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International Journal of Exercise Science


Mild traumatic brain injuries (mTBIs) are common in contact sports. There is an association between mTBIs and altered motor function. BioSway technology measures individuals’ balance using the Balance Error Scoring System (BESS). Prior to incorporating BESS testing in concussion protocol, other variables that influence the BESS test require review. The objective of this study is to determine if game fatigue in hockey players also influences the BESS score. 23 male (21.08 ± 1.09) National Collegiate Athletic Association (NCAA) athletes were tested using the BioSway™ (Biodex, USA). The BESS test measures the Sway Index (SI) - a calculation of deviation from the center of mass. Balance errors were counted according to BESS standard testing protocol. Baseline and post BESS scores were completed at rest and following exertion in a standard non-contact practice setting. Heart rate and rate of perceived exertion (RPE) were recorded to document fatigue during a 60 minute non contact game simulation. Statistical analysis was performed using SPSS v.25. A paired sample t-test comparing sway index in the single, double, and tandem pre and post stances demonstrated no significance (p=.567, .666, .098) respectively. A paired sample t-test demonstrated a significant increase in balance errors in the single leg stance following 60 minutes on ice (p=.006). While mTBIs influence balance, this study demonstrates that game-like exertion also influences single leg stance balance as measured by the BioSway technology and BESS testing protocol. Athlete fatigue should be considered a confounding variable in measure of balance as an indicator of mTBI.

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Original source: Cameron, Philip; Soltero, Noelle C.; and Byers, Justin (2018) "Effects of a 60 Minute on Ice Game Simulation on the Balance Error Scoring System," International Journal of Exercise Science: Vol. 11 : Iss. 6, Pages 462 - 467. Available at:

Associated course: HAS495 Biokinetics Symposium