Term of Award

Spring 2011

Degree Name

Master of Science in Kinesiology (M.S.)

Document Type and Release Option

Thesis (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Department of Health and Kinesiology

Committee Chair

Thomas Buckley

Committee Member 1

Barry Joyner

Committee Member 2

Barry Munkasy

Committee Member 3

Thomas Buckley

Committee Member 3 Email



Context: The Balance Error Scoring System (BESS) is a commonly utilized and recommended sideline assessment tool to evaluate post-concussion postural stability. Baseline BESS scores are typically recorded during preseason physical examinations in the athletic training room or nearby laboratory. However, post-concussion assessment typically takes place on the sideline during a sporting event. Objective: The purpose of this study was to evaluate the effect of a sideline environment on BESS performance. Setting: 37 NCAA Division 1 healthy, female student athletes (SA) and 32 healthy, female non-athlete healthy young adult (HYA) controls were assessed on BESS performance in three different environments: a controlled laboratory or baseline (BL), a basketball arena (BKB) and a football field (FB). The SA group performed the experimental trials during a live competition while the HYA group was tested with minimal distractions. Interventions: The BESS was administered using an Airex Pad and videotaped from the frontal and sagittal planes. Main Outcome Measures: Two 2 x 3 ANOVAs with repeated measures, one 2 x 6 ANOVA with repeated measures, and a frequency distribution were used to analyze the results. Results: A significant main effect was found for the two groups (p = .001) with the SA group scoring higher than the HYA group. Significance within the SA group was found between BL and FB (p = .047) environments and FB and BKB (p = .005) environments. Significance within the HYA group was noted between BL and BKB trials (p = .025). Significance was found between groups for the single leg firm (p = .032), single leg foam (p < .001), and tandem foam stances ( p < .001) with the SA group scoring significantly higher. Conclusions: A previous study reported no differences in total BESS score between a controlled environment and a baseball dugout, however our results suggest that a more distracting environment may impair BESS performance in female intercollegiate athletes. While this study is limited by testing athletes outside of their sport environment, the results of this study suggest that clinicians should consider the ambient environment when performing BESS during a postconcussion assessment.

Research Data and Supplementary Material