title: Assessing postural stability in the concussed athlete: what to do, what to expect, and when.
abstract: BACKGROUND
  Postural stability assessment is included as part of the diagnostic and monitoring process for sports-related concussions. Particularly, the relatively simple Balance Error Scoring System (BESS) and more sophisticated force plate measures like the Sensory Organization Test (SOT) are suggested.
  
  
  METHODS
  RELEVANT STUDIES WERE IDENTIFIED VIA THE FOLLOWING ELECTRONIC DATABASES: PubMed, MEDLINE, EMBASE, Web of Science, ScienceDirect, and CINAHL (1980 to July 2013). Inclusion was based on the evaluation of postural sway or balance in concussed athletes of any age or sex and investigating the reliability or validity of the included tests.
  
  
  METHODS
  Clinical review.
  
  
  METHODS
  Level 4.
  
  
  RESULTS
  Both the SOT and the BESS show moderate reliability, but a learning effect due to repetitive testing needs to be considered. Both tests indicate that postural stability returns to baseline by day 3 to 5 in most concussed athletes. While the BESS is a simple and valid method, it is sensitive to subjectivity in scoring and the learning effect. The SOT is very sensitive to even subtle changes in postural sway, and thus, more accurate than the BESS; however, it is a rather expensive method of balance testing.
  
  
  CONCLUSIONS
  Both tests serve the purpose of monitoring balance performance in the concussed athlete; however, neither may serve as a stand-alone diagnostic or monitoring tool.
  B.
authors.affiliation: School of Health Professions, Murdoch University, Murdoch, Australia ; Praxis für Chiropraktik, Wolfsburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ruhe
authors.affiliation: Spine Centre of Southern Denmark, Hospital Lillebaelt, Middelfart, Denmark ; Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark.
authors.forename: René
authors.initials: R
authors.lastname: Fejer
authors.affiliation: Klinikum Wolfsburg, Department of Trauma Surgery, Orthopedics and Hand Surgery, Wolfsburg, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Gänsslen
authors.affiliation: Klinikum Wolfsburg, Department of Trauma Surgery, Orthopedics and Hand Surgery, Wolfsburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Klein
keywords: Balance Error Scoring System; Sensory Organization Test; balance; concussion; sports