Balance Evaluation Systems Test (BESTest)

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Top Contributors - Manisha Shrestha, Kim Jackson, Vidya Acharya, PI YIN HUANG, Lucinda hampton and Leana Louw  

Objective

BESTest is the sensitive and quantitative assessment tool developed to identify the disordered systems underlying the postural control systems responsible for poor functional balance. It was first developed by Dr. Horak in 2009 for clinicians to differentiate balance into 6 underlying systems that may constrain balance. It has 36 items that evaluate performance of 6 balance systems: bio-mechanical constraints, stability limits/verticality, anticipatory responses, postural responses, sensory orientation, and stability in gait. It was developed from the theoretical understanding of balance control systems based on Bernstein's concept that postural control results from a set of interacting systems.

Strength of BESTest:

• It contains different balance systems which helps in postural control.
• It helps clinicians to determine the type of balance problems so as to direct the specific treatments for their patients.
• It will help to improve third party reimbursement by identifying the specific system affected and change with therapy.

Constraints of Postural control systems addresses following:

1. Biomechanical Systems: ankle strategy or compensatory steps for postural recovery (eg: flexed posture in frial elderly and Person's with Parkinson diseases).
2. Limits of Stability ( how far the body's center of mass can be moved over it's base of support) and Verticality (represent gravitational upright).
3. Anticipatory Postural Adjustments: readiness prior to the voluntary movements which depend on interaction of supplementary motor areas with basal ganglia nad brain stem areas).
4. Automatic Postural Responses: short, medium and long proprioceptive feedback loops.
5. Sensory Orientation: Spatial orientation maintain by pathways involving vestibular system and sensory integrative areas of the temporo-parietal cortex
6. Stability in Gait: Co-ordination between spinal locomotor and brain stem postural sensorimotor programs.

Intended Population

It can be used in varied age and severity of ambulator patients with neurological conditions ( Parkinson's Diseases, Stroke,Cerebellar Ataxia, Neuropathies, Head injury, Mulitiple Scelerosis, Cerebral palsy, etc.), Vestibular disorders, Cognitive Deficits and Elderly.

Method of Use

Time to administer: 30- 45 minutes.

Equipments Required:

Limitations

• Time to complete the assessment is longer with even longer depending upon severity if conditions.
• Equipment required is too many which may not be practical for regular use in all clinical settings.

Also See

Mini- BESTest

Brief- BESTest

TUG

References

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Original Papers Horak, F. B., Wrisley, D. M., & Frank, J. (2009). The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits. Physical Therapy, 89(5), 484–98. doi:10.2522/ptj.20080071

Franchignoni, F., Horak, F., Godi, M., Nardone, A., & Giordano, A. (2010). Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest. Journal of Rehabilitation Medicine : Official Journal of the UEMS European Board of Physical an Medicine, 42, 323–331. doi:10.2340/16501977-0537

King, L., & Horak, F. (2013). On the Mini-BESTest: Scoring and the Reporting of Total Scores. Physical Therapy, 93(4), 571–5. doi:10.2522/ptj.2013.93.4.571 (pub med link) note: subscription to Physical Therapy Jounral required for login

Related Papers

Duncan, R. P., Leddy, A. L., Cavanaugh, J. T., Dibble, L. E., Ellis, T. D., Ford, M. P., … Earhart, G. M. (2013). Comparative utility of the BESTest, mini-BESTest, and brief-BESTest for predicting falls in individuals with Parkinson disease: a cohort study. Physical Therapy, 93(4), 542–50. doi:10.2522/ptj.20120302

Franchignoni, F., Godi, M., Guglielmetti, S., Nardone, A., & Giordano, A. (2015). Enhancing the usefulness of the Mini-BESTest for measuring dynamic balance: A Rasch validation study. European Journal of Physical and Rehabilitation Medicine, 51(4), 429-437.

Godi, M., Franchignoni, F., Caligari, M., Giordano, A., Turcato, A., & Nardone, A. (2013). Comparison of Reliability, Validity, and Responsiveness of the Mini- BESTest and Berg Balance Scale in Patients With Balance Disorders. Journal of the American Physical Therapy Association, 93(2), 158-167.

Mak, M. K. Y., & Auyeung, M. M. (2013). The mini-BESTest can predict Parkinsonian recurrent fallers: a 6-month prospective study. Journal of Rehabilitation Medicine : Official Journal of the UEMS European Board of Physical and Rehabilitation Medicine, 45, 565–71. doi:10.2340/16501977-1144

O’Hoski, S., Winship, B., Herridge, L., Agha, T., Brooks, D., Beauchamp, M. K., & Sibley, K. M. (2014). Increasing the Clinical Utility of the BESTest, Mini-BESTest, and BriefBESTest: Normative Values in Canadian Adults Who Are Healthy and Aged 50 Years and Over. Physical Therapy, 94(3), 334–42. doi:10.2522/ptj.20130104

Padgett, P. K., Jacobs, J. V, & Kasser, S. L. (2012). Is the BESTest at Its Best? A Suggested Brief Version Based on Interrater Reliability, Validity, Internal Consistency, and Theoretical Construct. Physical Therapy, 92(9), 1197–207. doi:10.2522/ptj.20120056