An Alternative to the Balance Error Scoring System: Using a Low-Cost Balance Board to Improve the Validity/Reliability of Sports-Related Concussion Balance Testing

Objective:Recent guidelines advocate sports medicine professionals to use balance tests to assess sensorimotor status in the management of concussions. The present study sought to determine whether a low-cost balance board could provide a valid, reliable, and objective means of performing this balance testing.Design:Criterion validity testing relative to a gold standard and 7 day test-retest reliability.Setting:University biomechanics laboratory.Participants:Thirty healthy young adults.Assessment of Risk Factors:Balance ability was assessed on 2 days separated by 1 week using (1) a gold standard measure (ie, scientific grade force plate), (2) a low-cost Nintendo Wii Balance Board (WBB), and (3) the Balance Error Scoring System (BESS).Main Outcome Measures:Validity of the WBB center of pressure path length and BESS scores were determined relative to the force plate data. Test-retest reliability was established based on intraclass correlation coefficients.Results:Composite scores for the WBB had excellent validity (r = 0.99) and test-retest reliability (R = 0.88). Both the validity (r = 0.10-0.52) and test-retest reliability (r = 0.61-0.78) were lower for the BESS.Conclusions:These findings demonstrate that a low-cost balance board can provide improved balance testing accuracy/reliability compared with the BESS.Clinical Relevance:This approach provides a potentially more valid/reliable, yet affordable, means of assessing sports-related concussion compared with current methods.