The
Balance Error Scoring System (BESS) is a clinical tool used to assess postural stability and balance. Initially developed for adults, it has been adapted for use in
pediatric populations to evaluate balance impairments that may arise due to a
concussion or other neurological conditions. The BESS is often used in school settings, sports programs, and clinical environments to monitor recovery and guide return-to-play decisions.
The BESS test consists of three stance conditions (double-leg, single-leg, and tandem stance) performed on two different surfaces (firm and foam). Each stance is held for 20 seconds while the examiner counts the total number of errors. Errors include lifting hands off the iliac crests, opening eyes, stepping or stumbling, moving the hip into more than 30 degrees of flexion or abduction, lifting the forefoot or heel, and remaining out of the test position for more than five seconds.
Adapting the BESS for pediatric use involves some modifications to account for the developmental differences between children and adults. For example, younger children may have more difficulty maintaining the test positions due to their developing motor skills. Therefore, allowances may be made for slight variations in stance or balance, and the
scoring criteria might be adjusted to be more lenient. Additionally, using child-friendly language and instructions can help ensure the child understands the tasks.
The primary benefit of using the BESS in pediatric populations is its ability to provide a quantifiable measure of balance, which can be critical in diagnosing and managing
concussions and other balance-related conditions. It helps healthcare providers make informed decisions about a child's readiness to return to activities, thereby reducing the risk of further injury. The test is also non-invasive, quick to administer, and does not require expensive equipment.
While the BESS is a valuable tool, it does have some limitations when used with children. Younger children may have inherent variability in balance, making it difficult to distinguish between normal developmental differences and actual balance impairments. Additionally, the test may not be sensitive enough to detect subtle balance issues in children, necessitating the use of complementary assessments such as the
Pediatric Balance Scale or the
Bruininks-Oseretsky Test of Motor Proficiency.
Interpreting BESS scores in a pediatric context requires an understanding of age-appropriate norms. While specific normative data for children are limited, general trends indicate that balance improves with age and practice. Higher error scores typically suggest greater balance impairment. Clinicians often compare pre-injury and post-injury scores to assess the impact of an injury and track recovery, rather than relying solely on absolute scores.
To ensure accurate and reliable results when administering BESS to children, follow these best practices:
Provide clear, age-appropriate instructions and demonstrations of each stance.
Create a calm and supportive environment to reduce anxiety and distractions.
Use consistent scoring criteria and record any deviations from the standard protocol.
Consider the child's developmental stage and adjust the test as necessary.
Combine BESS with other balance and functional assessments for a comprehensive evaluation.
Conclusion
The Balance Error Scoring System (BESS) offers a practical and effective method for assessing balance in pediatric populations. By understanding the unique considerations when using BESS with children, healthcare providers can better diagnose balance impairments, manage recovery, and make informed decisions about safe return to activities. Despite its limitations, BESS remains a valuable tool in the pediatric clinical toolkit when used appropriately.
