Berg Balance Scale

Berg Balance Scale, BBS

The Berg Balance Scale is a measurement that occupational and physical therapists widely use due to its functional nature and availability in the public domain. That's right – the Berg Balance Scale is a free evidence-based tool. Read on for information about the scale, its use, alternative assessments, and more.

The purpose of the Berg Balance Scale

Developed in 1989 by Katherine Berg, the Berg Balance Scale (BBS) is commonly used to assess balance and fall risk in older adult populations. This functional test helps therapists quantify an individual's dynamic and static balance.

According to the CDC, falls are the number one cause of injury and death from injury among older adult populations. While the ability of the BBS to predict fall risk varies by population, the evaluation gives therapists foundational knowledge about their client's functional balance skills.

Necessary supplies

While the actual evaluation tool is free, the therapist must gather all the necessary tools.

The required equipment is common and can typically be found around a home or clinical setting and includes:
  • Standard height chair with armrests
  • Standard height chair without armrests
  • Step stool
  • Ruler
  • Shoe or slipper
  • Stopwatch

How to administer the Berg Balance Scale?
Instructions for administering the Berg Balance Scale are pretty straightforward. 
  • Interview the client, review their history, and start to build rapport before administering the Berg Balance Scale.
  • Gather and set up all materials prior to the start of the evaluation.
  • Place the ruler at shoulder height so the client's arm is at a 90-degree angle.
  • Check to make sure the client understands all of the directions.
  • Stay close to the client so that you can assist them in the event of balance loss.

The scale

The Berg Balance Scale consists of 14 different tasks for clients to perform. The items include activities such as picking up an object off the floor, transferring from a seated to a standing position, sitting unsupported with closed eyes, and turning to look behind each shoulder while standing.

For each item, the evaluator will score the client on a scale of 0-4, with 0 being the lowest level of function and 4 demonstrating the highest level. At first glance, this may appear subjective. However, the scale uses concise language to define scores of 0, 1, 2, 3, and 4 for each given task.

For example, for a standing to sitting transfer, the evaluator would score:

Score

Task

4

Ability to sit safely with minimal use of hands

3

Controlling descent by using hands

2

Using backs of legs against the chair to control descent

1

Sitting independently but having an uncontrolled descent

0

Needing assistance to sit


When all fourteen tasks are complete, the scores from each task are added to create a total score. A score of 56 indicates functional balance. A score of 44 or less means the client may be at risk for falls.

Alternative assessments

The Berg Balance Scale tends to be the gold standard for older adult balance assessments. However, other options exist. Among these is the Activities-specific Balance Confidence (ABC) Scale, in which clients self-report their confidence in completing certain activities, such as getting into a car and walking up the stairs. The Timed "Up and Go" allows therapists to get a measurement of a sit-to-stand transfer, ambulation, turning, and sitting. The Dynamic Gait Index is similar in design to the Berg Balance Scale and measures fall risk, but examines eight facets of gait instead of static and dynamic balance.

A lesser-known Pediatric Balance Scale is based on the Berg Balance Scale. This modified version of the BBS changed the order of tasks so that they get progressively more difficult, reduced the time standards for static positions, and changed the language for clarification. The Pediatric Berg Balance Scale does not have the extensive evidence that the original scale has.



Berg Balance Scale: pros and cons

Pros
  • The Berg Balance Scale is free and easily accessible.
  • The materials are easy to gather and likely already available in a clinic or hospital setting.
  • Level I evidence indicates reliability and validity within older adult populations.
  • The functional design of the BBS allows therapists to observe and score skills that clients use for mobility in their everyday lives.
  • Can be used for various populations, including those who are at risk for or have experienced:
    • Stroke
    • Parkinson's Disease
    • Osteoarthritis
    • Dementia
    • Traumatic brain injury
    • Vestibular disorders
    • Pulmonary disease
    • Intellectual disability
    • Loss of a limb

Cons
  • While the Berg Balance Scale can be used across several populations, it is essential for therapists to know that the BBS is reliable and valid for their client's specific population. For example, the BBS scores for patients with spinal cord injuries do not actually predict patient fall risk.

  • Interpretation of the results can vary between professionals and disciplines.

  • While the assessment generally takes 15-20 minutes to administer, it may take longer


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Documentation of results

As a functional assessment, therapists often write a narrative report regarding the client's ability to perform each task. Therapists should specify which tasks did not achieve total points and describe the quality of the client's performance. Clinical observations, such as increased respiratory rate, and correct or incorrect use of mobility equipment, should be reported. Therapists should also disclose any modifications made to the procedure in the report.

Summary

The Berg Balance Scale is one of the most widely used assessments to determine patient fall risk. There is abundant evidence available specific to the various populations that therapists may evaluate with this test. Therapists can feel confident selecting this widely accepted assessment.

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