HLTH2520

Balance & Functional Movement Screen

Balance Error Scoring System (BESS)

Test Purpose:
The balance error scoring system (BESS) is a brief, easily administered test of static
balance. It is often used in the population of athletes with concussion or mild
traumatic brain injury. Information obtained from this clinical balance tool can be
used to assist clinicians in making return to play decisions following mild head injury.

The test can be used with people who have problems with balance and postural
stability eg functional ankle instability and people with diseases affecting the
vestibular system and/or brain. eg sport-related concussion, stroke, Parkinson's
disease, multiple sclerosis, traumatic brain injury, blast exposure in the military.
Equipment
A foam balance pad. The foam pad is one piece of medium-density foam (45 cm 2×
13 cm thick, density 60 kg/m3, load deflection 80-90).

Procedure
1. Athlete/client stands with eyes closed and hands at hips
2. Two surfaces
1. Firm, flat ground
2. Block of foam large enough to stand on
3. Three positions
1. Both feet on the ground
2. Tandem stance (toes of one foot to heel of the other)
3. Balance on one leg

Technique
Test balance in 6 trials of 20 seconds each
1. Firm ground: Both feet, tandem and one leg
2. Foam block: Both feet, tandem and one leg

1. During the tandem stance, the dominant foot is in front of the non-dominant
foot.
2. During the single-leg stance, the subject stands on the non-dominant foot.
3. During the test, the eyes are closed and the hands are held on the hips (iliac
crests).

1 HLTH2520 – Lab 6
 4. Subjects are told to keep as steady as possible, and if they lose their balance,
they are to try to regain the initial position as quickly as possible.

Clients are assessed one point for the following errors

Observe for balance errors (1 point for each error)

1. Stepping
2. Stumbling or falls out of test position
3. Opening eyes
4. Hands lifted above the iliac crests
5. Forefoot or heel lifted from test surface
6. Hip moved >30 degrees flexion or abduction
7. Out of test position >5 seconds

Instruct the client to make any necessary adjustments if he or she loses balance and
return to position as quickly as possible
Instruct the client to maintain balance and not commit any of the balance errors
listed.

Analysis and Interpretation

A trial is considered incomplete if the subject cannot hold the position without error
for at least five seconds.
4. A minimum score of zero errors
5. The maximal number of errors per condition is 10.
are possible for each of the 6 testing conditions

An incomplete condition is given the maximal number of points (10). The numbers of
errors for all six conditions are summed into a single score.
6. Average of 12 errors following injury
Higher scores are thought to be associated with decreased postural control.

2 HLTH2520 – Lab 6
3 HLTH2520 – Lab 6
Observe for balance errors (1 point for each error)
 Errors A B C D E F
1.     Stepping            
2.     Stumbling or falls out of test
position            
3.     Opening eyes            
4.     Hands lifted above the iliac crests            
5.     Forefoot or heel lifted from test
surface            
6.     Hip moved >30 degrees
flexion/abduction         1   
7.     Out of test position >5 seconds          1  
Total          7  
7 Normative reference values for the BESS stratified by age.

Age N Mean Median SD Superior Above average Broadly normal Below average Poor Very poor

20–29 65 11.3 11.0 4.8 0–5 6-7 8–14 15–17 18–23 24+

30–39 173 11.5 11.0 5.5 0–4 5–7 8–15 16–18 19–26 27+

40–49 352 12.5 11.5 6.2 0–5 6–8 9–16 17–20 21–28 29+

50–54 224 14.2 12.0 7.5 0–6 7-8 9–18 19–24 25–33 34+

55–59 197 16.5 15.0 7.6 0–7 8–10 11–20 21–28 29–35 36+

60–64 148 18.0 16.5 7.8 0–8 9–12 13–22 23–28 29–40 41+

65-69 77 19.9 18.0 7.1 0–12 13–15 16–24 25–32 33–38 39+

4 HLTH2520 – Lab 6
Time-to-stabilisation (TTS)
Test Purpose:
The ability to attenuate landing force and regain postural control as quickly as
possible on landing is important for many sports which require the expression of
dynamic balance. Dynamic postural control involves a combination of the sensory,
motor, and central integration to process information and produce appropriate neural
responses to control posture and joint stability. The TTS method using the drop and
stick task measures the ability of an athlete to transition from a dynamic movement
in a controlled environment to land and remain motionless as quickly as possible.
Equipment
 Force platform
 Computer
 Box (that equates to 0.5m above platform)
Procedure
 The athletes instructed to step off a predetermined box height of 0.5 m
(Figure a). Athletes should be instructed to to step forward off the box with
their preferred leg, “land soft” on both feet, and as quickly as possible
squat to requisite position (upper thighs parallel to the ground, Figure b).
 TTS will be calculated from the time of initial landing contact until they
stabilized within 5% of BM (Figure 2).
 Repeat trial 3 times

5 HLTH2520 – Lab 6
Norms
Norms for the TTS will be relative to the population tested. However for comparison
we can look at results from Tran et a., (2015) for results specific to surfers.

Tran, T. T., Lundgren, L., Secomb, J., Farley, O. R., Haff, G. G., Newton, R. U., ... &
Sheppard, J. M. (2015). Development and evaluation of a drop-and-stick method to
assess landing skills in various levels of competitive surfers. International Journal of
Sports Physiology and Performance, 10(3), 396-400.

57.4
TSS - 1.07
1979

RPLF = 3.5101099681
563.5 * 9.80N
1979

https://www.google.com/search?client=safari&rls=en&q=Time-to-stabilisation+(TTS)
+in+assessing+injury+risk+in+afl+players&ie=UTF-8&oe=UTF-8

6 HLTH2520 – Lab 6
Athletic Ability Assessment (AAA)
The Athletic Ability Assessment (AAA) is not designed to be used as a clearance
screen in order to begin training safely, as is the suggested use of the FMS™, but as
an assessment methodology that can be utilised as athletes travel along their
sporting pathway and require increased movement competency under load and
under greater levels of movement complexity (McKeown, Taylor-McKeown, Woods &
Ball, 2014). The exercises used assess functional movement which are aligned with
the foundation movement skills underpinning sports performance. These movements
are still assessed in a way that highlights movement dysfunction, but have the
advantage of providing a more focused exercise progression template that is well
aligned to performance enhancement.
Equipment
- 60cm Box
- Wooden Dowel
- 20kg Olympic Bar
Modified Procedures & Scoring:
Exercise Selection Rationale Assessment Score
Points 3 Points 2 Points 1 Point
Prone Hold Isometric hold linking upper Upper back/ Scapula Inconsistent Unable to
(2min) body, trunk and lower shoulder position depression and positioning attain correct
body. The ability to retraction (repositioning) position
maintain neutral alignment constant for 2 throughout the
throughout body enables min No 2 min
the coach to assess protraction or
scapular positioning under elevation of
load and hip stability and scapular
control under tension. Hip position Neutral hip Inconsistent Unable to
Being able to stabilise and positioning with positioning attain correct
control trunk integrity is a no (repositioning) position
cornerstone to all anterior/posterior throughout the
subsequent actions in sport tilt or rotation 2 min
and movement.

Overhead Squat Squat movement with Hands/Bar Maintains bar Bar over mid‐ Excessive or
overhead position of arms, Overhead overhead with foot but inappropriate
with load, highlights appropriate incorrect trunk
strength of upper body to shoulder/thoracic movement inclination
hold this position along extension & trunk patterning
with compensatory angle with no
patterns through rotation
shoulder/arm/thoracic Hip/Knee/Ankle Perfect alignment Inconsistent Unable to
spine to cope with this Alignment and control of form with some attain correct
position and load whilst hip/knee/ankle perfect reps OR position
also assessing lower body throughout every minor
mobility and strength. rep misalignment
on all
repetitions

7 HLTH2520 – Lab 6
 Depth Hip below knee Depth beyond Not able to
(below parallel) parallel for achieve
while maintaining some but not all required
neutral spine for reps depth for any
all repetitions reps

Lateral Bound Lateral bound and stick Hip/Knee/Ankle Perfect alignment Slight deviation Poor
Left and Right progresses the SL hop to Alignment of hip/knee/ankle from ideal alignment
Sides × 3 mimic the forces produced landing throughout
repetitions to change direction. alignment
Change of direction and
rotational forces confound Balance/Control Sticks the landing Sticks landing No
the risk of injury, with perfect but is balance/contr
particularly of non‐contact balance and unbalanced. ol on landing
injury and especially in control Adjustments
females. For an athlete to made via other
perform agility or change of body
direction drills and sports movements
safely, lateral bound and Power Position on Lands in Single Inability to land Excessive
stick ability has to be Landing Leg power in power hip/knee/ankl
correct. position/quarter position on e flexion.
squat after every some but not all Poor
rep reps OR makes positioning to
adjustments reproduce
post‐ landing to force
attain power
position

Push ups The ability to move and Scapulohumeral Scapula Inconsistent Poor scapular
Minimum control bodyweight is vital Rhythm depression form. Some positioning
repetitions = 20 for many sports and and retraction perfect reps. and control
reps (males), 12 training environments. This constant for all reps
reps (females) ability should incorporate throughout
correct movement movement No
mechanics of the upper protraction or
body, particularly scapula elevation of
and trunk position and scapular or
synchronicity of movement flaring of elbows
Body Control Prefect body Prefect body Poor body
control and control and control and/or
alignment for alignment for alignment for
every repetition some but not all all reps
reps
Complete M ≥ 20 M < 20
repetitions F ≥ 12 F<6

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