Berg Balance Scale

Definition

The Berg Balance Scale is an a performance-based assessment tool that is used to evaluate standing balance during functional activities. The patient is scored on fourteen different tasks.

Purpose

The Berg Balance Scale is a widely used assessment tool to identify balance impairment. Functional activities such as reaching, bending, transferring, and standing are evaluated on the test to evaluate balance. The test is often used for patients who exhibit a decline in function, self-report a loss of balance, or have unexplained falls. The test has also been used for patients with other diseases such as Parkinson's disease, stroke, and multiple sclerosis.

Precautions

Tests for balance should be conducted in a safe and controlled area where patients cannot be injured if they fall or become dizzy. The health care professional should evaluate the patient's static and dynamic balance before leaving the patient unattended and provide close supervision during the test.

Description

Balance is the ability to maintain the center of gravity over a base of support, usually in an upright position. With good balance, a patient has the ability to sit, stand, or walk safely, falling, or reaching for external items for support. Balance is complex and is a coordinated response of the neuromuscular and musculoskeletal systems. The Berg Balance Test was developed in the early 1990s as a means of measuring balance in the elderly. It has been shown to be a consistent and reliable test.

Patients are asked to complete fourteen tasks while an examiner rates the patient's performance on each task. Elements of the test are representative of daily activities that require balance, such as sitting, standing, leaning over, and stepping. Some tasks are rated according to the quality of the performance of the task, while others are evaluated by the time required to complete the task.

The fourteen tasks evaluated in the Berg Balance Scale test include:

• sitting unsupported
• change of position: sitting to standing
• change of position: standing to sitting
• transfers
• standing unsupported
• standing with eyes closed
• standing with feet together
• tandem standing
• standing on one leg
• turning trunk (feet fixed)
• retrieving objects from floor
• turning 360 degrees
• stool stepping
• reaching forward while standing

Scores for each item can range from 0 (cannot perform) to 4 (normal performance). Overall scores can range from 0 (severely impaired balance) to 56 (excellent balance). Specifically, results are interpreted as:

• 0-20: wheelchair bound
• 21-40: walking with assistance
• 41-56: independent

On average, patients with scores less than 40 are almost twelve times more likely to fall than those with scores higher than 40.

Preparation

No special preparation is required prior to the administration of the Berg Balance Scale test.

Aftercare

Treatment of a patient who has been identified with a balance problem on the basis of the Berg Balance Scale may include strengthening, postural awareness exercises, various weight-shifting exercises, and increasing environmental stimuli in order to improve sensory awareness. The patient may be fearful of falling, and restoration of confidence may be required. Measures to take to decrease the likelihood of the patient falling include clear and safe pathways, adequate lighting, and guarding techniques by staff members.

Complications

A patient may be dizzy or exhibit other balance problems after completing the test, so the health care professional administering the test should make sure that the patient does not fall.

Results

Results of the Berg Balance Scale are used to identify areas of impairment and the effects of the impairment on function. Results may also be useful in developing treatments that will restore the patient's balance and mobility or identifying interventions to help the patient avoid falls. The test can also be used to evaluate and document progress over time.

Health care team roles

Nursing and other allied health professionals in hospitals, outpatient clinics, diagnostic centers, skilled nursing facilities, and assisted living facilities should be aware of their patients' balance and other mobility characteristics. It is the responsibility of the health care provider to request the use of the Berg Balance Scale if appropriate to minimize the risk of falls. The test is usually administered by a physical therapist.

KEY TERMS

Musculoskeletal— Of, relating to, or affecting all of the muscles, bones, and cartilages of the body.

Neuromuscular— Of, relating to, or affecting both the nerves and muscles of the body.

Parkinson's disease— A progressive nervous disease occurring most often after the age of 50, associated with the destruction of brain cells that produce dopamine and characterized by muscular tremor, slowing of movement, partial facial paralysis, peculiarity of gait and posture, and weakness.

Resources

BOOKS

Brill, Patricia A. Clinical Disorders of Balance, Posture, and Gait. London, England: Arnold Publishers, 2004.

PERIODICALS

Berg, K.O., S.L. Wood-Dauphinese, J.I. Williams, and B. Maki. "Measuring Balance in the Elderly: Validation of an Instrument." Archives of Physical Medicine and Rehabilitation 85 (7) (July 2004): 1128-1135.

Lajoie, Y. and S.P. Gallagher. "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." Archives of Physical Medicine and Rehabilitation 86(4) (April 2005): 789-792.

ORGANIZATIONS

American Physical Therapy Association. 1111 Fairfax Street, Alexandria, VA 22314-1488. (800) 999-2782.

Section on Geriatrics, American Physical Therapy Association. 1111 Fairfax Street, Alexandria, VA 22314-1488. (800) 999-2782, Ext. 3238.