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Balance Error Scoring System Modified (BESS-Modified)
| Availability |
Please visit this website for more information about the instrument: Balance Error Scoring System Modified |
| Classification |
Supplemental for Traumatic Brain Injury (TBI) |
| Short Description of Instrument |
In the Balance Error Scoring System Modified (BESS-M), 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 of the iliac crests, opening the eyes, step stumble or fall, abduction or flexion of the hip beyond 30°, lifting the forefoot or heel off of the testing surface, and remaining out of the proper testing position for greater than 5 seconds. |
| Scoring |
The Bess-M 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. |
| Rationale/Justification |
The test may be administered to children or adults and in military or civilian populations.
The BESS- M is inexpensive, easy to administer, and has been used extensively to assess athletes' balance on the playing field after injury.
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| References |
Concussion in Sports Group (2013). SCAT3TM Sport Concussion Assessment Tool - 3rd edition. Retrieved 3/23, 2015, from http://bjsm.bmj.com/content/47/5/259.full.pdf.
Guskiewicz, K. M. (2001). Postural stability assessment following concussion: one piece of the puzzle. Clin J Sport Med, 11(3), 182-189.
Guskiewicz, K. M. (2011). Balance assessment in the management of sport-related concussion. Clin Sports Med, 30(1), 89-102, ix.
Guskiewicz, K. M., Ross, S. E., & Marshall, S. W. (2001). Postural Stability and Neuropsychological Deficits After Concussion in Collegiate Athletes. J Athl Train, 36(3), 263-273.
Hunt, T. N., Ferrara, M. S., Bornstein, R. A., & Baumgartner, T. A. (2009). The reliability of the modified Balance Error Scoring System. Clin J Sport Med, 19(6), 471-475.
Iverson, G. L., & Koehle, M. S. (2013). Normative data for the modified balance error scoring system in adults. Brain Inj, 27(5), 596-599.
McCrory, P., Meeuwisse, W., Aubry, M., Cantu, B., Dvorak, J., Echemendia, R. J., . . . Tator, C. H. (2013). Consensus statement on concussion in sport--the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Clin J Sport Med, 23(2), 89-117.
National Football League (2009). NFL Sideline Concussion Assessment Tool. Retrieved 3/23, 2015, from
http://nflps.org/wp-content/uploads/2012/08/NFL_SIDELINE_TOOL-POST_INJURY_Final.pdf. Riemann, B. L., & Guskiewicz, K. M. (2000). Effects of Mild Head Injury on Postural Stability as Measured Through Clinical Balance Testing. J Athl Train, 35(1), 19-25.
Riemann, B. L., Guskiewicz, K. M., & Shields, E. W. (1999). Relationship between clinical and forceplate measures of postural stability. J sport Rehabil, 8(2), 71-82.
Document last updated April 2020
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