Key Points ▸ The modified Star Excursion Balance Test (mSEBT) should be used as a reliable clinical tool to assess dynamic postural control. We propose a compact version of the mSEBT for clinicians. ▸ All three directions as well as the composite score should be evaluated independently. ▸ Procedure
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Brice Picot, Romain Terrier, Nicolas Forestier, François Fourchet, and Patrick O. McKeon
Kunal Bhanot, Navpreet Kaur, Lori Thein Brody, Jennifer Bridges, David C. Berry, and Joshua J. Ode
Dynamic balance (DB) is the ability to maintain the center of mass over a stable base of support while performing a task. Core stability is considered an important aspect of DB, 1 , 2 and deficits in DB have been related to injuries in the athletic populations. 3 The Star Excursion Balance Test
Jupil Ko, Erik Wikstrom, Yumeng Li, Michelle Weber, and Cathleen N. Brown
Balance impairments are linked to an increased risk of injury in those with a history of a lateral ankle sprain and chronic ankle instability (CAI). 1 , 2 The Star Excursion Balance Test (SEBT) is one of the most common dynamic balance tests used to identify balance deficits in individuals with
Emily H. Gabriel, Cameron J. Powden, and Matthew C. Hoch
functional tasks, have been implemented specifically to identify associations with lower-extremity injury occurrence. Two of the more established lower-extremity injury screening assessments include the Star Excursion Balance Test (SEBT) and Y-Balance Test (YBT). 7 , 8 Both the SEBT and YBT are lower
Jay Hertel, S. John Miller, and Craig R. Denegar
0bjective:
To estimate intratester and intertester reliability and learning effects during the Star Excursion Balance Tests (SEBTs).
Setting:
A university athletic training research laboratory.
Subjects:
Sixteen healthy volunteers with no history of balance disorders or significant lower extremity joint pathology.
Measurements:
Length of excursion was measured manually for each trial.
Results:
ICCs for intratester reliability were .78–.96 on day 1 and 32–.96 on day 2. ICCs for intertester reliability were .35–.84 on day 1 and .81–.93 on day 2. Significant learning effects were identified for 4 of the 8 tests.
Conclusions:
Estimates of intratester and intertester reliability were high, but adequate practice trials should be performed before taking baseline measures.
Jennifer Erin Earl and Jay Hertel
Objective:
To identify integrated EMG (I-EMG) activity of 6 lower-extremity muscles during the 8 Star Excursion Balance Tests (SEBTs).
Design and Setting:
Repeated measures, laboratory setting.
Subjects:
10 healthy young adults.
Interventions:
The SEBTs require the subject to balance on the stance leg and maximally reach with the contralateral foot along each of 8 lines extending from a common axis at 45° intervals.
Measures:
I-EMG activity of the vastus medialis obliquus (VMO), vastus lateralis (VL), medial hamstring (MH), biceps femoris (BF), anterior tibialis (AT), and gas-trocnemius.
Results:
Significant differences were found in all muscles (P < .05) except the gastrocnemius (P = .08). VMO and VL activity tended to be greatest with anteriorly directed excursions, whereas the MH and BF activity were greatest with posteriorly directed excursions. AT activity was lowest with the lateral excursion.
Conclusions:
Performance of the different SEBTs results in different lower-extremity muscle-activation patterns.
Richard Robinson and Phillip Gribble
Context:
The Star Excursion Balance Test (SEBT) is composed of 8 reaching directions that are potentially measuring the same functional component, leading to the suggestion that the number of reach directions could be reduced without compromising the assessment of dynamic postural control.
Objective:
To determine whether the relationship of stance-leg angular displacement on normalized reach distance is a source of dynamic-postural-control measurement redundancy.
Design:
Single-session within-subjects design.
Setting:
Athletic training research laboratory.
Participants:
10 women and 10 men.
Interventions:
None.
Main Outcome Measures:
Normalized reach distance and angular displacement at the knee and hip.
Results:
Stepwise regression revealed that hip flexion and knee flexion, separately and in combination, accounted for 62% to 95% of the variance in reach distances.
Conclusion:
Similarity in lower extremity function could account for the previously observed measurement redundancy in the SEBT.
Tyler R. Keith, Tara A. Condon, Ayana Phillips, Patrick O. McKeon, and Deborah L. King
The Star Excursion Balance Test (SEBT) is a valid and reliable measure of dynamic postural control. Center of pressure (COP) behavior during the SEBT could provide additional information about direction-dependent SEBT balance strategies. The purpose of this study was to quantify spatiotemporal COP differences using COP area and velocity among three different SEBT reach directions (anterior, posteromedial, posterolateral). The anterior direction COP velocity was significantly lower than both posterior directions. However, the anterior COP area was significantly greater than posterior. Based on COP behavior, the anterior and posterior reach directions appear to use different postural control strategies on the SEBT.
Beth Norris and Elaine Trudelle-Jackson
Context:
The Star Excursion Balance Test (SEBT) is often used to train and assess dynamic balance and neuromuscular control. Few studies have examined hip- and thigh-muscle activation during the SEBT.
Objective:
To quantify hip- and thigh-muscle activity during the SEBT.
Design:
Repeated measures.
Setting:
Laboratory.
Participants:
22 healthy individuals, 11 men and 11 women.
Methods:
EMG measurements were taken as participants completed 3 trials of the anterior (A), medial (M), and posteromedial (PM) reach directions of the SEBT.
Main Outcome Measures:
Mean EMG data (% maximal voluntary isometric contraction) from the gluteus medius (Gmed), gluteus maximus (Gmax), and vastus medialis (VM) were measured during the eccentric phase of each SEBT reach direction. Test–retest reliability of EMG data across the 3 trials in each direction was calculated. EMG data from each muscle were compared across the 3 reach directions.
Results:
Test–retest reliability ranged from ICC3,1 values of .91 to .99. A 2-way repeated-measure ANOVA revealed a significant interaction between muscle activation and reach direction. One-way ANOVAs showed no difference in GMed activity between the A and M directions. GMed activity in the A and M directions was greater than in the PM direction. There was no difference in GMax and VM activity across the 3 directions.
Conclusion:
GMed was recruited most effectively when reaching was performed in the A and M directions. The A, M, and PM directions elicited similar patterns of muscle recruitment for the GMax and VM. During all 3 SEBT directions, VM activation exceeded the 40–60% threshold suggested for strengthening effects. GMed activity also exceeded the threshold in the M direction. GMax activation, however, was below the 40% threshold for all 3 reach directions, suggesting that performing dynamic lower extremity reaching in the A, M, and PM directions may not elicit strengthening effects for the GMax.
Maude Bastien, Hélène Moffet, Laurent Bouyer, Marc Perron, Luc J. Hébert, and Jean Leblond
The Star Excursion Balance Test (SEBT) has frequently been used to measure motor control and residual functional deficits at different stages of recovery from lateral ankle sprain (LAS) in various populations. However, the validity of the measure used to characterize performance—the maximal reach distance (MRD) measured by visual estimation—is still unknown.
Objectives:
To evaluate the concurrent validity of the MRD in the SEBT estimated visually vs the MRD measured with a 3D motion-capture system and evaluate and compare the discriminant validity of 2 MRD-normalization methods (by height or by lower-limb length) in participants with or without LAS (n = 10 per group).
Results:
There is a high concurrent validity and a good degree of accuracy between the visual estimation measurement and the MRD gold-standard measurement for both groups and under all conditions. The Cohen d ratios between groups and MANOVA products were higher when computed from MRD data normalized by height.
Conclusion:
The results support the concurrent validity of visual estimation of the MRD and the use of the SEBT to evaluate motor control. Moreover, normalization of MRD data by height appears to increase the discriminant validity of this test.
