Evaluation of postural stability in youth athletes: the relationship between two rating systems.
OBJECTIVE
The Balance Error Scoring System (BESS) has been documented as a useful way to evaluate postural control following sport-related concussions sustained by youth athletes. However, limitations have been reported with its use due to the reliance on visual observation as the primary measurement outcome. The primary purpose of this study was to examine the correlation between the modified BESS (mBESS) as rated by a clinician and a simultaneous analysis performed by an integrated video-force plate system. The secondary purpose was to assess if a history of prior concussion affected postural control.


METHODS
A group of healthy youth athletes (n = 398; mean age 13.7 ± 2.4 years) completed the mBESS while simultaneously undergoing an integrated video-force plate evaluation to measure postural stability. Spearman rank-order correlations were used to determine the strength of correlation between the 2 rating systems. In addition, performance on the mBESS between those with and without a history of concussion was compared using univariate ANCOVAs.


RESULTS
A moderately high correlation was found during single-leg stance (ρ = -0.64, p < .001), while a weak correlation was found during tandem stance (ρ = -0.30, p < .001). No postural control differences were found between groups with and without a concussion history.


CONCLUSIONS
The video-force plate rating system correlates well with the clinician rating during the single-leg stance of the mBESS, but not during double-leg or tandem stances. A history of concussion did not affect mBESS scores.
a The Micheli Center for Sports Injury Prevention , Waltham , MA , USA.|b Division of Sports Medicine , Boston Children's Hospital , Boston , MA , USA.|c Department of Orthopaedics , Boston Children's Hospital , Boston , MA , USA.|d Brain Injury Center , Boston Children's Hospital , Boston , MA , USA.
David R
DR
Howell
c Department of Orthopaedics , Boston Children's Hospital , Boston , MA , USA.|e Department of Orthopaedic Surgery , Harvard Medical School , Boston , MA , USA.
Benjamin J
BJ
Shore
a The Micheli Center for Sports Injury Prevention , Waltham , MA , USA.|b Division of Sports Medicine , Boston Children's Hospital , Boston , MA , USA.|c Department of Orthopaedics , Boston Children's Hospital , Boston , MA , USA.
Emily
E
Hanson
a The Micheli Center for Sports Injury Prevention , Waltham , MA , USA.|b Division of Sports Medicine , Boston Children's Hospital , Boston , MA , USA.|c Department of Orthopaedics , Boston Children's Hospital , Boston , MA , USA.|d Brain Injury Center , Boston Children's Hospital , Boston , MA , USA.|e Department of Orthopaedic Surgery , Harvard Medical School , Boston , MA , USA.
William P
WP
Meehan
D000293:Adolescent; D056352:Athletes; D001265:Athletic Injuries / Q000503:physiopathology*; D001696:Biomechanical Phenomena / Q000502:physiology; D001924:Brain Concussion / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D004856:Postural Balance / Q000502:physiology*
Postural balance; balance error scoring system; cerebral concussion; kinematics; kinetics