fund and by the University of Michigan-Flint’s Research and Creative Activity (RCA) Award. The authors report no other conflicts of interest.