Berg balance scale. By Philans Cosmos Ankrah

Outcome measure

1. BY: PHILANS COSMOS ANKRAH
BERG BALANCE
SCALE

3. OBJECTIVES
•At the end of this presentation, students should be able to:
Define what a berg balance scale is
State when the scale is used
Describe and demonstrate how a berg balance test is carried
out.
State limitations in the use of the Berg balance scale

4. BERG BALANCE SCALE???
The Berg Balance Scale (or BBS) is a
widely used clinical test of a person's
static and dynamic balance abilities,
named after Katherine Berg, the main
developer.
The Berg balance scale is used to
objectively determine a patient's ability
(or inability) to safely balance during a
series of predetermined tasks.
For functional balance tests, the BBS is
generally considered to be the gold
standard.
Needed: two chairs, a stop-watch, a tape
measure and a step.

5. The test takes 15–20 minutes and
comprises a set of 14 simple balance
related tasks, ranging from standing
up from a sitting position, to
standing on one foot.
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 the final measure is the
sum of all of the scores.
It does not include the assessment of
gait.
BERG BALANCE TEST

6. SAMPLE
1.Sitting to standing ____
2.Standing unsupported ______(2min)
3.Sitting w/back unsup. feet sup. _______(2min)
4.Standing to sitting _______
5.Transfers ________
6.Standing unsupwith eyes closed ____(10secs)
7.Standing with feet together _____(1min)
8.Reaching forward with outstretched arm ______
(25cm)
9.Retrieving object from floor _____
10.Turning to look behind ________
11.Turning 360 degrees ________(4secs)
12.Placing alternate foot on stool __(8 steps in
20secs)
13.Standing with one foot in front __(30secs)
14.Standing on one foot ___(above 10secs)
15.Total _____(56)

7. INTERPRETATION OF ITEM SCORES
41-56= low fall risk, 21-40= medium
fall risk, 0-20= high fall risk
Possible impairments associated with
low Scores:
lower and upper body weakness; poor
dynamic COG control; Abnormal
weight distribution.
Poor gaze stabilization; lower body
weakness; abnormal weight
distribution in standing.
Poor use of somatosensory inputs;
Visual dependency and/or fear-of-
falling; Lower body weakness.

8. OUTCOME MEASURES
The Berg Balance Scale Test can be
administered every few months of
treatment to determine if the treatment
was effective for increasing the patient's
functional mobility.
The Berg Balance Scale is used by
Physiotherapists and other health care
professionals to determine the functional
mobility of an individual.
Can be administered prior to treatment for
elderly individuals and patients with a hxof
(but not limited to) stroke, Multiple
sclerosis, Parkinson's disease, vertigo,
cardiovascular disease and respiratory
disease.

9. The BBS correlates
satisfactorily with laboratory
measures, including postural
sway, and has good concurrent
criterion, predictive criterion,
and construct validity.
Considerable evidence indicates
that the BBS is also a valid
measure of standing balance in
post-stroke patients, but only
for those who ambulate
independently, due to the tasks
that are required of the patient.
EVIDENCE BASED

10. EVIDENCE BASED
The BBS was recently identified as the
most commonly used assessment tool
across the continuum of stroke
rehabilitation and it is considered a
sound measure of balance impairment.

11. EVIDENCE BASED
(cont.d)
The BBS has been strongly
established as valid and reliable.
It has been validated as a
predictor of length of stay and
discharge destination in stroke
rehabilitation and as a predictor
of length of stay and outcomes in
acute inpatient rehabilitation
when used in conjunction with
the Functional Independence
Measure

12. LIMITATIONS
Lack of items requiring postural
response to external stimuli or
uneven support surfaces.
The use of the BBS as an outcome
measure is compromised when
participants score high on initial
trials.

13. LIMITATIONS
The BBS has been strongly established as valid and
reliable but there are still several factors which may
indicate that the BBS should be used in conjunction
with other balance measures.
For example, there are a few tasks in the BBS to test
dynamic balance, which may limit its ability to
challenge older adults who live independently in the
community.
It takes somewhat longer than other balance measures

14. LIMITATIONS
The BBS may suffer from decreased sensitivity in
early stages post stroke among severely affected
patients as the scale includes only one item relating
to balance in the sitting position (Mao et al. 2002).
No common interpretation exists for BBS scores,
the relationship to their mobility status and the use
of mobility aides (Wee et al. 2003).

15. SUMMARY
•Interpretability: While the reliability and validity of the scale
are excellent, there are no common standards for the
interpretation of BBS scores though there is an accepted cutoff
point to indicate the presence of balance impairment.
•Acceptability: This direct observation test would not be suited
for severely affected patients as it assesses only one item
relative to balance while sitting. Active individuals would find it
too simple. The scale is not suited for use by proxy.
•Feasibility: The BBS requires no specialized training to
administer and relatively little equipment or space.

16. REFERENCES
•Berg K, Wood-DauphineeS, Williams JI, GaytonD: Measuring balance in the
elderly: Preliminary development of an instrument. Physiotherapy Canada,
41:304-311, 1989.
•Berg K, Wood-DauphineeS, Williams JI, Maki, B: Measuring balance in the
elderly: Validation of an instrument. Can. J. Pub. Health, July/August
supplement 2:S7-11, 1992.
•Harada N, Chiu V, Damron-Rodrick J, Fowler E, Siu A, ReuberD (1995)
Screening for balance and mobility impairment in elderly individuals living in
residential care facilities Physical Therapy 75, 6, 462-469.
•Mao HF, Hsueh IP, Tang PF, SheuCF, Hsieh CL. Analysis and comparison of
the psychometric properties of three balance measures for stroke patients.
Stroke 2002;33:1022-1027
•ThorbahnLD, Newton RA (1996) Use of the Berg Balance Test to predict falls
in elderly persons PhysTher76, 6, 576-83
•Wee JYM, Wong H, PalepuA. Validation of the Berg Balance Scale as a
predictor of length of stay and discharge destination in stroke rehabilitation.
Arch PhysMed Rehabil2003;84:731-735.
•Whitney SL, Poole JL, Cass SP. A review of balance instruments for older

17. THANK YOU…