Balance Error Scoring System Performance in Children and Adolescents With No History of Concussion

Sports Health. 2015 Jul;7(4):341-5. doi: 10.1177/1941738115571508.


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.

Keywords: balance; concussion; pediatrics; postural stability; traumatic brain injury.