Berg Balance Scale

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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

• 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.

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.

Reference

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.

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.

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 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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