Balance Error Scoring System (BESS) Flashcards
What does it assess?
Static postural stability
In the absence of expensive sophisticated postural stability assessment tools, 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 clinicans in making return to paly decisions following mild head injury
Materaials:
Two testing surfaces are needed to complete the BESS test: floor/ ground and foam pad
1a) floor/ground - any level surface is appropratite
1b) Foam Pad (power systems airex balance pad 81000)
Dimensions: Length: 10”m Width: 10” height 2.5”
The purpose of the goam pad is to create an unstable surface and a more challenging balance task, which varies by body wt. It has been hypothesized that as body weight increases the foam will deform to a greater degree around the foot. The heavier the person the more the foam will deform. As the foam deforms around the foot, there is an icnrease in support on the latearl surfaces of the foot. The icnreased contact area between the foot and foam has also been theorized to increase the tactile sense of the foot, also helping to icnrease postural stability. The increase in tactile sense will cause additional sensory information to be sent to the CNS. AS the brain processes this information it can make better decisions when responding to the unstable foam surface.
2) Stop watch
- necessary for timing the subjects during the 6 20 second trials
3) An assistant to act as a spotter
- the spotter is necessary to assist the subject should they become unstable and begin to fall. The spotters attention is especially important during the foam surface
4) BESS testing Protocol
- These instructions should be read to the subject during administration of the BESS
BESS Test Adminstration
1) Before administering the BESS, the following materials should be present:
- Foam pad
- Stop Watch
- Spotter
- BESS Testing Protocol
- BESS Score Card
2) Before Testing, instruct the idnividual to rmove shoes and any ankle taping if necessary. Socks may be worn if desired
3) Read the instructions to the subject as they are written in the BESS testing protocol.
4) Record errors on the BESS score card as they are described below
Scoring the BESS
* Each of the twenty-second trials is scored by counting the errors, or deviations from the proper stance, accumlated by the subject. The examiner will begin counting errors only after the idnividual has assumed the proper testing positions
Errors: An error is credited to the subject when any of the following occur:
* Moving the hands off of the iliac crests
* OPening the eyes
* Step / stumble / fall
* Abduction or flexion of the hip beyond 30 degrees
* Lifting the forefoot or heel off the testing surface
* Remaining out of the proper testing position for greater than 5 seconds
What is the max # of errors pt can have on the BESS?
10
If subject commits multiple errors simultaneously, only one error is recorded. For
NOTE: Individiuals who are unable to maintain the testing procedure for a minimum of five seconds are assigned the highest possible score, ten, for that testing condition
So its 6 trials at 20 seconds each and you’re counting errors
* 3 w/ flat surface 3 w/ mat
A and D: Double leg stance: Standing on a firm surface w/ feet side by side (touching), hands on hips and eyes closed
B&E: Single leg stance: Standing on a firm surface on the non-dominant foot, the hip is flxesed to approximately 30 degrees and the knee is flexed to 45. Hands are on the hips and eyes are closed
C&F: Tandem Stance: Standing heel to toe on a firm surface with a non-dominate foot in the back. Heel of the dominant foot should be touching the toe of the non-dominant foot. Hands are on the hips and eyes are closed
Are eyes closed or open during the BESS?
Closed
Script for the BESS Testing Protocol:
Please take your shoes off, roll up your pant legs above ankle, and remove any ankel taping
This test will consist of 6 twenty second tests with three different stance on two different surfaces
Double Leg Stance
* This will be feet together
* You will be standing w/ your hands on your hips w/ eyes closed. You should try to maintain stability in that position for the entire 20 seconds. I will be counting the # of times you move out of this position. For example: if you take your hands off your hips, open your eyes, take a step, lift your toes or your heels, If you move out of the testing stance, simply open your eyes, regain your balance, get back into the testing position as quickly as possible and close your eyes again
Single Leg Stance:
* If you were able to kick a ball which foot will you use - do find their dominant foot
* Now stand on non-dominant foot
* before continuing the test assess the position of the dominant leg as such: The dominant leg should be held in approximately 30 degrees of hip flexion and 45 degrees of knee flexion
* Again you should try to maintain stability for 20 seconds w/ your eyes closed. I will begin counting the number of times you move out of this position
* PLace your hands on your hips. When you close your eyes the testing time will begin.
Tandem Stance:
* Now stand heel to toe w/ your nondominant foot in back
* Your wt should be evenly distributed across both feet
* Again, you should try to maintain stability for 20 seconds w/ your eyes closed. Will begin counting the # of times you move outof this position
* Place your ahnds on your hips. When you close your eyes the testing time will begin
Then repeat all these instructions ecept on foam pad
Max error points = 60
10 for each trial possible
