# Berg Balance Scale

The Berg Balance Scale (BBS) was developed to measu re balance among older people with impairment in balance function by assessing the per formance of functional tasks. It is a valid

instrument used for evaluation of the effectiveness of interventions and for quantitative descriptions of function in clinical practice and r esearch. The BBS has been evaluated in several reliability studies. A recent study of the BBS, which was completed in F inland, indicates that a change of eight (8) BBS points is required to reveal a gen uine change in function between two assessments among older people who are dependent in ADL and liv ing in residential care facilities.

Description: 14-item scale designed to measure balance of the ol der adult in a clinical setting.

Equipment needed: Ruler, two standard chairs (one with arm rests, o ne without), footstool or step, stopwatch or wristwatch, 15 ft w alkway

Completion:

Time: 15-20 minutes Scoring: A five-point scale, ranging from 0-4. “0” indicate s the lowest level of function and “4” the high est level of function. Total Score = 56

Interpretation: 41-56 = low fall risk

21-40 = medium fall risk 0 –20 = high fall risk

A change of 8 points is required to reveal a genuin e change in function between 2 assessments.

# Berg Balance Scale

Name: __________________________________ Date: ____

_______________

Location: ________________________________ Rater: _

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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 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 g iven 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

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

.

Equipment required for testing is a stopwatch or wa tch with a second hand, and a ruler or other

indicator of 2, 5, and 10 inches. Chairs used durin g testing should be a reasonable height. Either a step or a stool of average step height may be use d for item # 12.

# Berg Balance Scale

SITTING TO STANDING INSTRUCTIONS: Please stand up. Try not to use your hand for support. ( ) 4 able to stand without using hands and stab ilize independently ( ) 3 able to stand independently using hands ( ) 2 able to stand using hands after several tr ies ( ) 1 needs minimal aid to stand or stabilize ( ) 0 needs moderate or maximal assist to stand

STANDING UNSUPPORTED

INSTRUCTIONS: Please stand for two minutes without holding on. ( ) 4 able to stand safely for 2 minutes ( ) 3 able to stand 2 minutes with supervision ( ) 2 able to stand 30 seconds unsupported ( ) 1 needs several tries to stand 30 seconds un supported ( ) 0 unable to stand 30 seconds unsupported

If a subject is able to stand 2 minutes unsupported , score full points for sitting unsupported. Procee d to item #4.

SITTING WITH BACK UNSUPPORTED BUT FEET SUPPORTED ON FLOOR OR ON A STOOL

INSTRUCTIONS: Please sit with arms folded for 2 min utes. ( ) 4 able to sit safely and securely for 2 minu tes ( ) 3 able to sit 2 minutes under supervision ( ) 2 able to able to sit 30 seconds ( ) 1 able to sit 10 seconds ( ) 0 unable to sit without support 10 seconds

STANDING TO SITTING

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 de scent ( ) 0 needs assist to sit

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 cha irs (one with and one without armrests) or a bed an d a chair. ( ) 4 able to transfer safely with minor use of hands ( ) 3 able to transfer safely definite need of h ands ( ) 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

STANDING UNSUPPORTED WITH EYES CLOSED INSTRUCTIONS: Please close your eyes and stand stil l 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 3 seconds but s tays safely ( ) 0 needs help to keep from falling

STANDING UNSUPPORTED WITH FEET TOGETHER INSTRUCTIONS: Place your feet together and stand wi thout holding on. ( ) 4 able to place feet together independently and stand 1 minute safely ( ) 3 able to place feet together independently and stand 1 minute with supervision ( ) 2 able to place feet together independently but unable to hold for 30 seconds ( ) 1 needs help to attain position but able to stand 15 seconds feet together ( ) 0 needs help to attain position and unable t o hold for 15 seconds

# Berg Balance Scale continued...

REACHING FORWARD WITH OUTSTRETCHED ARM WHILE STANDI NG INSTRUCTIONS: Lift arm to 90 degrees. Stretch out y our fingers and reach forward as far as you can. (E xaminer places a ruler at the end of fingertips when arm is at 90 degrees. Fi ngers should not touch the ruler while reaching for ward. The recorded measure is the distance forward that the fingers reach while t he subject is in the most forward lean position. Wh en possible, ask subject to use both arms when reaching to avoid rotation of the tr unk.) ( ) 4 can reach forward confidently 25 cm (10 in ches) ( ) 3 can reach forward 12 cm (5 inches) ( ) 2 can reach forward 5 cm (2 inches) ( ) 1 reaches forward but needs supervision ( ) 0 loses balance while trying/requires extern al support

PICK UP OBJECT FROM THE FLOOR FROM A STANDING POSIT ION INSTRUCTIONS: Pick up the shoe/slipper, which is in front of your feet. ( ) 4 able to pick up slipper safely and easily ( ) 3 able to pick up slipper but needs supervis ion ( ) 2 unable to pick up but reaches 2-5 cm(1-2 i nches) from slipper and keeps balance independently ( ) 1 unable to pick up and needs supervision wh ile trying ( ) 0 unable to try/needs assist to keep from lo sing balance or falling

TURNING TO LOOK BEHIND OVER LEFT AND RIGHT SHOULDER S WHILE STANDING INSTRUCTIONS: Turn to look directly behind you over toward the left shoulder. Repeat to the right. (Ex aminer may pick an object to look at directly behind the subject to encourage a better twist turn.) ( ) 4 looks behind from both sides and weight sh ifts well ( ) 3 looks behind one side only other side show s less weight shift ( ) 2 turns sideways only but maintains balance ( ) 1 needs supervision when turning ( ) 0 needs assist to keep from losing balance o r falling

TURN 360 DEGREES INSTRUCTIONS: Turn completely around in a full circ le. Pause. Then turn a full circle in the other dir ection. ( ) 4 able to turn 360 degrees safely in 4 secon ds or less ( ) 3 able to turn 360 degrees safely one side o nly 4 seconds or less ( ) 2 able to turn 360 degrees safely but slowly ( ) 1 needs close supervision or verbal cuing ( ) 0 needs assistance while turning

PLACE ALTERNATE FOOT ON STEP OR STOOL WHILE STANDIN G UNSUPPORTED INSTRUCTIONS: Place each foot alternately on the st ep/stool. Continue until each foot has touched the step/stool four times. ( ) 4 able to stand independently and safely and complete 8 steps in 20 seconds ( ) 3 able to stand independently and complete 8 steps in > 20 seconds ( ) 2 able to complete 4 steps without aid with supervision ( ) 1 able to complete > 2 steps needs minimal a ssist ( ) 0 needs assistance to keep from falling/unab le to try

STANDING UNSUPPORTED ONE FOOT IN FRONT INSTRUCTIONS: (DEMONSTRATE TO SUBJECT) Place one fo ot 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 excee d the length of the other foot and the width of the stance should approximate the subject’s normal stride width.) ( ) 4 able to place foot tandem independently an d hold 30 seconds ( ) 3 able to place foot ahead independently and hold 30 seconds ( ) 2 able to take small step independently and hold 30 seconds ( ) 1 needs help to step but can hold 15 seconds ( ) 0 loses balance while stepping or standing

STANDING ON ONE LEG INSTRUCTIONS: Stand on one leg as long as you can w ithout holding on. ( ) 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 ≥ 3 seconds ( ) 1 tries to lift leg unable to hold 3 seconds but remains standing independently. ( ) 0 unable to try of needs assist to prevent f all



# ( ) TOTAL SCORE (Maximum = 56)