Serial administration of clinical concussion assessments and learning effects in healthy young athletes

Objective: To determine if serial administration of the Standardized Assessment of Concussion (SAC) and Balance Error Scoring System (BESS) would elicit a learning effect in young athletes and to determine the intratester reliability of scoring the BESS. Design: A prospective study of 50 healthy young athletes who were assigned to either the control or practice group. All subjects were administered the assessments on 2 occasions, 60 days apart. In addition, subjects in the practice group received serial administration of the assessments on 3 occasions in the week following the initial assessment. Setting: University Sports Medicine/Athletic Training Research Laboratory. Subjects: Fifty uninjured young athletes between 9 and 14 years of age. Main Outcome Measured: Scores on 2 clinical concussion assessments, the SAC and the BESS. Results: We found a significant learning effect upon serial BESS testing in the practice group. BESS error scores were significantly lower than baseline (15.0 +/- 14.6) on days 5 (11.3 +/- 5.33), 7 (12.4 +/- 6.2), oand 60 (12.6 +/- 6.2). We also found a significant learning effect upon the day 60 BESS administration across all subjects. We did not find a practice or learning effect with serial SAC test administration. The intratester reliability of the investigator's ability to score repeated observations of the same BESS test ranged from 0.87 to 0.98. Conclusions: Our results demonstrated that serial administration of the BESS elicited a learning effect, which was more prominent during the tandem conditions. Clinicians utilizing the BESS as a measure of postural stability should be aware of the potential for improvement with repeated testing. Clinicians should not expect improvement with the SAC, as scores remained relatively stable across all trials.