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Updated: Feb 15, 2026

A Mouse Model of Single and Repetitive Mild Traumatic Brain Injury
Published on: June 20, 2017
Reliability of the balance error scoring system in a population with protracted recovery from mild traumatic brain
Daniel Cushman1, John Hendrick2, Masaru Teramoto1
1a Division of Physical Medicine & Rehabilitation , University of Utah , Salt Lake City , Utah , USA.
Objective:
This study aimed to identify the Balance Error Scoring System's (BESS) intraclass reliability in a cohort of patients with prolonged symptoms using variance component analysis and intraclass correlation coefficient (ICC).
Setting:
Outpatient sports medicine/concussion clinic.
Participants:
A total of 241 paediatric and 102 adult patients with symptoms lasting longer than 10 days.
Interventions:
BESS testing.
Design:
Retrospective review.
Main Outcome Measures:
Percent variance for each BESS component and intraclass reliability. A five-component model (including all components except for firm double-leg) and a four- component model (including all components except for firm and foam doubleleg) were also performed to compare ICC values.
Results:
The largest source of variance came from stance (41.1%). The BESS components firm single (25.5%) and foam tandem (27.5%) stances accounted for the largest percentages of variance, while firm double (1.1%) and foam double (6.9%) accounted for the smallest percentages. The ICC for all patients was 0.800, and increased both if the firm double stance was excluded, or if both double-leg stances were excluded.
Conclusion:
BESS reliability appears to be high in a concussed cohort, regardless of age. Removing the two double-leg stance portions increases the ICC of the test without failing to identify balance deficits.
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