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Leungbootnak A, Puntumetakul R, Chatprem T, Sae-Jung S, Boucaut R. Validity and reliability of the Balance Error Score System (BESS) Thai version in patients with chronic non-specific neck pain. PLoS One 2024; 19:e0301386. [PMID: 38547308 PMCID: PMC10977775 DOI: 10.1371/journal.pone.0301386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/11/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Neck pain has been found to affect the somatosensory system, which can lead to impaired balance control. To assess the balance of patients with neck pain and other conditions, the balance error scoring system (BESS) is commonly used as a static balance measurement tool. However, this tool is seldom used in Thailand due to its English language format. OBJECTIVE To translate and determine the content, convergent validity, and reliability of a Thai version of the BESS tool. MATERIAL AND METHODS A process of cross-cultural adaptation was utilized to translate BESS into a Thai version, called BESS-TH. To assess content validity, five physical therapy lecturers specializing in the musculoskeletal field used BESS to measure balance in participants with neck pain. For the convergent validity process, 130 patients diagnosed with chronic non-specific neck pain (CNSNP) were randomly assessed using four static balance tests (BESS, Single-leg balance test (SLBT), Romberg test, and Tandem stance test). For reliability, two assessors with varying years of work experience independently assessed videos of the participants twice using the BESS-TH, with a minimum 7-day interval between assessments. RESULTS The BESS-TH used to assess balance of patients with neck pain demonstrated acceptable content validity (index of item objective congruence (IOC) = 0.87). The Spearman's Rank Correlation Coefficient was calculated between the BESS-TH and three other measures: the SLBT with eyes open and eyes closed, the Romberg test with eyes open and eyes closed, and the Tandem stance test with eyes open and Tandem stance test with eyes closed. The values obtained were as follows: -0.672, -0.712, -0.367, -0.529, -0.570, and -0.738, respectively. The inter-rater and intra-rater reliability were 0.922 (95% CI = 0.864-0.956) and 0.971 (95% CI = 0.950-0.983), respectively. Minimum detectable change (MDC) for the total BESS score of inter-rater and intra-rater reliability were 7.16 and 4.34 points, respectively. CONCLUSION The BESS-Thai version was acceptable, reliable, and valid for evaluating balance performance in patients with CNSNP. This tool can be used and applied to clinically evaluate postural control in Thailand.
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Affiliation(s)
- Arisa Leungbootnak
- Faculty of Associated Medical Science, Human Movement Sciences, School of Physical Therapy, Khon Kaen University, Khon Kaen, Thailand
| | - Rungthip Puntumetakul
- Faculty of Associated Medical Science, School of Physical Therapy, Khon Kaen University, Khon Kaen, Thailand
- Faculty of Associated Medical Science, Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand
| | - Thiwaphon Chatprem
- Faculty of Associated Medical Science, School of Physical Therapy, Khon Kaen University, Khon Kaen, Thailand
- Faculty of Associated Medical Science, Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand
| | - Surachai Sae-Jung
- Faculty of Medicine, Department of Orthopedics, Khon Kaen University, Khon Kaen, Thailand
| | - Rose Boucaut
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
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Footwear Type and Testing Environment Do Not Affect Baseline Modified Balance Error Scoring System Performance Among Middle School Athletes. J Sport Rehabil 2023; 32:9-13. [PMID: 35894918 DOI: 10.1123/jsr.2021-0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 01/03/2023]
Abstract
CONTEXT Limited evidence exists to demonstrate the effect of extrinsic factors, such as footwear worn or the testing environment, on performance of the modified balance error scoring system (mBESS) in the middle school age (10-14 y) population. Therefore, the purpose of our study was to investigate the effect of footwear types and testing environments on performance of the mBESS by middle school athletes. DESIGN Cross-sectional. METHODS In total, 2667 middle school athletes (55.9% boys and 44.1% girls; age = 12.3 [0.94] y) were administered the mBESS while wearing their self-selected footwear (barefoot, cleats, or shoes) either indoors (basketball court) or outdoors (football field or track). The number of errors committed (range = 0-10) during the double-leg, single-leg, and tandem stances of the mBESS were summed to calculate a total score (range = 0-30). Kruskal-Wallis tests were used to assess for differences among the footwear groups for each mBESS stance and the total score. Mann-Whitney U tests with calculated nonparametric effect sizes (r) were used to assess for differences between the footwear groups and testing environments when appropriate. RESULTS There were significant differences for the number of committed errors among the footwear groups in the single-leg (P < .001) and tandem (P < .001) stances of the mBESS and mBESS total scores (P < .001). Significantly fewer errors (better) were committed while wearing shoes compared with other footwear in the single-leg and tandem stances of the mBESS (Ps ≤ .032, r = .07-.13). Participants assessed indoors committed significantly fewer errors than those assessed outdoors in each stance of the mBESS (Ps ≤ .022, r = .04-.14). Lower (better) mBESS total scores were observed for participants while wearing shoes (Ps ≤ .002, r = .10-.15) or assessed indoors (P = .001, r = .14). CONCLUSIONS Although our data suggest that the type of footwear worn and the testing environment have a significant effect on mBESS scores of middle school athletes, the magnitudes of these differences are negligible.
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Wah SW, Puntumetakul R, Boucaut R. Effects of Proprioceptive and Craniocervical Flexor Training on Static Balance in University Student Smartphone Users with Balance Impairment: A Randomized Controlled Trial. J Pain Res 2021; 14:1935-1947. [PMID: 34234540 PMCID: PMC8242145 DOI: 10.2147/jpr.s312202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose University student smartphone users adopt flexed neck postures during smartphone use, creating an increased compressive load on their neck structures. This study was conducted to compare the effects of proprioceptive and craniocervical flexor training with a control group on static balance in a group of university student smartphone users with balance impairment. Methods A double-blinded, randomized controlled trial was conducted involving 42 university students (19.67±1.68 years old) with balance impairment. Participants were randomized into a proprioceptive training (ProT) group (n=14), a craniocervical flexor training (CCFT) group (n=14), and a control group (CG; n=14) for a 6-week intervention. The balance error scoring system (BESS), cervical joint position sense (CJPS), craniocervical flexion (CCF) test, and visual analog scale (VAS) for neck pain were evaluated using univariate analysis of covariance (ANCOVA). Results After 6 weeks of intervention, the ProT group showed significantly greater improvement of CJPS than the CG (p=0.000) and the CCFT group significantly improved of CCF test than CG (p=0.002). Findings, at 4 weeks after intervention, were (i) the ProT group had significantly more improvement in BESS than the CCFT group (p=0.014) and CG (p=0.003), (ii) the ProT group had significantly more improvement of CJPS than the CG (right and left rotate) (p=0.001, p=0.016, respectively) and CCFT group (right rotate) (p=0.004), (iii) the CCFT group had significantly more improvement of craniocervical flexor strength than CG (p=0.004), and (iv) the ProT group and CCFT group had significantly more decreased pain than CG (p=0.015, p=0.033, respectively). No adverse effects occurred during or after training in any group. Conclusion ProT is important for regaining static balance and CJPS, while CCFT improved craniocervical flexor strength. Moreover, both ProT and CCFT can reduce neck pain. We recommend performing ProT to improve static balance, CJPS and to reduce neck pain in smartphone users with static balance impairment. Clinical Trail Registration Number TCTR20190909003.
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Affiliation(s)
- Saw Wah Wah
- Human Movement Sciences, School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, 40002, Thailand.,Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Rungthip Puntumetakul
- Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, 40002, Thailand.,School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Rose Boucaut
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, 5001, Australia.,University of South Australia: Allied Health and Human Performance, Adelaide, SA, 5001, Australia
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Alawna M, Unver B, Yuksel E. Effect of ankle taping and bandaging on balance and proprioception among healthy volunteers. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-020-00730-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Is an Elastic Ankle Support Effective in Improving Jump Landing Performance, and Static and Dynamic Balance in Young Adults With and Without Chronic Ankle Instability? J Sport Rehabil 2020; 29:789-794. [PMID: 31629338 DOI: 10.1123/jsr.2019-0147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/23/2019] [Accepted: 06/09/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT In some patients, ankle sprains lead to chronic symptoms like pain or muscular weakness called chronic ankle instability (CAI). External ankle supports have shown to be effective in preventing sprains and reducing recurrence, but the underlying mechanisms are unclear. As sensorimotor variables are associated with injury incidence, an influence of external ankle support on landing performance and balance seems plausible. OBJECTIVE To analyze the effects of an elastic ankle support on jump landing performance and static and dynamic balance in patients with CAI and healthy controls. DESIGN Crossover study. SETTING Functional tests in a laboratory setting. PATIENTS OR OTHER PARTICIPANTS Twenty healthy students and 20 patients with CAI were included for study participation based on their scores in ankle stability and function questionnaires. INTERVENTION Healthy and CAI participants performed each test with and without an elastic ankle support. MAIN OUTCOME MEASURES (1) Jump landing performance was measured with the Landing Error Scoring System, (2) static balance was assessed with the Balance Error Scoring System, and (3) dynamic balance was assessed using the Y Balance Test. Linear mixed models were used to analyze the effects of the elastic ankle support on sensorimotor parameters. RESULTS Healthy controls performed significantly better in the Landing Error Scoring System (P = .01) and Y Balance Test anterior direction (P = .01). No significant effects of elastic ankle support on Landing Error Scoring System, Balance Error Scoring System, or Y Balance Test performance were observed in the CAI or control group. There were no significant group-by-ankle support interactions. CONCLUSIONS In the current study, the acute use of elastic ankle support was ineffective for enhancing jump landing performance, and static and dynamic balance. Further research is needed to identify the underlying mechanisms of the preventive effects of elastic ankle support.
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Choi SH, Lim CG. Immediate Effects of Ankle Non-elastic Taping on Balance and Gait Ability in Patients With Chronic Stroke: A Randomized, Controlled Trial. J Manipulative Physiol Ther 2020; 43:922-929. [PMID: 32684325 DOI: 10.1016/j.jmpt.2019.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the immediate effects of ankle non-elastic taping on balance and gait ability in patients with chronic stroke. METHODS Thirty patients (inpatients and outpatients) with stroke were randomly assigned to 2 groups: the non-elastic taping group (n = 15) and the placebo-taping group (n = 15). Patients in the non-elastic taping group received Endura sports taping for their ankle joint, and patients in the placebo-taping group received Endura fix tape for their ankle joint. The Balance System SD assessed balance, and the GAITRite system assessed gait ability. We recorded measurements before and after intervention. RESULTS The non-elastic taping group showed a significant improvement in static and dynamic standing balance (P ≤ .001) after intervention; in addition, this group showed significant increases in the velocity, cadence, step length, and stride length of gait (P ≤ .001) after intervention. However, the placebo-taping group showed no significant improvements in standing balance and gait ability after intervention (P >.05). Furthermore, significant differences in static and dynamic standing balance, cadence, and velocity were observed between the 2 groups after intervention (P ≤ .001). CONCLUSIONS Our results demonstrate that the application of ankle non-elastic taping is effective at improving balance and gait abilities in patients with stroke. Ankle non-elastic taping appears to be an effective method to facilitate active rehabilitation in patients with hemiplegia.
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Affiliation(s)
- Suk-Hun Choi
- Department of Physical Therapy, Gyeongin Rehabilitation Center Hospital, Incheon, South Korea
| | - Chae-Gil Lim
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon, South Korea.
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Evaluating Postural Control and Ankle Laxity Between Taping and High-Top Cleats in High School Football Players. J Sport Rehabil 2018; 27:111-117. [PMID: 27992287 DOI: 10.1123/jsr.2016-0084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT Lateral ankle sprains are the most common injuries in high school sports. While ankle taping is a preferred method of external prophylactic support, its restrictive properties decline during exercise. The Under Armour® Highlight cleat is marketed on the premise that it provides added support without the need for additional ankle taping. OBJECTIVE To determine if differences in ankle joint laxity and postural control exist between football players wearing the Under Armour® Highlight cleat (Under Armour Inc, Baltimore, MD) as compared to a low/mid-top cleat with ankle tape. DESIGN Crossover trial. SETTING Athletic training room and football practice field sideline. PATIENTS 32 interscholastic football players (15.8 ± 1.0 y; 178.9 ± 7.4 cm; 87.1 ± 21.4 kg). INTERVENTIONS Ankle laxity was assessed using an instrumented ankle arthrometer (Blue Bay Research Inc, Milton, FL), while postural control testing was performed on the Tekscan MobileMat™ Balanced Error Scoring System (BESS; South Boston, MA). The 2 treatments included Under Armour® Highlight cleats and a low/mid-top cleat with ankle tape applied to the nondominant ankle only. Measurements were taken before and immediately after practice. MAIN OUTCOME MEASURES The independent variable was treatment (Highlight vs low/mid-top cleat with ankle tape). Dependent variables included ankle arthrometry measures of anterior displacement (mm), inversion/eversion rotation (deg), and the modified BESS error scores. A linear mixed-effects model was used for analysis. RESULTS The low/mid-top cleat with tape condition had significantly higher inversion range-of-motion (ROM) and inversion/eversion rotation postexercise when compared to the Highlight cleat (P < 0.05). CONCLUSIONS The results of this study provide some evidence that the Under Armour® Highlight cleat restricts ankle ROM following a training session better than the taped low/mid-top cleat. Further study is warranted to determine if this high-top style of football cleat can reduce the incidence of ankle sprains and how it might compare to spat taping.
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Smalley A, White SC, Burkard R. The effect of augmented somatosensory feedback on standing postural sway. Gait Posture 2018; 60:76-80. [PMID: 29161626 DOI: 10.1016/j.gaitpost.2017.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/11/2017] [Accepted: 11/13/2017] [Indexed: 02/02/2023]
Abstract
Impaired balance resulting from reduced postural control occurs with aging and various medical conditions. Sensory input for balance control is provided by the visual, vestibular and somatosensory systems. Previous research suggests that increased proprioceptive feedback from various lower extremity devices improves balance. Mixed results have been reported with the use of orthoses such as ankle foot orthoses (AFOs). In this study, 20 healthy subjects wore footplates in their shoes or straps around their lower legs in order to imitate the somatosensory feedback produced by wearing AFOs, but without providing ankle restriction. Subjects' standing balance was assessed using force plates and computerized dynamic posturography (the sensory organization test-SOT) to determine if either the footplates or the lower-leg straps would affect standing balance. The results revealed no significant difference with the use of the footplates, however, wearing the straps resulted in reduced postural sway for conditions when visual cue deprivation was combined with manipulation of somatosensory or vestibular feedback. This effect was more pronounced in participants with the poorest baseline measures of balance. These findings suggest that lower extremity devices, such as AFOs, may augment somatosensory feedback that could improve balance during challenging sensory deprivation conditions, independent of orthotic support at the ankle.
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Affiliation(s)
- Angela Smalley
- University at Buffalo, School of Public Health and Health Professions, Department of Rehabilitation Science, Kimball Tower, 3435 Main St., Buffalo, NY 14215, United States.
| | - Scott C White
- University at Buffalo, School of Public Health and Health Professions, Department of Exercise Science, Kimball Tower, 3435 Main St., Buffalo, NY 14215, United States
| | - Robert Burkard
- University at Buffalo, School of Public Health and Health Professions, Department of Rehabilitation Science, Kimball Tower, 3435 Main St., Buffalo, NY 14215, United States
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Woo MT, Davids K, Liukkonen J, Orth D, Chow JY, Jaakkola T. Effects of different lower-limb sensory stimulation strategies on postural regulation-A systematic review and meta-analysis. PLoS One 2017; 12:e0174522. [PMID: 28355265 PMCID: PMC5371369 DOI: 10.1371/journal.pone.0174522] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/10/2017] [Indexed: 11/23/2022] Open
Abstract
Systematic reviews of balance control have tended to only focus on the effects of single lower-limb stimulation strategies, and a current limitation is the lack of comparison between different relevant stimulation strategies. The aim of this systematic review and meta-analysis was to examine evidence of effects of different lower-limb sensory stimulation strategies on postural regulation and stability. Moderate- to high- pooled effect sizes (Unbiased (Hedges’ g) standardized mean differences (SMD) = 0.31–0.66) were observed with the addition of noise in a Stochastic Resonance Stimulation Strategy (SRSS), in three populations (i.e., healthy young adults, older adults, and individuals with lower-limb injuries), and under different task constraints (i.e., unipedal, bipedal, and eyes open). A Textured Material Stimulation Strategy (TMSS) enhanced postural control in the most challenging condition—eyes-closed on a stable surface (SMD = 0.61), and in older adults (SMD = 0.30). The Wearable Garments Stimulation Strategy (WGSS) showed no or adverse effects (SMD = -0.68–0.05) under all task constraints and in all populations, except in individuals with lower-limb injuries (SMD = 0.20). Results of our systematic review and meta-analysis revealed that future research could consider combining two or more stimulation strategies in intervention treatments for postural regulation and balance problems, depending on individual needs.
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Affiliation(s)
- Mei Teng Woo
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- School of Sports, Health and Leisure, Republic Polytechnic, Singapore, Singapore
- * E-mail:
| | - Keith Davids
- Centre for Sports Engineering Research, Sheffield Hallam University, Sheffield, United Kingdom
| | - Jarmo Liukkonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Dominic Orth
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherland
| | - Jia Yi Chow
- Physical Education and Sports Science, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Timo Jaakkola
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Halim-Kertanegara S, Raymond J, Hiller CE, Kilbreath SL, Refshauge KM. The effect of ankle taping on functional performance in participants with functional ankle instability. Phys Ther Sport 2017; 23:162-167. [DOI: 10.1016/j.ptsp.2016.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 02/24/2016] [Accepted: 03/24/2016] [Indexed: 12/26/2022]
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Alsalaheen B, McClafferty A, Haines J, Smith L, Yorke A. Reference values for the balance error scoring system in adolescents. Brain Inj 2016; 30:914-8. [PMID: 27057617 DOI: 10.3109/02699052.2016.1146965] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Adolescents with mild traumatic brain injury (i.e. concussion) may experience postural stability impairments. The Balance Error Scoring System (BESS) is widely used in assessment of postural stability after concussion. Despite its common use in adolescents, the BESS lacks reference values in adolescents, limiting its clinical utility. The objective of this study is to report the reference values for the BESS in adolescents and to examine the effect of gender on the BESS scores. METHODS One hundred and ninety-one high school adolescents between the ages of 14-18 (M = 16.1, SD = 1.1) years of age completed the BESS. The effects of gender, age, body mass and height on the performance of BESS were examined. Additionally, the reported reference values for the BESS were stratified by gender. RESULTS Female participants demonstrated better performance on five of the six BESS conditions as well as the total error score (p < 0.001). No relationships were observed between age and body mass to the BESS scores. CONCLUSIONS The effects of gender on the BESS performance support the gender-specific reference values reported in this study. These reference values provide benchmarks for clinicians when interpreting the BESS in the absence of individual baseline scores.
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Affiliation(s)
- Bara Alsalaheen
- a Department of Physical Therapy , University of Michigan-Flint , Flint , MI , USA
| | - Adam McClafferty
- a Department of Physical Therapy , University of Michigan-Flint , Flint , MI , USA
| | - Jamie Haines
- a Department of Physical Therapy , University of Michigan-Flint , Flint , MI , USA
| | - Laura Smith
- a Department of Physical Therapy , University of Michigan-Flint , Flint , MI , USA
| | - Amy Yorke
- a Department of Physical Therapy , University of Michigan-Flint , Flint , MI , USA
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Kim MK, Cha HG. The effects of ankle joint taping on gait and balance ability of healthy adults. J Phys Ther Sci 2015; 27:2913-4. [PMID: 26504323 PMCID: PMC4616124 DOI: 10.1589/jpts.27.2913] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/17/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study examined the effects of the application of elastic taping over the ankle joints of healthy subjects on their gait, balance ability, and muscle strength. [Subjects] Fifty healthy subjects with no orthopedic history of the ankle joint were selected and elastic taping was applied to their ankle joints. [Methods] Before and after application of the elastic taping, gait and balance ability of the subjects were evaluated. [Results] After the taping application, gait velocity significantly increased and there were significant differences in all variables of balance ability. [Conclusion] Application of elastic taping aimed at improving stability of the ankle joint had a positive effect on gait speed and balance ability.
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Affiliation(s)
- Myoung-Kwon Kim
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Republic of Korea
| | - Hyun-Gyu Cha
- Department of Physical Therapy, College of Kyungbuk, Republic of Korea
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Alsalaheen BA, Haines J, Yorke A, Stockdale K, Broglio SP. Reliability and concurrent validity of instrumented balance error scoring system using a portable force plate system. PHYSICIAN SPORTSMED 2015; 43:221-6. [PMID: 26109242 DOI: 10.1080/00913847.2015.1040717] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The Balance Error Scoring System (BESS) is a commonly used test in adolescents and young adults. Affordability and portability of newer force plates has led to instrumentation of many clinical balance tests including the BESS. Despite the higher precision of force plate measures compared with clinical scoring, it is unclear if the instrumented BESS demonstrate concurrent validity and reliability when compared with the original BESS. The purpose of this study was to examine the reliability and concurrent validity of instrumented BESS testing using a commercially available force plate system. METHODS Thirty-six participants participated in the initial testing day (17 male/19 female, M = 15.9 years, SD = 1.5 years). The test-retest sample consisted of 26 participants who completed the same testing procedure after 1 week. For all testing sessions, participants performed the BESS while standing on a portable force plate system. Number of errors and sway velocity were obtained. Concurrent validity was established through correlation analysis examining the relationship between the original and the instrumented BESS scores. Reliability was established using Intraclass Correlation Coefficient (ICC3,1) computed for the instrumented and the original BESS. RESULTS A significant moderate relationship exists between the total scores of the original and the instrumented BESS (rs = 0.54, p = 0.001). Despite a range of reliability scores for the different conditions in the instrumented BESS (ICC3,1 = 0.19-0.61) and the clinically scored BESS (ICC3,1 = 0.13-0.71), the reliability score for the total test score was the same for the instrumented and the clinical test (ICC3,1 = 0.74). CONCLUSION Although the instrumented BESS may appear to demonstrate concurrent validity against the original BESS, instrumentation did not improve its reliability. Future research should examine if the instrumented BESS demonstrates validity against laboratory level force plates and if it is able to overcome the ceiling effect reported for the clinical BESS test.
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Affiliation(s)
- Bara A Alsalaheen
- a 1 Department of Physical Therapy, University of Michigan-Flint , Flint, MI, USA
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Silva AG, Cruz A, Ganesan M. A comparison of the effects of white athletic tape and kinesiotape on postural control in healthy individuals. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.4.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Anabela G Silva
- Physiotherapist and assistant professor, School of Health, University of Aveiro, Portugal
| | - Ana Cruz
- Physiotherapist and senior lecturer, School of Health, University of Aveiro, Portugal
| | - Mohan Ganesan
- Research scholar, Knecht Movement Science Laboratory, Department of Physical Therapy, University of Illinois, Chicago
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Guskiewicz KM, Broglio SP. Acute sports-related traumatic brain injury and repetitive concussion. HANDBOOK OF CLINICAL NEUROLOGY 2015; 127:157-172. [PMID: 25702215 DOI: 10.1016/b978-0-444-52892-6.00010-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Concussions are described as functional, not structural injuries, and therefore cannot be easily detected through standard diagnostic imaging. The vast differences between individual athletes makes identifying and evaluating sport-related concussion one of the most complex and perplexing injuries faced by medical personnel. The literature, as well as most consensus statements, supports the use of a multifaceted approach to concussion evaluation on the sideline of the athletic field. Using a standardized clinical examination that is supported by objective measures of concussion-related symptoms, cognitive function, and balance provides clinicians with the ability to track recovery in an objective manner. When used in combination, these tests allow for more informed diagnosis and treatment plan, which should involve a graduated return to play progression. Establishing a comprehensive emergency action plan that can guide the on-field management of a more serious and potentially catastrophic brain injury is also essential. This review will address these management issues, as well as the recent concerns about the risk of long-term neurologic conditions believed to be associated with repetitive concussion.
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Affiliation(s)
- Kevin M Guskiewicz
- Matthew Gfeller Sport-Related TBI Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Steven P Broglio
- NeuroSport Research Laboratory, Michigan NeuroSport, School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
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Ruhe A, Fejer R, Gänsslen A, Klein W. Assessing postural stability in the concussed athlete: what to do, what to expect, and when. Sports Health 2014; 6:427-33. [PMID: 25177420 PMCID: PMC4137680 DOI: 10.1177/1941738114541238] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Context: 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. Evidence Acquisition: 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. Study Design: Clinical review. Level of Evidence: 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. Conclusion: 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. Strength of Recommendation Taxonomy: B
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Affiliation(s)
- Alexander Ruhe
- School of Health Professions, Murdoch University, Murdoch, Australia ; Praxis für Chiropraktik, Wolfsburg, Germany
| | - René Fejer
- Spine Centre of Southern Denmark, Hospital Lillebaelt, Middelfart, Denmark ; Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark
| | - Axel Gänsslen
- Klinikum Wolfsburg, Department of Trauma Surgery, Orthopedics and Hand Surgery, Wolfsburg, Germany
| | - Wolfgang Klein
- Klinikum Wolfsburg, Department of Trauma Surgery, Orthopedics and Hand Surgery, Wolfsburg, Germany
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Comparison of a Mobile Technology Application With the Balance Error Scoring System. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY & TRAINING 2014. [DOI: 10.1123/ijatt.2013-0094] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Context:The most widely used method for postural balance assessment relies on the subjective observations of a test administrator. Accelerometry has been shown to provide a valid and reliable method for assessment of balance, and recent advances in microelectromechanical systems have made the technology available in mobile electronic devices.Objective:To compare a mobile technology application with a commonly used subjective balance assessment.Setting:Biomechanics laboratory.Participants:Twenty-one nonathlete college-aged individuals (7 men, 14 women; mean age 23 ± 3 years) volunteered to participate. Subjects were excluded if they reported any preexisting condition that might affect postural balance.Results:A strong inverse correlation was found between the scores for the two balance assessment methods (r= -.767,p< .01).Conclusions:Advances in technology have provided an attractive means to objectively quantify postural balance with off-the-shelf mobile consumer electronic devices.
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Broglio SP, Cantu RC, Gioia GA, Guskiewicz KM, Kutcher J, Palm M, Valovich McLeod TC. National Athletic Trainers' Association position statement: management of sport concussion. J Athl Train 2014; 49:245-65. [PMID: 24601910 DOI: 10.4085/1062-6050-49.1.07] [Citation(s) in RCA: 471] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To provide athletic trainers, physicians, and other health care professionals with best-practice guidelines for the management of sport-related concussions. BACKGROUND An estimated 3.8 million concussions occur each year in the United States as a result of sport and physical activity. Athletic trainers are commonly the first medical providers available onsite to identify and evaluate these injuries. RECOMMENDATIONS The recommendations for concussion management provided here are based on the most current research and divided into sections on education and prevention, documentation and legal aspects, evaluation and return to play, and other considerations.
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Abstract
CONTEXT The vast differences between individual athletes makes identifying and evaluating sports-related concussion one of the most complex and perplexing injuries faced by medical personnel. EVIDENCE ACQUISITION This review summarizes the existing literature supporting the use of a multifaceted approach to concussion evaluation on the sideline of the athletic field. Information was drawn from a PubMed search (MEDLINE) for the terms sport concussion for the most recent and relevant literature. CONCLUSIONS By using a standardized clinical examination that is supported by objective measures of concussion-related symptoms, mental status, and postural control, the medical professional becomes well equipped to make an informed diagnosis.
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Abstract
Context: The Balance Error Scoring System (BESS) is commonly used by researchers and clinicians to evaluate balance.A growing number of studies are using the BESS as an outcome measure beyond the scope of its original purpose. Objective: To provide an objective systematic review of the reliability and validity of the BESS. Data Sources: PubMed and CINHAL were searched using Balance Error Scoring System from January 1999 through December 2010. Study Selection: Selection was based on establishment of the reliability and validity of the BESS. Research articles were selected if they established reliability or validity (criterion related or construct) of the BESS, were written in English, and used the BESS as an outcome measure. Abstracts were not considered. Results: Reliability of the total BESS score and individual stances ranged from poor to moderate to good, depending on the type of reliability assessed. The BESS has criterion-related validity with force plate measures; more difficult stances have higher agreement than do easier ones. The BESS is valid to detect balance deficits where large differences exist (concussion or fatigue). It may not be valid when differences are more subtle. Conclusions: Overall, the BESS has moderate to good reliability to assess static balance. Low levels of reliability have been reported by some authors. The BESS correlates with other measures of balance using testing devices. The BESS can detect balance deficits in participants with concussion and fatigue. BESS scores increase with age and with ankle instability and external ankle bracing. BESS scores improve after training.
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Ambegaonkar JP, Redmond CJ, Winter C, Cortes N, Ambegaonkar SJ, Thompson B, Guyer SM. Ankle stabilizers affect agility but not vertical jump or dynamic balance performance. Foot Ankle Spec 2011; 4:354-60. [PMID: 22184741 DOI: 10.1177/1938640011428509] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
UNLABELLED Ankle stabilizers can reduce ankle sprain incidence and severity by limiting range of motion. Still whether using them affects performance remains unclear. The authors compared effects of 3 ankle stabilizers, tape, lace-up (Swede-O Ankle Lok), and semirigid (Air-Cast Air-Stirrup) braces, and a nonsupport control on vertical jump (Sargent Jump Test), agility (Right-Boomerang Run test), and dynamic balance (Modified Bass Test) in 10 volunteers (4 males, 6 females; 25.6 ± 2.8 years, 167.8 ± 13.7 cm, 61.4 ± 10.7 kg) using repeated-measures ANOVAs. Participants had similar vertical jump (P = .27; control = 41.40 ± 11.89 cm, tape = 37.90 ± 7.92 cm, Swede-O = 41.40 ± 11.89 cm, Air-Cast = 39.29 ± 10.85 cm) and dynamic balance (P = .08; control = 92.50 ± 2.46, tape = 91.55 ± 3.53, Swede-O = 97.00 ± 5.32, Air-Cast = 89.40 ± 6.08) but differing agility scores (P = .03; control = 13.55 ± 1.35 seconds, tape = 14.03 ± 1.5 seconds, Swede-O = 14.10 ± 1.36 seconds, Air-Cast = 14.14 ± 1.41 seconds). Post hoc tests revealed a significant difference (P = .03) between control and Air-Cast but not between Swede-O (P = .06) or tape (P = .07). Effect size (d) analyses indicated that compared with control, all stabilizers trended to increase agility run times (tape, d = 0.33; Swede-O, d = 0.40; Air-Cast, d = 0.43). Since participants primarily required sagittal plane motion when jumping vertically and had relatively slow directional changes in the dynamic balance test, wearing ankle stabilizers did not hamper jump or balance. However, ankle stabilizers hindered participants' ability to perform quick directional changes required in the agility test, with the most rigid stabilizer (Air-Cast) affecting agility the most. Clinicians should be aware that ankle stabilizers may affect some performance measures (agility) but not others (jumping, balance) and continue examinations in larger cohorts. LEVEL OF EVIDENCE Therapeutic, Level II.
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Affiliation(s)
- Jatin P Ambegaonkar
- Sports Medicine Assessment Research and Testing Laboratory, George Mason University, Manassas, VA 20110, USA.
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Guskiewicz KM, Broglio SP. Sport-Related Concussion: On-Field and Sideline Assessment. Phys Med Rehabil Clin N Am 2011; 22:603-17, vii. [PMID: 22050938 DOI: 10.1016/j.pmr.2011.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hadadi M, Mazaheri M, Mousavi ME, Maroufi N, Bahramizadeh M, Fardipour S. Effects of soft and semi-rigid ankle orthoses on postural sway in people with and without functional ankle instability. J Sci Med Sport 2011; 14:370-5. [PMID: 21237708 DOI: 10.1016/j.jsams.2010.12.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 10/07/2010] [Accepted: 12/10/2010] [Indexed: 12/26/2022]
Affiliation(s)
- Mohammad Hadadi
- Center for Human Movement Science Research, Shiraz University of Medical Sciences, Shiraz, Iran
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Je HD, Ma SY, Kim HD. The Effects of Ankle Taping and a Lace-up Ankle Brace on Balance Control while Initiating Gait. J Phys Ther Sci 2011. [DOI: 10.1589/jpts.23.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hyun Dong Je
- Department of Pharmacology, College of Pharmacy, Catholic University of Daegu
| | - Sang-Yeol Ma
- Department of Physical Therapy, Sewoori Hospital
| | - Hyeong-Dong Kim
- Department of Physical Therapy, College of Health Science, Korea University
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AAOP State-of-the-Science Evidence Report: The Effect of Ankle-Foot Orthoses on Balance—A Systematic Review. ACTA ACUST UNITED AC 2010. [DOI: 10.1097/jpo.0b013e3181f379b7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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