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Updated: Nov 1, 2025
Author Spotlight: Developing Low-Tech Balance Assessment Methods for Broad-Spectrum Healthcare Applications
Published on: September 1, 2023
Contributions of PCSS, BESS, Tandem Gait, and Romberg Test for Identifying Balance Deficits in Pediatric Concussions
Rishi D Patel1, Cynthia R LaBella
1Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Drs Patel and LaBella); and Division of Orthopaedic Surgery and Sports Medicine, Lurie Children's Hospital, Chicago, Illinois (Dr LaBella).
Objective:
Balance deficits are common after concussions in pediatric patients. This study evaluates 3 clinical tools for identifying postconcussion balance deficits in a pediatric population: (1) Post-Concussion Symptom Scale (PCSS); (2) Balance Error Scoring System (BESS); and (3) physical examination measures of balance: tandem gait (TG) and Romberg test.
Setting:
Data were collected in a tertiary care outpatient pediatric sports medicine clinic.
Participants:
English-speaking patients aged 8 to 17 years who presented to a tertiary care hospital-based pediatric sports medicine clinic and diagnosed with concussion between August 2014 and February 2018 were invited to participate. A total of 614 patients were screened and/or approached during the inclusion period and 500 were enrolled. Of those enrolled, 423 patients had complete data collected and analyzed.
Design:
This is a cross-sectional, observational data set from a longitudinal, prospective study.
Main Measures:
Data extracted from patients' electronic medical records included physical examination, PCSS, and BESS scores from their initial visit. Descriptive statistics were calculated for the outcome measures. A logistic regression was performed to evaluate significant contributors to abnormal BESS score (≥25).
Results:
There were 423 patients (56.7% female; 14.7 ± 2.01 years old) included in the study. Overall, we identified 336 patients (79.4%) with balance difficulties. Of the 336 with balance difficulties, 284 (84.5%) reported "balance problems" and/or "dizziness" on PCSS, 153 (45.5%) had abnormal BESS scores (≥25), and 100 (29.8%) had an abnormality on either TG or Romberg test.
Conclusion:
Balance difficulties were identified in close to 80% of children with concussions. Using PCSS and BESS along with physical examination measures, TG and Romberg test, identified more patients with balance deficits than using TG and Romberg test alone.
