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Updated: Jul 2, 2026
Vision Training Methods for Sports Concussion Mitigation and Management
Published on: May 5, 2015
Development of the sBESS, a Pragmatic Dual-Task Balance Test in Adolescents With Acute Concussion
Jacqueline van Ierssel1, Richard Webster2, Lamia Hayawi2
1Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Objective:
Develop a clinically pragmatic dual-task balance test to identify balance problems in acutely concussed adolescents more accurately than the current standard.
Design:
Observational cohort study.
Setting:
Pediatric emergency department.
Participants:
Adolescents aged 10 to 18 years with acute (<48 hours) concussion.
Independent Variables:
Single tasks: balance (mBESS errors); cognitive function (Oral Trail-Making Test-B [OTMT-B] completion rate and accuracy); vestibular-oculomotor function (gaze stabilization test); and symptom change (pre-/post-test numeric pain rating scale). Dual tasks: (1) balance + cognitive function; (2) balance + vestibular-oculomotor function.
Main Outcome Measures:
Primary outcome was change in center-of-pressure (COP) on a force plate (95% ellipse sway area), during single and dual tasks. We evaluated associations between clinical outcomes and gold-standard COP sway area using Spearman correlation coefficients and P-values.
Results:
Eighty-three adolescents (median [IQR] age = 12.86 [11.52-15.41 years; 62.65% male; median [IQR] time from injury = 3.03 [2.08-13.37] hours) were included. Balance errors during dual-task gaze stabilization with tandem stance correlated more strongly with sway area (rs = 0.77, P < 0.001) than with mBESS balance errors (double-leg stance, rs = 0.44, P < 0.001; tandem stance, rs = 0.58, P < 0.001; single-leg stance, rs = 0.39, P < 0.001). Cognitive dual task (OTMT-B completion rate) was associated with fewer balance errors and decreased sway area in tandem stance (rs = -0.28, P = 0.02) and single-leg stance (rs = -0.21, P = 0.07). Pre-/post-test symptom change was not associated with sway area.
Conclusions:
Dual-task gaze stabilization with tandem stance ("sharpened BESS" [sBESS]) is a new vestibular dual task that is more strongly associated with gold-standard balance performance in concussed adolescents than mBESS. Diagnostic and prognostic accuracy studies are needed to determine the clinical utility of sBESS to inform concussion diagnosis and return to sport decisions.
