***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Ankle supports are commonly used in an attempt to decrease the risk of ankle injury during sport . However , their use may also impair postural control , which is an integral component of sports participation . The aim of this study was to investigate the effects of three different ankle supports ( tape , brace , and elastic b and age ) on postural control in 24 normal subjects with a mean age of 24.8 years ( + /- 4.4 ) . Two measures were used to evaluate postural control in one-legged stance with the eyes closed : variability of mediolateral ground reaction force ( acquired from a force platform ) and frequency of foot touchdowns by the nonsupport leg ( assumed to indicate ability of the subject to maintain one-legged stance posture ) . Both measures revealed a differential effect for ankle support on postural control . The use of an elastic b and age had no significant effect on postural control ( p > 0.05 ) , while the use of tape or a brace had a significant detrimental effect ( p < 0.05 ) . While wearing the tape or a brace , subjects were less steady and touched down more frequently . Restriction of ankle movement was offered as a possible explanation for the results , since postural control was impaired only by the ankle supports which limited ankle motion . These findings may have implication s regarding impaired athletic performance OBJECTIVE : To assess whether repeated administration of the St and ardized Assessment of Concussion ( SAC ) and Balance Error Scoring System ( BESS ) demonstrates a practice effect in high school athletes . DESIGN AND SETTING : Subjects were assigned to either a control or practice group . Subjects in the control group were assessed twice , 30 days apart . Subjects in the practice group were assessed on 5 occasions . Four assessment s were performed within a 7-day period and 1 more assessment 30 days after the initial test . SUBJECTS : Thirty-two uninjured high school athletes participated in this investigation . Sixteen were r and omly assigned to a control group and 16 to a practice group . MEASUREMENTS : We measured performance on the SAC and on 6 test conditions of the  BESS .  RESULTS : We found a significant time-by-group interaction on BESS performance on the day-30 test session . A significant practice effect of the BESS was found during the course of repeated administrations in the practice group . After repeated testing , the number of BESS errors decreased with each test session , and error scores on day 5 ( 10.94 + /- 2.17 ) and day 7 ( 9.44 + /- 3.32 ) were significantly lower than the baseline score ( 12.88 + /- 3.34 ) . We did not find group differences or a practice effect on the SAC ( baseline score = 26.16 ) . CONCLUSIONS : Our results revealed no practice effect with the SAC and a slight practice effect with repeated administrations of the BESS , especially with the single-leg stance on foam . Clinicians must acknowledge the potential for practice effects when readministering these concussion assessment s to track recovery of an athlete or as a guide in return-to-play decision making The purpose of this study was to determine the effect of a 4-week balance training program on specified functional tasks . Thirty-six subjects ( age = 22.7 ± 2.10 years ; height = 168.30 ± 9.55 cm ; weight = 71.15 ± 16.40 kg ) were r and omly placed into control ( C ; n = 19 ) and experimental groups ( Tx ; n = 17 ) . The Tx group trained using a commercially available balance training device ( BOSU ) . Postural limits ( displacement and sway ) and functional task ( time on ball , shuttle run , and vertical jump ) were assessed during a pretest ( T1 ) , a posttest ( T2 ) , and 2 weeks posttraining ( T3 ) . Multivariate repeated measures analysis ( a = 0.05 ) revealed significant differences in time on ball , shuttle run , total sway , and fore/aft displacement after the exercise intervention ( T2 ) . T3 assessment revealed that total sway and time on ball remained controlled ; however , no other measures were retained . Balance training improved performance of selected sport-related activities and postural control measures , although it is unclear whether the effect of training would transfer to general functional enhancement Objective : To determine if serial administration of the St and ardized 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 prospect i ve study of 50 healthy young athletes who were assigned to either the control or practice group . All subjects were administered the assessment s on 2 occasions , 60 days apart . In addition , subjects in the practice group received serial administration of the assessment s 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 assessment s , 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 ± 4.6 ) on days 5 ( 11.3 ± 5.33 ) , 7 ( 12.4 ± 6.2 ) , and 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 t and em 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 CONTEXT Lack of empirical data on recovery time following sport-related concussion hampers clinical decision making about return to play after injury . OBJECTIVE To prospect ively measure immediate effects and natural recovery course relating to symptoms , cognitive functioning , and postural stability following sport-related concussion . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 1631 football players from 15 US colleges . All players underwent preseason baseline testing on concussion assessment measures in 1999 , 2000 , and 2001 . Ninety-four players with concussion ( based on American Academy of Neurology criteria ) and 56 noninjured controls underwent assessment of symptoms  , cognitive functioning  , and postural stability immediately , 3 hours , and 1 , 2 , 3 , 5 , 7 , and 90 days after injury . MAIN OUTCOME MEASURES Scores on the Grade d Symptom Checklist ( GSC ) , St and ardized Assessment of Concussion ( SAC ) , Balance Error Scoring System ( BESS ) , and a neuropsychological test battery . RESULTS No player with concussion was excluded from participation ; 79 players with concussion ( 84 % ) completed the protocol through day 90 . Players with concussion exhibited more severe symptoms ( mean GSC score 20.93 [ 95 % confidence interval [ CI ] , 15.65 - 26.21 ] points higher than that of controls ) , cognitive impairment ( mean SAC score 2.94 [ 95 % CI , 1.50 - 4.38 ] points lower than that of controls ) , and balance problems ( mean BESS score 5.81 [ 95 % CI , -0.67 to 12.30 ] points higher than that of controls ) immediately after concussion . On average , symptoms gradually resolved by day 7 ( GSC mean difference , 0.33 ; 95 % CI , -1.41 to 2.06 ) , cognitive functioning improved to baseline levels within 5 to 7 days ( day 7 SAC mean difference , -0.03 ; 95 % CI , -1.33 to 1.26 ) , and balance deficits dissipated within 3 to 5 days after injury ( day 5 BESS mean difference , -0.31 ; 95 % CI , -3.02 to 2.40 ) . Mild impairments in cognitive processing and verbal memory evident on neuropsychological testing 2 days after concussion resolved by day 7 . There were no significant differences in symptoms or functional impairments in the concussion and control groups 90 days after concussion . CONCLUSIONS Collegiate football players may require several days for recovery of symptoms , cognitive dysfunction , and postural instability after concussion . Further research is required to determine factors that predict variability in recovery time after concussion . St and ardized measurement of postconcussive symptoms , cognitive functioning , and postural stability may enhance clinical management of athletes recovering from concussion OBJECTIVE The purpose of this study was to determine the intrarater and interrater reliability of the Balance Error Scoring System ( BESS ) . DESIGN A prospect i ve observational study . SETTING Academic sports medicine center . PARTICIPANTS Three scorers participated in this study . METHODS Three scorers experienced in using the  BESS viewed a videotape depicting 30 consecutive individuals performing the BESS stance positions . The 3 scorers independently scored each of the 30 videotaped individuals using the BESS scoring criteria . A week later , the same 3 subjects viewed and scored the videotape again . MAIN OUTCOME MEASUREMENTS The interrater and intrarater reliability of the BESS  was determined using intraclass correlation coefficients ( ICC ) , reported with 95 % confidence intervals . The minimum detectible change was also determined . RESULTS The interrater and intrarater reliability ICCs for the total BESS scores were 0.57 and 0.74 , respectively . The interrater reliability ICCs for the 6 different stance positions were between 0.44 and 0.83 , while the intrarater reliability ICCs were between 0.50 and 0.88 . The interrater and intrarater minimum detectible change for the total BESS score were 9.4 and 7.3 points , respectively . CONCLUSION This study suggests that certain subcategories of the BESS have sufficient reliability to be used in the evaluation of postural stability but that the total BESS score is not reliable . In addition , a change in score of greater than 9.4 ( interrater ) or 7.3 ( intrarater ) points is required before the change in postural stability can be attributed to the balancer rather than to the scorer CONTEXT Poor balance has been associated with increased injury risk among athletes .  Neuromuscular-training programs have been advocated as a means of injury prevention , but little is known about the benefits of these programs on balance in high school athletes . OBJECTIVE To determine whether there are balance gains after participation in a neuromuscular-training program in high school athletes . DESIGN Nonr and omized controlled trial . SETTING All data were collected at each participating high school before and after a 6-wk intervention or control period . PARTICIPANTS 62 female high school basketball players recruited from the local high school community and assigned to a training ( n = 37 ) or control ( n = 25 ) group . INTERVENTION Training-group subjects participated in a 6-wk neuromuscular-training program that included plyometric , functional-strengthening , balance , and stability-ball exercises . MAIN OUTCOME MEASURES Data were collected for the Balance Error Scoring System ( BESS ) and Star Excursion Balance Test ( SEBT ) before and after the 6-wk intervention or control period . RESULTS The authors found a significant decrease in total BESS errors in the trained group at the posttest compared with their pretest and the control group ( P = .003 ) . Trained subjects also scored significantly fewer BESS errors on the single-foam and t and em-foam conditions at the posttest than the control group and demonstrated improvements on the single-foam compared with their pretest ( P = .033 ) . The authors found improvements in reach in the lateral , anteromedial , medial , and posterior directions in the trained group at the posttest compared with the control group ( P < .05 ) using the SEBT . CONCLUSION The study demonstrates that a neuromuscular-training program can increase the balance and proprioceptive capabilities of female high school basketball players and that clinical balance measures are sensitive to detect these differences Objective : Study 1 investigated the intraclass reliability and percent variance associated with each component within the traditional Balance Error Scoring System ( BESS ) protocol . Study 2 investigated the reliability of subsequent modifications of the BESS . Design : Prospect i ve cross-sectional examination of the traditional and modified BESS protocol s. Setting : Schools participating in Georgia High School Athletics Association . Intervention : The modified BESS consisted of 2 surfaces ( firm and foam ) and 2 stances ( single-leg and t and em-leg stance ) repeated for a total of three 20-second trials . Participants : Participants consisted of 2 independent sample s of high school athletes aged 13 to 19 years . Main Outcome Measures : Percent variance for each condition of the BESS  was obtained using GENOVA 3.1 . An intraclass reliability coefficient and repeated measures analysis of variance were calculated using SPSS 13.0 . Results : Study 1 obtained an intraclass correlation coefficient ( r = 0.60 ) with stance accounting for 55 % of the total variance . Removing the double-leg stance increased the intraclass correlation coefficient ( r = 0.71 ) . Study 2 found a statistically significant difference between trials 1 and 2 ( F(1.65,286 ) = 4.890 , P = 0.013 ) and intraclass reliability coefficient of r = 0.8 
    Output:
    
Results : Reliability of the total BESS score and individual stances ranged from poor to moderate to good , depending on the type of reliability assessed .
The BESS has criterion-related validity with force plate measures ; more difficult stances have higher agreement than do easier ones .
The BESS is valid to detect balance deficits where large differences exist ( concussion or fatigue ) .
It may not be valid when differences are more subtle .
Conclusions : Overall , the BESS has moderate to good reliability to assess static balance .
The BESS correlates with other measures of balance using testing devices .
The BESS can detect balance deficits in participants with concussion and fatigue .
BESS scores increase with age and with ankle instability and external ankle bracing .
BESS scores improve after training