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Berg Balance Scale (BBS)
Available in the public domain: Berg Balance Scale Link .
Please click here for more information on the Pediatric Modification of the Berg Balance Scale.
NeuroRehab Supplemental - Highly Recommended
Recommendations for Use: Indicated for studies requiring a measure of balance.
Supplemental: Cerebral Palsy (CP), Multiple Sclerosis (MS), Spinal Cord Injury (SCI); not recommended for youth <18y, and Stroke
Exploratory: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)
Short Description of Instrument
Construct measured: Balance function by assessing the performance of functional tasks
Generic vs. disease specific: Generic
Means of administration: In-person by a trained examiner
Intended respondent: Participant
# of items: 14
# of subscales and names of sub-scales: N/A
# of items per sub-scale: N/A
Comments/Special Instructions
The Berg Balance Scale (BBS) was developed to measure balance among stroke patients and older people with impairment in balance function by assessing the performance of functional tasks. It is a valid instrument used for evaluation of the effectiveness of interventions and for quantitative descriptions of function in clinical practice and research. This test has been validated for use in individuals with SCI, and has the advantage of being valuable for other neurologic populations.
Pediatric Balance Scale, has been evaluated in children age 5-15 with known balance impairments. Shows good test-retest and inter-rater reliability. Child must be able to follow directions. It has not been evaluated specifically for children with SCI.
Scoring and Psychometric Properties
A five-point scale, ranging from 0-4. "0" indicates the lowest level of function and "4" the highest level of function. Total Score = 0-56. Score of 41-56 = low fall risk, 21-40 = medium fall risk, 0-20 = high fall risk.
Administration takes approximately 15-20 minutes.
Psychometric Properties: Overall, the BBS appears to be a reliable tool used to measure outcomes. Berg et al demonstrated that the inter-rater reliability ICC was .99. The BBS may have a ceiling effect and is insensitive to individuals with very high levels of balance.
Strengths/Weaknesses: Conradsson and colleagues (2007) demonstrated that a change of 8 BBS points is required to reveal a genuine change in function between two assessments among older people who are dependent in ADL and living in residential care facilities. The BBS is appropriate for community dwelling elderly people, individuals that have suffered a stroke, and the elderly population with balance difficulties.
NeuroRehab Specific: This is a gold standard measure that, although having clear ceiling effects, is widely used, and has known cutoff values for fall risk. It often correlates highly with FGA and with Mini-BESTest. This test is often more appropriate for lower-functioning persons where balance during walking is not the primary concern/focus.
Key References:
Berg K, Wood-Dauphinee S, Williams JI and Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada. 1989;41:304-311.
Berg KO, Wood-Dauphinee SL, Williams JI Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health. 1992;83 Suppl 2:S7-S11.
Conradsson M, Lundin-Olsson L, Lindelof N, Littbrand H, Malmqvist L, Gustafson Y, Rosendahl E. Berg balance scale: intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities. Phys Ther. 2007;87(9):1155-1163.
Additional References:
Arora T, Oates A, Lynd K, Musselman KE. Current state of balance assessment during transferring, sitting, standing and walking activities for the spinal cord injured population: A systematic review. J Spinal Cord Med. 2018;5:1-14.
Jorgensen V, Opheim A, Halvarsson A, Franzen E, Roaldsen KS. Comparison of the Berg Balance Scale and the Mini-BESTest for Assessing Balance in Ambulatory People with Spinal Cord Injury: Validation Study. Phys Ther. 2017;97(6):677-687.
Bogle Thorbahn LD & Newton RA. Use of the Berg Balance Test to predict falls in elderly persons. Phys Ther. 1996;76(6):576-583; discussion 584-575.
Wirz M, Muller R, Bastiaenen C. Falls in persons with spinal cord injury: validity and reliability of the Berg Balance Scale. Neurorehabil Neural Repair. 2010;24(1):70-77.
Franjoine MR, Gunther JS, Taylor MJ. Pediatric balance scale: a modified version of the berg balance scale for the school-age child with mild to moderate motor impairment. Pediatr Phys Ther. 2003;15(2):114-128.
Berg K, Wood-Dauphinee S, Williams JI. The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995;27(1):27-36.
Nakamura DM, Holm MB, Wilson A. Measures of Balance and Fear of Falling in the Elderly: a review. Phys Occup Ther Geriatr. 1998;15(4):17-32.
Whitney SL, Poole JL, Cass SP. A review of balance instruments for older adults. Am J Occup Ther. 1998;52(8):666-671.
Zwick D, Rochelle A, Choksi A, Domowicz J. Evaluation and treatment of balance in the elderly: A review of the efficacy of the Berg Balance Test and Tai Chi Quan. NeuroRehabil. 2000;15(1):49-56.
Moore J, Potter K, Blankshain K, Kaplan S, O'Dwyer L, Sullivan J. A Core Set of Outcome Measures for Adults with Neurologic Conditions Undergoing Rehabilitation. American Physical Therapy Association.
Document last updated January 2022