Berg balance scale

Balance is the condition in which all the forces acting on the body are balanced such that the center of mass (COM) is within the stability limits, the boundaries of the base of support (BOS). The overall goals of the postural control system, stability and function, are achieved through integrated CNS systems of control.

The Berg Balance Scale (BBS) is an objective measure of static and dynamic balance abilities. The scale consists of 14 functional tasks commonly performed in everyday life. The items range from sitting or standing unsupported, to movement transitions (sit-to-stand, stand-to-sit), variations in standing position (EO/EC), feet together, forward reach, retrieving an object from the floor, turning, standing on one foot, to placing the foot on a stool. Scoring uses a five-point ordinal scale, with scores ranging from 0 to 4.

1.Sitting to standing

Instructions: Please stand up, try not to use your hands for support.

  • 4 able to stand without using hands and stabilizes independently
  • 3 able to stand independently using hands
  • 2 able to stand using hands after several tries
  • 1 needs minimal aid to stand or stabilize
  • 0 needs moderate or maximal assist to stand

2.standing unsupported

Instructions: Please stand for 2 minutes without holding.

  • 4 able to stand safely 2 minutes
  • 3 able to stand 2 minutes with supervision
  • 2 able to stand 30 seconds unsupported
  • 1 needs several tries to stand unsupported 30 seconds
  • 0 unable to stand 30 seconds without support

3.Sitting with back unsupported but feet supported on floor or on a stool

Instructions: Please sit with arms folded for 2 minutes.

  • 4 able to sit safely and securely 2 minutes
  • 3 able to sit 2 minutes with supervision
  • 2 able to sit 30 seconds
  • 1 able to sit 10 seconds
  • 0 unable to sit without support 10 seconds

4.standing to sit

Instructions: Please sit down.

  • 4 sits safely with minimal use of hands
  • 3 controls descent by using hands
  • 2 uses back of legs against chair to control descent
  • 1 sits independently, but has uncontrolled descent
  • 0 needs assistance to sit

5.Transfer

Instructions: Arrange chairs for a pivot transfer. Ask the patient to transfer one way toward a seat without armrests and one way toward a seat with arms. You may use two chairs or a bed/mat and a chair.

  • 4 able to transfer safely with minor use of hands
  • 3 able to transfer safely with definite need of hands
  • 2 able to transfer with verbal cuing and/or supervision
  • 1 needs one person to assist
  • 0 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.

  • 4 able to stand 10 seconds safely
  • 3 able to stand 10 seconds with supervision
  • 2 able to stand 3 seconds
  • 1 unable to keep eyes closed for 3 seconds but stands safely
  • 0 needs help to keep from falling

7.Standing unsupported with feet together

Instructions: Place your feet together and stand without holding.

  • 4 able to place feet together independently and stand safely 1 minute
  • 3 able to place feet together independently and stand with supervision for 1 minute
  • 2 able to place feet together independently but unable to hold for 30 seconds
  • 1 needs help to assume the position but can stand for 15 seconds, feet together
  • 0 needs help to assume the position and unable to stand for 15 seconds

8.Reaching forward with outstretched arm while standing

Instructions: Lift arm to 90°. Stretch out your fingers and reach forward as far as you can. (Clinician places a ruler at the tips of the outstretched fingers—subject should not touch the ruler when reaching.) Distance recorded is from the fingertips with the subject in the most forward position. he subject should use both hands when possible to avoid trunk rotation.

  • 4 can reach forward confidently 20–30 cm (10 inches)
  • 3 can reach forward safely 12 cm (5 inches)
  • 2 can reach forward safely 5 cm (2 inches)
  • 1 reaches forward but needs supervision
  • 0 loses balance when trying, requires external support

9.Pick up object from the floor from a standing position

Instructions: Pick up the shoe slipper which is placed in front of your feet.

  • 4 able to pick up the slipper safely and easily
  • 3 able to pick up the slipper but needs supervision
  • 2 unable to pick up the slipper, but reaches 2–5 cm (1–2 inches) from the slipper and keeps balance independently
  • 1 unable to pick up and needs supervision while trying
  • 0 unable to try/needs assistance to keep from losing balance/falling

10.Turning to look behind over your left and right shoulders while standing

Instructions: Turn and 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.

  • 4 looks behind from both sides and weight shifts well
  • 3 looks behind one side only, other side shows less weight shift
  • 2 turns sideways only but maintains balance
  • 1 needs close supervision or verbal cuing
  • 0 needs assistance while turning

11.Turn 360°

Instructions: Turn completely around in a full circle,pause, then turn a full circle in the other direction.

  • 4 able to turn 360° safely in 4 seconds or less
  • 3 able to turn 360° safely, one side only, 4 seconds or less
  • 2 able to turn 360° safely, but slowly
  • 1 needs close supervision or verbal cuing
  • 0 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 touched the step stool 4 times.

  • 4 able to stand independently and safely and complete 8 steps in 20 seconds
  • 3 able to stand independently and complete 8 steps >20 seconds
  • 2 able to complete 4 steps without aid with supervision
  • 1 able to complete >2 steps needs minimal assistance
  • 0 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 and step far enough ahead that the heel of your forward foot is ahead of the toes of your other foot. To score three 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 stance width.

  • 4 able to place foot tandem independently and hold 30 seconds
  • 3 able to place foot ahead of the other independently and hold 30 seconds
  • 2 able to take a small step independently and hold 30 seconds
  • 1 needs help to step but can hold 15 seconds
  • 0 loses balance while stepping or standing

14. Standing on one leg

Instructions: Stand on one leg as long as you can without holding

  • 4 able to lift leg independently and hold >10 seconds
  • 3 able to lift leg independently and hold 5–10 seconds
  • 2 able to lift leg independently and hold >2 seconds
  • 1 tries to lift leg unable to hold 3 seconds but remains standing independently
  • 0 unable to try or needs assistance to prevent fall

———–Total score (maximum 52)

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