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Stephen M. Glass, Alessandro Napoli, Elizabeth D. Thompson, Iyad Obeid and Carole A. Tucker

and testing protocols, 3 , 4 but such methods are seldom used for wide-scale or field-based testing due to their prohibitive cost and lack of accessibility. Where laboratory methods are impractical, field-based tests may be used in their place. The balance error scoring system (BESS) 5 and its

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Jason P. Mihalik, Elizabeth F. Teel, Robert C. Lynall and Erin B. Wasserman

Key Points ▸ Balance Error Scoring System scores were worse while wearing skates. ▸ Balance Error Scoring System scores (traditional and skates) were only moderately correlated. ▸ The Balance Error Scoring System (traditional and skates) had low overall reliability. Over 1 million youth athletes

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Ainaz Shamshiri, Iman Rezaei, Ehsan Sinaei, Saeed Heidari and Ali Ghanbari

of balance assessment tools has been developed to date, including clinical tests, which are inherently inexpensive and easily obtainable, designed for a clinical context. 3 The Balance Error Scoring System (BESS) is an easy-to-administer test widely used to evaluate static postural stability. 1 , 3

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Eamon T. Campolettano, Gunnar Brolinson and Steven Rowson

athletes in assessing postural control in athletes is the Balance Error Scoring System (BESS). 13 The BESS is a clinical, static balance assessment that is easy to administer and may be used without instrumented testing devices. 17 The BESS testing protocol is described in the methods section of this

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Jeremy A. Patterson, Ryan Z. Amick, Priyanka D. Pandya, Nils Hakansson and Michael J. Jorgensen

Context:

The most widely used method for postural balance assessment relies on the subjective observations of a test administrator. Accelerometry has been shown to provide a valid and reliable method for assessment of balance, and recent advances in microelectromechanical systems have made the technology available in mobile electronic devices.

Objective:

To compare a mobile technology application with a commonly used subjective balance assessment.

Setting:

Biomechanics laboratory.

Participants:

Twenty-one nonathlete college-aged individuals (7 men, 14 women; mean age 23 ± 3 years) volunteered to participate. Subjects were excluded if they reported any preexisting condition that might affect postural balance.

Results:

A strong inverse correlation was found between the scores for the two balance assessment methods (r = -.767, p < .01).

Conclusions:

Advances in technology have provided an attractive means to objectively quantify postural balance with off-the-shelf mobile consumer electronic devices.

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Jaclyn B. Caccese, Thomas A. Buckley and Thomas W. Kaminski

The Balance Error Scoring System (BESS) is often used for sport-related concussion balance assessment. However, moderate intratester and intertester reliability may cause low initial sensitivity, suggesting that a more objective balance assessment method is needed. The MobileMat BESS was designed for objective BESS scoring, but the outcome measures must be validated with reliable balance measures. Thus, the purpose of this investigation was to compare MobileMat BESS scores to linear and nonlinear measures of balance. Eighty-eight healthy collegiate student-athletes (age: 20.0 ± 1.4 y, height: 177.7 ± 10.7 cm, mass: 74.8 ± 13.7 kg) completed the MobileMat BESS. MobileMat BESS scores were compared with 95% area, sway velocity, approximate entropy, and sample entropy. MobileMat BESS scores were significantly correlated with 95% area for single-leg (r = .332) and tandem firm (r = .474), and double-leg foam (r = .660); and with sway velocity for single-leg (r = .406) and tandem firm (r = .601), and double-leg (r = .575) and single-leg foam (r = .434). MobileMat BESS scores were not correlated with approximate or sample entropy. MobileMat BESS scores were low to moderately correlated with linear measures, suggesting the ability to identify changes in the center of mass–center of pressure relationship, but not higher-order processing associated with nonlinear measures. These results suggest that the MobileMat BESS may be a clinically-useful tool that provides objective linear balance measures.

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Jaclyn B. Caccese and Thomas W. Kaminski

Context:

The Balance Error Scoring System (BESS) is the current standard for assessing postural stability in concussed athletes on the sideline. However, research has questioned the objectivity and validity of the BESS, suggesting that while certain subcategories of the BESS have sufficient reliability to be used in evaluation of postural stability, the total score is not reliable, demonstrating limited interrater and intrarater reliability. Recently, a computerized BESS test was developed to automate scoring.

Objective:

To compare computerderived BESS scores with those taken from 3 trained human scorers.

Design:

Interrater reliability study.

Setting:

Athletic training room.

Patients:

NCAA Division I student athletes (53 male, 58 female; 19 ± 2 y, 168 ± 41 cm, 69 ± 4 kg).

Interventions:

Subjects were asked to perform the BESS while standing on the Tekscan (Boston, MA) MobileMat® BESS. The MobileMat BESS software displayed an error score at the end of each trial. Simultaneously, errors were recorded by 3 separate examiners. Errors were counted using the standard BESS scoring criteria.

Main Outcome Measures:

The number of BESS errors was computed for the 6 stances from the software and each of the 3 human scorers. Interclass correlation coefficients (ICCs) were used to compare errors for each stance scored by the MobileMat BESS software with each of 3 raters individually. The ICC values were converted to Fisher Z scores, averaged, and converted back into ICC values.

Results:

The double-leg, single-leg, and tandem-firm stances resulted in good agreement with human scorers (ICC = .999, .731, and .648). All foam stances resulted in fair agreement.

Conclusions:

Our results suggest that the MobileMat BESS is suitable for identifying BESS errors involving each of the 6 stances of the BESS protocol. Because the MobileMat BESS scores consistently and reliably, this system can be used with confidence by clinicians as an effective alternative to scoring the BESS.

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Mason D. Smith and David R. Bell

Context:

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.

Objective:

The purpose of this study is to determine if postural-control deficits are present in individuals with ACLR as measured by the BESS.

Participants:

Thirty participants were included in this study. Fifteen had a history of unilateral ACLR and were compared with 15 matched controls.

Interventions:

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.

Main Outcome Measures:

Each participant performed 3 trials of each stance (18 total), and errors were assessed during each trial and summed to create a total score.

Results:

We observed a significant group × 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).

Conclusions:

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.

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Rebecca L. Dubas, Elizabeth F. Teel, Melissa C. Kay, Eric D. Ryan, Meredith A. Petschauer and Johna K. Register-Mihalik

students who were trained by the lead investigator of the study. The SCAT-3 is a widely used sideline concussion screening tool that evaluates symptoms, balance, and cognitive outcomes. The SCAT-3 recommends participants complete either the Balance Error Scoring System (BESS) or tandem gait task to assess

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Ian McGinnis, Justin Cobb, Ryan Tierney and Anne Russ

pursuits, saccadic eye movements, near-point convergence testing, vestibulo-ocular reflex testing, visual motion sensitivity testing, the Balance Error Scoring System (BESS) test, and the Sensory Organization Test (SOT). 7 Most individuals who experience a sport-related concussion will clinically recover