Balance Error Scoring System (BESS)

The Balance Error Scoring System provides a portable, cost effective and objective method of assessing static postural stability. The BESS can be used to assess the effects of mild head injury on static postural stability.

Information obtained from this clinical balance tool can be used to assist clinicians in making return to play decisions following milk head injury. The BESS can be performed in nearly any environment and takes approximately 10 minutes to conduct.

The balance testing regime consists of three stances on two different surfaces. The three stances are double leg stance, single leg stance and tandem stance. The two different surfaces include both a firm (ground) and foam surface.

The athlete will stand with hands on hips and eyes closed with a consistent foot position depending on the stance. Shoes should not be worn. In the double leg stance, the feet are flat on the testing surface approximately pelvic width apart. In the single leg stance position, the athlete is to stand on the non-dominant leg with the contralateral limb held in approximately 20° of hip flexion, 45° of knee flexion and neutral position in the frontal plane.

In the tandem stance, one foot is placed in front of of the other with heel of the anterior foot touching the toe of the posterior foot. The athlete’s non-dominant leg is in the posterior position. Leg dominance should be determined by the athlete’s kicking preference.

Administration

Establish baseline score prior to the start of the athletic season. After a concussive injury, re-assess the athlete and compare to baseline score. Only consider return to activity if scores are comparable to baseline score. Use with Standardized symptom Scale Checklist.

Scoring

Each of the trials is 20 seconds. Count the number ofd errors from the proper stance. The examiner should begin counting errors only after the individual has assumed the proper testing position.

Errors:

  • Moving hands off of hips
  • Opening eyes
  • Step, stumble or fall
  • Abduction or flexion of the hip beyond 30°
  • Lifting the forefoot or heel off of the testing surface
  • Remaining out of the proper testing position for greater than 5 seconds

*The maximum total number of errors for any single condition is 10. If a subject commits multiple errors simultaneously, only one error is recorded.

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