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Berg Balance Scale (BBS)

Overview - Equipment Needed

The Berg Balance Scale (BBS) is a strongly established tool that has been found to be both valid and reliable when used as a clinical test of a person's static and dynamic balance abilities as well as fall risk.1,2  The test takes between 15 and 20 minutes and consists of a set of 14 simple balance related tasks.  Each item is scored from 0 to 4, and the maximum total score is 56.

The following equipment is needed to perform the test:  yardstick/ruler, 2 standard chairs (one with arm rests, one without), footstool or step, stopwatch or wristwatch, 15 foot walkway. 

Does the patient have a history of falls
1. SITTING TO STANDING
INSTRUCTIONS: Please stand up. Try not to use your hand for support.
Able to stand without using hands and stabilize independently
Able to stand independently using hands
Able to stand using hands after several tries
Needs minimal aid to stand or stabilize
Needs moderate or maximal assist to stand

2. STANDING UNSUPPORTED
INSTRUCTIONS: Please stand for two minutes without holding on.
Able to stand safely for 2 minutes
Able to stand 2 minutes with supervision
Able to stand 30 seconds unsupported
Needs several tries to stand 30 seconds unsupported
Unable to stand 30 seconds unsupported
If a subject is able to stand 2 minutes unsupported, score full points for sitting unsupported. Proceed to item #4.

3. SITTING WITH BACK UNSUPPORTED BUT FEET SUPPORTED ON FLOOR OR ON A STOOL
INSTRUCTIONS: Please sit with arms folded for 2 minutes.
Able to sit safely and securely for 2 minutes
Able to sit 2 minutes under supervision
Able to able to sit 30 seconds
Able to sit 10 seconds
Unable to sit without support 10 seconds


4. STANDING TO SITTING
INSTRUCTIONS: Please sit down.
Sits safely with minimal use of hands
Controls descent by using hands
Uses back of legs against chair to control descent
Sits independently but has uncontrolled descent
Needs assistance to sit


5. TRANSFERS
INSTRUCTIONS: Arrange chair(s) for pivot transfer. Ask subject to transfer one way toward a seat with armrests and one way toward a seat without armrests. You may use two chairs (one with and one without armrests) or a bed and a chair.
Able to transfer safely with minor use of hands
Able to transfer safely definite need of hands
Able to transfer with verbal cuing and/or supervision
Needs one person to assist
Needs two people to assist or supervise to be safe


6. STANDING UNSUPPORTED WITH EYES CLOSED
INSTRUCTIONS: Please close your eyes and stand still for 10 seconds.
Able to stand 10 seconds safely
Able to stand 10 seconds with supervision
Able to stand 3 seconds
Unable to keep eyes closed 3 seconds but stays safely
Needs help to keep from falling


7. STANDING UNSUPPORTED WITH FEET TOGETHER
INSTRUCTIONS: Place your feet together and stand without holding on.
Able to place feet together independently and stand 1 minute safely
Able to place feet together independently and stand 1 minute with supervision
Able to place feet together independently but unable to hold for 30 seconds
Needs help to attain position but able to stand 15 seconds feet together
Needs help to attain position and unable to hold for 15 seconds


8. REACHING FORWARD WITH OUTSTRETCHED ARM WHILE STANDING
INSTRUCTIONS: Lift arm to 90 degrees. Stretch out your fingers and reach forward as far as you can. (Examiner places a ruler at the end of fingertips when arm is at 90 degrees. Fingers should not touch the ruler while reaching forward. The recorded measure is the distance forward that the fingers reach while the subject is in the most forward lean position. When possible, ask subject to use both arms when reaching to avoid rotation of the trunk.)
Can reach forward confidently 25 cm (10 inches)
Can reach forward 12 cm (5 inches)
Can reach forward 5 cm (2 inches)
Reaches forward but needs supervision
Loses balance while trying/requires external support


9. PICK UP OBJECT FROM THE FLOOR FROM A STANDING POSITION
INSTRUCTIONS: Pick up the shoe/slipper, which is place in front of your feet.
Able to pick up slipper safely and easily
Able to pick up slipper but needs supervision
Unable to pick up but reaches 2-5 cm(1-2 inches) from slipper and keeps balance independently
Unable to pick up and needs supervision while trying
Unable to try/needs assist to keep from losing balance or falling


10. TURNING TO LOOK BEHIND OVER LEFT AND RIGHT SHOULDERS WHILE STANDING
INSTRUCTIONS: Turn to look directly behind you over toward the left shoulder. Repeat to the right. Examiner may pick an object to look at directly behind the subject to encourage a better twist turn.
Looks behind from both sides and weight shifts well
Looks behind one side only other side shows less weight shift
Turns sideways only but maintains balance
Needs supervision when turning
Needs assistance to keep from losing balance or falling


11. TURN 360 DEGREES
INSTRUCTIONS: Turn completely around in a full circle. Pause. Then turn a full circle in the other direction.
Able to turn 360 degrees safely in 4 seconds or less
Able to turn 360 degrees safely one side only 4 seconds or less
Able to turn 360 degrees safely but slowly
Needs close supervision or verbal cuing
Needs assistance while turning


12. PLACE ALTERNATE FOOT ON STEP OR STOOL WHILE STANDING UNSUPPORTED
INSTRUCTIONS: Place each foot alternately on the step/stool. Continue until each foot has touch the step/stool four times.
Able to stand independently and safely and complete 8 steps in 20 seconds
Able to stand independently and complete 8 steps in > 20 seconds
Able to complete 4 steps without aid with supervision
Able to complete > 2 steps needs minimal assist
Needs assistance to keep from falling/unable to try


13. STANDING UNSUPPORTED ONE FOOT IN FRONT
INSTRUCTIONS: (DEMONSTRATE TO SUBJECT) Place one foot directly in front of the other. If you feel that you cannot place your foot directly in front, try to step far enough ahead that the heel of your forward foot is ahead of the toes of the other foot. (To score 3 points, the length of the step should exceed the length of the other foot and the width of the stance should approximate the subject’s normal stride width.)
Able to place foot tandem independently and hold 30 seconds
Able to place foot ahead independently and hold 30 seconds
Able to take small step independently and hold 30 seconds
Needs help to step but can hold 15 seconds
Loses balance while stepping or standing


14. STANDING ON ONE LEG
INSTRUCTIONS: Stand on one leg as long as you can without holding on.
Able to lift leg independently and hold > 10 seconds
Able to lift leg independently and hold 5-10 seconds
Able to lift leg independently and hold geq 3 seconds
Aries to lift leg unable to hold 3 seconds but remains standing independently.
Unable to try and needs assistance to prevent fall


Background Info


The BBS is considered to be the gold standard compared to other functional balance tests.  It is also the most commonly used assessment tool during stroke rehabilitation.1   The Berg Balance Scale is used by physiotherapists and occupational therapists to determine the functional mobility of an individual. The test is usually administered prior to treatment for elderly patients with one of the following conditions1:

  • Ataxia
  • Brain injury
  • Cardiovascular disease
  • Multiple sclerosis
  • Osteoarthritis
  • Parkinson's disease
  • Stroke
  • Vertigo
  • Vestibular dysfunction
  • Others

 The Berg Balance Scale Test can be administered every few months of treatment to determine if the treatment was effective for increasing the patient's functional mobility (a difference of 8 points is considered a significant change).4

References

  1. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther. 2008 May;88(5):559-66. doi: 10.2522/ptj.20070205. Epub 2008 Feb 21.

  2. Berg K, Wood-Dauphinėe S, et al. Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada. 41 (6): 304–311.

  3. Berg K, Wood-Dauphinee S, Williams JI, Maki, B (1992). Measuring balance in the elderly: validation of an instrument. Can. J. Pub. Health July/August supplement 2:S7-11.

  4. Steffen T.M, Hacker TA, Mollinger L. Age- and Gender-Related Test Performance in Community-Dwelling Elderly People: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and Gait Speeds. Journal of Physical Therapy. 82 (2): 128–137.

  5. Shumway-Cook, A., Baldwin, M., et al. (1997). Predicting the probability for falls in community-dwelling older adults. Physical Therapy 77(8): 812-819.

  6. Donoghue D; Physiotherapy Research and Older People (PROP) group, Stokes EK. (2009). How much change is true change? The minimum detectable change of the Berg Balance Scale in elderly people. J Rehabil Med. 41(5):343-6.

  7. Rehabilitation Measures Database:  Accessed: August 2017.
    http://www.rehabmeasures.org/Lists/RehabMeasures/PrintView.aspx?ID=888






Disclaimer

All calculations must be confirmed before use. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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