8/22/2021 Berg Balance Scale - Physiopedia

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Contents
1 Objective
2 Intended Population
3 Method of Use
3.1 Equipment required
3.2 The scale
3.3 General instructions for completing the scale
4 Interpretation
5 Evidence
5.1 Reliability
5.2 Validity
5.3 Responsiveness
5.4 Miscellaneous
5.5 Limitations
6 Links
7 References
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Objective
The Berg balance scale is used to objectively determine a patient's ability (or inability) to safely balance during a series of
predetermined tasks. It is a 14 item list with each item consisting of a five-point ordinal scale ranging from 0 to 4, with 0 indicating the
lowest level of function and 4 the highest level of function and takes approximately 20 minutes to complete. It does not include the
assessment of gait.

Intended Population
Elderly population with impairment of balance, patients with acute stroke (Berg et al 1995, Usuda et al 1998).

Method of Use
Equipment required

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5253 Assessment Process Berg …

[1]

A ruler
2 standard chairs (one with arm rests, one without)
A footstool or step
15 ft walkway
Stopwatch or wristwatch

The scale
Name: __________________________________ Date: ___________________

Location: ________________________________ Rater: ___________________

ITEM DESCRIPTION SCORE (0-4)

Sitting to standing ________

Standing unsupported ________

Sitting unsupported ________

Standing to sitting ________

Transfers ________

Standing with eyes closed ________

Standing with feet together ________

Reaching forward with outstretched arm ________

Retrieving object from floor ________

Turning to look behind ________

Turning 360 degrees ________

Placing alternate foot on stool ________

Standing with one foot in front ________

Standing on one foot ________

Total ________

General instructions for completing the scale

Please document each task and/or give instructions as written. When scoring, please record the lowest response category that applies
for each item.

In most items, the subject is asked to maintain a given position for a specific time. Progressively more points are deducted if:

the time or distance requirements are not met

the subject’s performance warrants supervision
the subject touches an external support or receives assistance from the examiner

The subject should understand that they must maintain their balance while attempting the tasks. The choices of which leg to stand on or
how far to reach are left to the subject Poor judgment will adversely influence the performance and the scoring
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how far to reach are left to the subject. Poor judgment will adversely influence the performance and the scoring.

Equipment required for testing is a stopwatch or watch with a second hand, and a ruler or other indicator of 2, 5, and 10 inches. Chairs
used during testing should be a reasonable height. Either a step or a stool of average step height may be used for item # 12.

Interpretation
Cut-off scores for the elderly were reported by Berg et al 1992 [2] as follows :

A score of 56 indicates functional balance.

A score of < 45 indicates individuals may be at greater risk of falling.

It has been reported more recently that in the elderly population a change of 4 points is needed to be 95% confident that true change
has occurred if a patient scores within 45–56 initially, 5 points if they score within 35–44, 7 points if they score within 25–34 and, finally,
5 points if their initial score is within 0–24 on the Berg Balance Scale [3].

Evidence
Reliability
Studies of various elderly populations (N = 31–101, 60–90 + years of age) have shown high intrarater and interrater reliability (ICC
=.98,14,15 ratio of variability among subjects to total = .96–1.0,16 rs =.8817). Test-retest reliability in 22 people with hemiparesis is also
high (ICC [2,1]=.98).

Berg K et al (1995) The Balance Scale: reliability assessment for elderly residents and patients with an acute stroke Scandinavian Journal
of Rehabilitation Medicine 27, 27-36

Validity
Content validity of the BBS was established in a 3-phase development process involving 32 health care professionals who were experts
working in geriatric settings. Criterion-related validity has been supported by moderate to high correlations between BBS scores and
other functional measurements in a variety of older adults with disability.

Berg K, Wood-Dauphine SL, Williams JL, Gayton D (1992) Measuring balance in the elderly: validation of an instrument Canadian Journal
of Public Health S2: s7-s11.

Usuda S, Araya K, Umehara K, Endo M, Shimizu T, Endo F (1998) Construct validity of functional balance scale in stroke inpatients Journal
of Physical Therapy Science 10, 53-56.

Whitney, S., D. Wrisley, et al. (2003). Concurrent validity of the Berg Balance Scale and the Dynamic Gait Index in people with vestibular
dysfunction. Physiother Res Int 8(4): 178-86.

Responsiveness
Increasing age has not been shown to correlate with decreasing BBS scores.

Steffen, T. M., T. A. Hacker, et al. (2002). Age- and gender-related test performance in community-dwelling elderly people: Six-Minute
Walk Test, Berg Balance Scale, Timed Up and Go Test, and gait speeds. Phys Ther 82(2): 128-37.

Mao, H. F., I. P. Hsueh, et al. (2002). Analysis and comparison of the psychometric properties of three balance measures for stroke
patients. Stroke 33(4): 1022-7.

Stevenson, T. J. (2001). Detecting change in patients with stroke using the Berg Balance Scale. Aust J Physiother 47(1): 29-38.

Salbach, N. M., N. E. Mayo, et al. (2001). Responsiveness and predictability of gait speed and other disability measures in acute stroke.
Arch Phys Med Rehabil 82(9): 1204-12.

Miscellaneous
Harada N, Chiu V, Damron-Rodrick J, Fowler E, Siu A, Reuber D (1995) Screening for balance and mobility impairment in elderly
individuals living in residential care facilities Physical Therapy 75, 6, 462-469.

Piotrowski A, Cole J (1994) Clinical measures of balance and functional assessment in elderly persons Australian Physiotherapy 40, 3,
183-188.

Russo SG (1997) Clinical balance measures: literature resources Neurology Report 21, 1, 29-36.

Whitney SL, Poole JL, Cass SP (1998) A review of balance instruments for older adults American Journal of Occupational Therapy 52, 8,
666-71.

Thorbahn LD, Newton RA (1996) Use of the Berg Balance Test to predict falls in elderly persons Phys Ther 76, 6, 576-83.

Lajoie, Y. and S. P. Gallagher (2004). Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg
balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers. Arch Gerontol Geriatr
38(1): 11-26.

Wee, J. Y., H. Wong, et al. (2003). Validation of the Berg Balance Scale as a predictor of length of stay and discharge destination in stroke
rehabilitation. Arch Phys Med Rehabil 84(5): 731-5.

Chiu, A. Y., S. S. Au-Yeung, et al. (2003). A comparison of four functional tests in discriminating fallers from non-fallers in older people.
Disabil Rehabil 25(1): 45-50.

Feld, J. A., M. H. Rabadi, et al. (2001). Berg balance scale and outcome measures in acquired brain injury. Neurorehabil Neural Repair
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Feld, J. A., M. H. Rabadi, et al. (2001). Berg balance scale and outcome measures in acquired brain injury. Neurorehabil Neural Repair
15(3): 239-44.

Wee, J. Y., S. D. Bagg, et al. (1999). The Berg balance scale as a predictor of length of stay and discharge destination in an acute stroke
rehabilitation setting. Arch Phys Med Rehabil 80(4): 448-52.

Whitney, S. L., J. L. Poole, et al. (1998). A review of balance instruments for older adults. Am J Occup Ther 52(8): 666-71.

Limitations
In ataxic clients it cannot, however, reflect problems in the performance of daily living activities, which are caused by the effects of ataxia
on the upper extremities, because none of the items are designed to do this.

Links
http://www.strokecenter.org/trials/scales/berg.html
Berg balance scale
Berg balance scale with instructions

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Berg Balance Scale - Physiopedia

Objective The Berg balance scale is used to objectively determine a patient's ability (or inability) to safely balance during a series of predetermined tasks. It is a 14 item list with each
item consisting of a five-point ordinal scale ranging from 0 to 4, with 0 indicating the lowest level of function and 4 the highest level of function and takes approximately 20 minutes to
Community Balance and Mobility Scale - Physiopedia
Objective The Community Balance and Mobility Scale (CB&M) was developed to evaluate the balance and mobility of patients who may be ambulatory, yet still have balance deficits
that affect their engagement in the community[1]. This test can be beneficial for patients that have reached a ceiling effect on other objective measures, such as the Berg Balance
Community Balance and Mobility Scale - Physiopedia
Objective The Community Balance and Mobility Scale (CB&M) was developed to evaluate the balance and mobility of patients who may be ambulatory, yet still have balance deficits
that affect their engagement in the community[1]. This test can be beneficial for patients that have reached a ceiling effect on other objective measures, such as the Berg Balance
Berg Balance Scale
Berg K, Wood-Dauphinee S, Williams JI, Maki, B: Measuring balance in the elderly: Validation of an instrument. Can. J. Pub. Health, July/August supplement 2:S7-11, 1992. Berg K,
Wood-Dauphinee S, Williams JI, Gayton D: Measuring balance in the elderly: Preliminary development of an instrument. Physiotherapy Canada, 41:304-311, 1989. Provided by the
Balance Evaluation Systems Test (BESTest) - Physiopedia
Objective BESTest is the quantitative assessment tool that aims to identify the disordered systems underlying the postural control responsible for poor functional balance. It was first
developed by Dr. Horak in 2009 for clinicians to differentiate balance problems into six underlying systems that may constrain balance. It was developed from the theoretical

References
1. Kembe Frederick. 5253 Assessment Process Berg Balance Scale F.H.F. Available from: http://www.youtube.com/watch?
v=i_Jlc5kL6KU[last accessed 08/02/13]
2. Berg K, Wood-Dauphinee S, Williams JI, Maki, B: Measuring balance in the elderly: Validation of an instrument. Can. J. Pub. Health,
July/August supplement 2:S7-11, 1992.
3. Donoghue, D. and Stokes, E.K., (2009). How much change is true change? The minimum detectablefckLRchange of the Berg Balance
Scale in elderly people. Journal of Rehabilitation Medicine, 41(5), pp.fckLR343-346.

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