Bergs Balanseskala

The Berg Balance Scale (BBS) is a standardized tool used to assess a person’s balance function through 14 predefined tasks. It objectively determines whether an individual has impaired balance ability, which can increase the risk of falls. Each item is scored from 0 to 4, where 0 indicates lowest function and 4 indicates highest function. The test takes about 20 minutes to complete and does not include assessment of gait.

Target Population

BBS is particularly relevant for:

• Older adults with balance problems

• Patients recovering from acute stroke¹²³⁴

Method

Required Equipment

• Ruler

• Two standard chairs (one with armrests, one without)

• Footstool or step

• 15-foot walkway

• Stopwatch or clock with a second hand

• Test form

Test Procedure

1. Sit to stand – Patient rises from a chair without using armrests.

2. Standing unsupported – Patient stands without support for a set duration.

3. Sitting unsupported – Patient sits upright on a chair without back support.

4. Stand to sit – Patient sits down in a controlled manner.

5. Transfers – Patient moves between two chairs with minimal support.

6. Standing with eyes closed – Patient maintains balance without visual input.

7. Standing with feet together – Patient stands with feet together without losing balance.

8. Reaching forward with outstretched arm – Patient reaches forward without falling.

9. Picking up an object from the floor – Patient bends down to pick up an item.

10. Turning to look behind – Patient looks over each shoulder.

11. Turning 360° – Patient turns in a full circle both directions.

12. Placing alternate feet on a stool – Patient steps alternately up and down.

13. Standing with one foot in front of the other – Patient holds tandem stance.

14. Standing on one leg – Patient balances on one leg as long as possible.

Scoring and Interpretation

• 56 points – Indicates functional balance

• <45 points – Increased risk of falls⁶

• ≤49 points – Indicates fall risk in stroke patients⁷

For older adults, a clinically significant change is:

• 4 points for baseline score 45–56

• 5 points for baseline score 35–44

• 7 points for baseline score 25–34

• 5 points for baseline score 0–24(to be 95% confident that a true change has occurred)⁸

Evidence

Reliability

• Older adults (N = 31–101, aged 60–90+): High intra-rater and inter-rater reliability (ICC = 0.98).

• Test-retest reliability in hemiparesis patients: ICC = 0.98⁹.

Validity

• Developed through a three-step process with input from 32 healthcare professionals working with older adults.

• Shows moderate to high correlations with other functional outcome measures²³¹⁰.

Responsiveness

• Advancing age does not show a direct correlation with decreasing BBS scores¹¹¹²¹³¹⁴.

Limitations

BBS is not optimal for patients with ataxia, since it does not capture problems in daily activities caused by upper body coordination impairments.

Refrences:

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. 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. 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: http://www.youtube.com/watch?v=i_Jlc5kL6KU[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.