Emergency Medicine Book


Balance Error Scoring System

Aka: Balance Error Scoring System, BESS
  1. See Also
    1. Sport Concussion Assessment Tool (SCAT2)
  2. Indications
    1. Sideline Concussion evaluation in age over 10 years
  3. Preparation
    1. Shoes off and pants (if worn) rolled up to ankle
    2. Ankle taping removed
    3. Athlete stands with eyes closed and hands at hips
    4. Two surfaces
      1. Firm, flat ground
      2. Block of foam large enough to stand on
        1. Included in the original BESS, but not in the SCAT2
    5. Three positions for 20 seconds each
      1. Double leg stance (both feet on the ground)
      2. Single leg stance (balance on one leg)
      3. Tandem stance (toes of one foot to heel of the other)
    6. Observe for balance errors (1 point for each error)
      1. Stepping
      2. Stumbling
      3. Opening eyes
      4. Hands lifted above the iliac crests
      5. Forefoot or heel lifted
      6. Hip moved >30 degrees flexion or abduction
      7. Out of test position >5 seconds
  4. Technique: Balance Testing
    1. Patient performs 3 stances for 20 seconds each
      1. Count the number of times they move during each 20 second period
      2. Timer starts when the patient closes their eyes
      3. If stumbles out of position
        1. Open eyes, return to position and timing will resume
    2. Double leg stance (maximum of 10 errors)
      1. Feet together
      2. Hands on hips
      3. Eyes closed
    3. Single leg stance (maximum of 10 errors)
      1. Stand on non-dominant foot
      2. Lift the dominant leg (kicking leg)
        1. Hip flexion 30 degrees
        2. Knee flexion 45 degrees
    4. Tandem stance (maximum of 10 errors)
      1. Stand heel to toe with non-dominant foot in back
      2. Distribute weight equally on each foot
  5. Interpretation
    1. Total score is 30 minus the cummulative errors on each of the 3 stances
    2. Maximum total score is 30 points
    3. Average of 12 errors following Concussion (when 3 stances each on ground and foam block are performed)
  6. Resources
    1. Sport Concussion Assessment Tool ( SCAT2)
  7. References
    1. Guskiewicz (2003) Current Sports Medicine Reports 2: 24-30
    2. Guskiewicz (2001) Clin J Sport Med 11:182-9 [PubMed]




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