Sports Medicine Research: In the Lab & In the Field: BESS Test Can Be A Screen for Concussions and Need for Ankle Rehab (Sports Med Res)


Monday, October 12, 2015

BESS Test Can Be A Screen for Concussions and Need for Ankle Rehab

Balance error scoring system stances that identify division I athletes with chronic ankle instability most in need of rehabilitation

Dobo B., White A., Linens S. Athl Train Sports Health Care. 2015; 7(5): 190-196

Take Home Message: Single-leg and tandem stances on a foam surface may be a quick and inexpensive screening tool for athletes who need a preventative ankle rehabilitation program.

Recurrent ankle sprains negatively impact a patient’s life. Screening tools for chronic ankle instability could lead to improved interventions. Many sports medicine clinics have little equipment or time to establish a screening assessment for every joint. However, many medical professionals use the balance error scoring system (BESS) test, which could serve a dual purpose for concussion assessment and ankle screening. Therefore, the authors had 51 Division I collegiate athletes (32 with reported chronic ankle instability and 19 healthy participants) perform the BESS test to determine which stances athletes with chronic ankle instability were more likley to perform poorly. The athletes performed the BESS test based on a concussion testing protocol except that all the trials were recorded using a video camera. The athletic trainer scored the errors by reviewing the video at a later time. The authors found that the single leg stance on a foam surface or the tandem leg stance on a foam surface were most effective at correctly identifying those with or without chronic ankle instability. The authors also identified the number of errors that would ideally identify those with chronic ankle instability: single leg stance on foam surface (more than 5 errors) and tandem leg stance on foam surface (more than 3 errors).

Overall the authors found that the single-leg and tandem stances on a foam surface may be an accurate screen for Division I athletes with chronic ankle instability. These patients may  need preventative ankle rehabilitation to decrease risk of ankle re-injury. The results make sense, if you decrease the base of support and alter the surface; someone with ankle instability is going to have trouble balancing. Further research is necessary in a larger cohort with a wider array of athletes to further validate the cut-off, which should be conducted with an evaluator that is blinded to whether the athlete reported chronic ankle instability or not. It is important to note that the BESS scoring used a video recording. This adds some cost to conducting the BESS test but an advantage is that the athletic trainer could review the video at their convenience and rewind the video if needed. This could be a time efficient strategy for using the BESS test as part of a prescreening protocol. Ultimately, these authors provide evidence that medical professionals could use the BESS test, particularly the two stances, to screen for athletes that need ankle rehabilitation.

Questions for Discussion: Would you use the BESS to screen for chronic ankle instability? Do you think results would be similar for those with knee instability?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

Related Posts:
Differences Among Sports and Teams on Baseline Concussion Performance

Dobo, B., White, A., & Linens, S. (2015). Balance Error Scoring System Stances That Identify Division I Athletes With Chronic Ankle Instability Most in Need of Rehabilitation Athletic Training & Sports Health Care, 7 (5), 190-196 DOI: 10.3928/19425864-20150831-04


Ryan Eddy said...

I would just like to know if they are doing the concussion screen and ankle instability screen at the same time. This was a little unclear. Its difficult to do both at the same time. When testing balance for concussion, you are testing the non dominant leg. So if the participants dont have ankle instability in that ankle, then the deficits will be for concussion. If they do have ankle instability, how do you determine if the deficits are due to concussion or ankle instability? Also when you test the dominant leg, you are no longer doing the BESS test for concussion so the results cannot be extrapolated for concussion symptoms.

Jane McDevitt said...

Hello Ryan,
The authors were not assessing for concussion in this study. They were really looking at the BESS test and its ability to identify athletes with chronic ankle instability. They used the same testing protocol except for the fact that some of the athlete in the chronic ankle instability group used the dominant leg. To clarify further, during the single leg and tandem stances the control group always used their non dominant limb. However, the "non dominant" limb for the ankle instability group was determined by which leg they most associated with giving way. Future research needs to assess if the BESS test is still a reliable measure when someone reports non dominant ankle instability.

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