Berg Balance Scale

Objective[edit | edit source]

The Berg Balance Scale (BBS) 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[edit | edit source]

Elderly population with balance impairments, patients with acute stroke[1][2][3][4].

Method of Use[edit | edit source]

Equipment required[edit | edit source]

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

The scale[edit | edit source]

Name: __________________________________ Date: ___________________

Location: ________________________________ Rater: ___________________


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[edit | edit source]

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.

Interpretation[edit | edit source]

Cut-off scores for the elderly were reported by Berg et al 1992 [6] as follows :

  • A score of 56 indicates functional balance.
  • A score of < 45 indicates individuals may be at greater risk of falling.
  • A score of ≤49 indicates a risk of falls in individuals with stroke [7].

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 [8].

Evidence[edit | edit source]

Reliability[edit | edit source]

Studies of various elderly populations (N = 31–101, 60–90 + years of age) have shown high intra-rater and inter-rater 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).[9]

Validity[edit | edit source]

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.[2][3][10]

Responsiveness[edit | edit source]

Increasing age has not been shown to correlate with decreasing BBS scores.[11][12][13][14]

Limitations[edit | edit source]

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[edit | edit source]

References[edit | edit source]

  1. Badke MB, Shea TA, Miedaner JA, Grove CR. Outcomes after rehabilitation for adults with balance dysfunction. Archives of physical medicine and rehabilitation. 2004 Feb 1;85(2):227-33.
  2. 2.0 2.1 Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Canadian journal of public health= Revue canadienne de sante publique. 1992 Jul 1;83:S7-11.
  3. 3.0 3.1 Usuda S, Araya K, Umehara K, Endo M, Shimizu T, Endo F. Construct validity of functional balance scale in stroke inpatients. Journal of Physical Therapy Science. 1998;10(1):53-6.
  4. Wee JY, Bagg SD, Palepu A. The Berg balance scale as a predictor of length of stay and discharge destination in an acute stroke rehabilitation setting. Archives of physical medicine and rehabilitation. 1999 Apr 1;80(4):448-52.
  5. Kembe Frederick. 5253 Assessment Process Berg Balance Scale F.H.F. Available from:[last accessed 08/02/13]
  6. 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.
  7. Simpson LA, Miller WC, Eng JJ. Effect of stroke on fall rate, location and predictors: a prospective comparison of older adults with and without stroke. PloS one. 2011 Apr 29;6(4):e19431.
  8. Donoghue, D. and Stokes, E.K., (2009). How much change is true change? The minimum detectable change of the Berg Balance Scale in elderly people. Journal of Rehabilitation Medicine, 41(5), pp.fckLR343-346.
  9. Berg K, Wood-Dauphinee S, Williams JI. The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scandinavian journal of rehabilitation medicine. 1995 Mar 1;27(1):27-36.
  10. Whitney S, Wrisley D, Furman J. Concurrent validity of the Berg Balance Scale and the Dynamic Gait Index in people with vestibular dysfunction. Physiotherapy Research International. 2003 Nov;8(4):178-86.
  11. Steffen TM, 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. Physical therapy. 2002 Feb 1;82(2):128-37.
  12. Mao HF, Hsueh IP, Tang PF, Sheu CF, Hsieh CL. Analysis and comparison of the psychometric properties of three balance measures for stroke patients. Stroke. 2002 Apr 1;33(4):1022-7.
  13. Stevenson TJ. Detecting change in patients with stroke using the Berg Balance Scale. Australian Journal of Physiotherapy. 2001 Jan 1;47(1):29-38.
  14. Salbach NM, Mayo NE, Higgins J, Ahmed S, Finch LE, Richards CL. Responsiveness and predictability of gait speed and other disability measures in acute stroke. Archives of physical medicine and rehabilitation. 2001 Sep 1;82(9):1204-12.