Berg Balance Scale (BBS)
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Overview - Equipment Needed
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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.
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Does the patient have a history of falls:
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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  3 seconds
Aries to lift leg unable to
hold 3 seconds but remains standing independently.
Unable to try and needs assistance
to prevent fall
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Background Info
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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
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References
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- 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.
- Berg K, Wood-Dauphinėe S, et al. Measuring balance in the elderly:
preliminary development of an instrument. Physiotherapy Canada. 41 (6):
304–311.
- 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.
- 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.
- Shumway-Cook, A., Baldwin, M., et al. (1997). Predicting the
probability for falls in community-dwelling older adults. Physical
Therapy 77(8): 812-819.
- 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.
- Rehabilitation Measures Database: Accessed: August 2017.
https://www.rehabmeasures.org/Lists/RehabMeasures/PrintView.aspx?ID=888
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