title: Serial administration of clinical concussion assessments and learning effects in healthy young athletes.
abstract: OBJECTIVE
  To determine if serial administration of the Standardized Assessment of Concussion (SAC) and Balance Error Scoring System (BESS) would elicit a learning effect in young athletes and to determine the intratester reliability of scoring the BESS.
  
  
  METHODS
  A prospective study of 50 healthy young athletes who were assigned to either the control or practice group. All subjects were administered the assessments on 2 occasions, 60 days apart. In addition, subjects in the practice group received serial administration of the assessments on 3 occasions in the week following the initial assessment.
  
  
  METHODS
  University Sports Medicine/Athletic Training Research Laboratory.
  
  
  METHODS
  Fifty uninjured young athletes between 9 and 14 years of age.
  
  
  METHODS
  Scores on 2 clinical concussion assessments, the SAC and the BESS.
  
  
  RESULTS
  We found a significant learning effect upon serial BESS testing in the practice group. BESS error scores were significantly lower than baseline (15.0 +/- 4.6) on days 5 (11.3 +/- 5.33), 7 (12.4 +/- 6.2), and 60 (12.6 +/- 6.2). We also found a significant learning effect upon the day 60 BESS administration across all subjects. We did not find a practice or learning effect with serial SAC test administration. The intratester reliability of the investigator's ability to score repeated observations of the same BESS test ranged from 0.87 to 0.98.
  
  
  CONCLUSIONS
  Our results demonstrated that serial administration of the BESS elicited a learning effect, which was more prominent during the tandem conditions. Clinicians utilizing the BESS as a measure of postural stability should be aware of the potential for improvement with repeated testing. Clinicians should not expect improvement with the SAC, as scores remained relatively stable across all trials.
authors.affiliation: Department of Sports Health Care, Arizona School of Health Sciences, Mesa, AZ 85206, USA. tmcleod@atsu.edu
authors.forename: Tamara C
authors.initials: TC
authors.lastname: Valovich McLeod
authors.forename: David H
authors.initials: DH
authors.lastname: Perrin
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Guskiewicz
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Shultz
authors.forename: Robert
authors.initials: R
authors.lastname: Diamond
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Gansneder
mesh_terms: D000293:Adolescent; D001924:Brain Concussion / Q000150:complications / Q000175:diagnosis*; D002648:Child; D003943:Diagnostic Techniques, Neurological / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D004856:Postural Balance; D011446:Prospective Studies; D012678:Sensation Disorders / Q000175:diagnosis / Q000209:etiology; D013178:Sports Medicine / Q000295:instrumentation* / Q000379:methods*; D014163:Transfer, Psychology