Berg Balance Scale

Assesses risk of fall and balance impairment in elderly frail patients with static and dynamic tasks.

Below the calculator there is more information on the activities in the assessment and how they should be scored.

The Berg Balance Scale determines the risk of fall for geriatric patients based on their ability to maintain their balance during static activities and their ability to perform specific dynamic activities without falling.

It is addressed to community dwelling elderly and patients who suffered or suffer from brain injury, stroke, Parkinson’s disease, multiple sclerosis or vestibular dysfunction, amongst other.

This is a 14 item scale with different static and dynamic activities that carry different degrees of difficulty and mobility requirements.

The result is interpreted as follows:

Berg score (points)	Patient status	Fall risk
45 - 56	Mostly independent	Low fall risk
41 - 44	Mostly independent	Significant fall risk
21 - 40	May require assistance	100% fall risk
0 – 20	Wheelchair bound currently or in the future	100% fall risk

The Shumway-Cook cut off for prediction of fall probability (with 91% sensitivity and 82% specificity) depends on patient history of falls:

■ History of falls and BBS <51;

■ No history of falls and BBS <42.

Sitting to standing

Able to stand without using hands and stabilize independently (4 points)

Able to stand independently using hands (3 points)

Able to stand using hands after several tries (2 points)

Needs minimal aid to stand or stabilize (1 point)

Needs moderate or maximal assist to stand (0 points)

Standing unsupported

Able to stand safely for 2 minutes (4 points)

Able to stand 2 minutes with supervision (3 points)

Able to stand 30 seconds unsupported (2 points)

Needs several tries to stand 30 seconds unsupported (1 point)

Unable to stand 30 seconds unsupported (0 points)

Sitting with back unsupported but feet supported on floor or on a stool

Able to sit safely and securely for 2 minutes (4 points)

Able to sit 2 minutes under supervision (3 points)

Able to sit 30 seconds (2 points)

Able to sit 10 seconds (1 point)

Unable to sit without support 10 seconds (0 points)

Standing to sitting

Sits safely with minimal use of hands (4 points)

Controls descent by using hands (3 points)

Uses back of legs against chair to control descent (2 points)

Sits independently but has uncontrolled descent (1 point)

Needs assist to sit (0 points)

Transfers

Able to transfer safely with minor use of hands (4 points)

Able to transfer safely definite need of hands (3 points)

Able to transfer with verbal cuing and/or supervision (2 points)

Needs one person to assist (1 point)

Needs two people to assist or supervise to be safe (0 points)

Standing unsupported with eyes closed

Able to stand 10 seconds safely (4 points)

Able to stand 10 seconds with supervision (3 points)

Able to stand 3 seconds (2 points)

Unable to keep eyes closed 3 seconds but stays safely (1 point)

Needs help to keep from falling (0 points)

Standing unsupported with feet together

Able to place feet together independently and stand 1 minute safely (4 points)

Able to place feet together independently and stand 1 minute with supervision (3 points)

Able to place feet together independently but unable to hold for 30 seconds (2 points)

Needs help to attain position but able to stand 15 seconds feet together (1 point)

Needs help to attain position and unable to hold for 15 seconds (0 points)

Reaching forward with outstretched arm while standing

Can reach forward confidently 25 cm (10 inches) (4 points)

Can reach forward 12 cm (5 inches) (3 points)

Can reach forward 5 cm (2 inches) (2 points)

Reaches forward but needs supervision (1 point)

Loses balance while trying/requires external support (0 points)

Pick up object from the floor from a standing position

Able to pick up slipper safely and easily (4 points)

Able to pick up slipper but needs supervision (3 points)

Unable to pick up but reaches 2-5 cm (1-2 inches) from slipper and keeps balance independently (2 points)

Unable to pick up and needs supervision while trying (1 point)

Unable to try/needs assist to keep from losing balance or falling (0 points)

Turning to look behind over left and right shoulders while standing

Looks behind from both sides and weight shifts well (4 points)

Looks behind one side only other side shows less weight shift (3 points)

Turns sideways only but maintains balance (2 points)

Needs supervision when turning (1 point)

Needs assist to keep from losing balance or falling (0 points)

Turn 360 degrees

Able to turn 360 degrees safely in 4 seconds or less (4 points)

Able to turn 360 degrees safely one side only 4 seconds or less (3 points)

Able to turn 360 degrees safely but slowly (2 points)

Needs close supervision or verbal cuing (1 point)

Needs assistance while turning (0 points)

Place alternate foot on step/stool while standing unsupported

Able to stand independently and safely and complete 8 steps in 20 seconds (4 points)

Able to stand independently and complete 8 steps in > 20 seconds (3 points)

Able to complete 4 steps without aid with supervision (2 points)

Able to complete > 2 steps needs minimal assist (1 point)

Needs assistance to keep from falling/unable to try (0 points)

Standing unsupported one foot in front

Able to place foot tandem independently and hold 30 seconds (4 points)

Able to place foot ahead independently and hold 30 seconds (3 points)

Able to take small step independently and hold 30 seconds (2 points)

Needs help to step but can hold 15 seconds (1 point)

Loses balance while stepping or standing (0 points)

Standing on one leg

Able to lift leg independently and hold > 10 seconds (4 points)

Able to lift leg independently and hold 5-10 seconds (3 points)

Able to lift leg independently and hold 3 seconds (2 points)

Tries to lift leg unable to hold 3 seconds but remains standing independently (1 point)

Unable to try or needs assist to prevent fall (0 points)

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Steps on how to print your input & results:

1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.

Balance scale items

This is a 14-item scale used to assess balance in elderly patients and predict fall risk. The elderly population to which the scale addresses to includes conditions such as stroke, traumatic and acquired brain injury, spinal cord injury, multiple sclerosis, osteoarthritis, Parkinson’s disease or vestibular dysfunction.

The balance test created by Berg et al. in 1992, consists of both static and dynamic activities, with varying difficulty and requiring different degrees of mobility.

At the beginning of the test, the assessor should explain the tasks to be given and make sure the subject understands that the main aim is to maintain balance throughout the tasks.

The equipment required for the evaluation is:

■ Two chairs, one with arm rests, one without arm rests;

■ Footstool;

■ Yardstick;

■ Stopwatch;

■ Available 15 ft (approx. 4.5 m) walkway.

The following table introduces the items in the scale and their accompanying instructions:

Berg balance scale item	Instruction
1. Sitting to standing	The subject must not use hands or other support.
2. Standing unsupported	No support is allowed for two minutes.
3. Sitting with back unsupported but feet supported on floor or on a stool	The subject must maintain position with arms folded for 2 minutes.
4. Standing to sitting	The subject must be in standing position at the beginning.
5. Transfers	Chairs are to be arranged for pivot transfer and the subject asked to transfer from one to another, alternatively.
6. Standing unsupported with eyes closed	The subject must maintain a still position for 10 seconds.
7. Standing unsupported with feet together	The action must be performed without support.
8. Reaching forward with outstretched arm while standing	Arm must be lifted at 90 degrees and the subject instructed to stretch fingers and reach forward as much as possible.
9. Pick up object from the floor from a standing position	The object to be picked must be placed in front of the subject’s feet.
10. Turning to look behind over left and right shoulders while standing	Assessment of the twist turn action.
11. Turn 360 degrees	Assessment of a complete full circle turn in one direction, followed by another complete turn in the opposite direction.
12. Place alternate foot on step/stool while standing unsupported	The action must be performed until each foot has touched the step/stool 4 times.
13. Standing unsupported one foot in front	If this is not possible, the foot can be placed forward ahead of the toes of the other foot.
14. Standing on one leg	The subject must maintain their position for as long as possible.

The Berg scale has been validated and is being used in practice as a reliable measurement ever since.

However, there is discussion of a ceiling and floor effect which may distort the reported results of the Berg scale in community dwelling elderly.

When a patient scores high on an initial evaluation, the BBS outcome measure may be compromised for subsequent evaluations even if the status of the patient does not change dramatically.

Result interpretation

Each of the 14 items in the Berg balance test is assessed on a five point ordinal scale (from 0 to 4 points). The lowest level of function is awarded 0 points whilst the highest level of function is awarded 4 points.

The recommendation is to deduct points progressively when the subject is not able to follow the instruction and when performance requires supervision or the subject has to use external assistance.

In the original study interpretation, the maximum obtainable score is 56 and there are four ranges of scores. Patients scoring below 45 are at a greater risk of fall than patients scoring 45 or above.

The table below introduces the score ranges and their interpretation:

Berg score (points)	Interpretation
45 - 56	Patient is mostly independent in their movement and carries a low risk of falling.
41 - 44	Patient is mostly independent in their movement but carries a significant risk of falling.
21 - 40	Patient may require assistance performing some of the tasks in the balance test and in general, activities of daily living. There is a 100% fall risk.
0 – 20	The patient is wheelchair bound at the moment or may be in the future and carries a 100% fall risk.

The Shumway-Cook prediction of fall probability (with 91% sensitivity and 82% specificity) provides two different cut off points (below which the fall risk is imminent), depending on whether the patient has a history of falls:

■ History of falls and BBS <51;

■ No history of falls and BBS <42.

According to the original study, the minimal detectable change for 95% accuracy in change differs at different cut offs.

When the initial score was between 45 and 56 the MDC is at 4 points. For an initial score between 25 and 34, the MDC is 7 points.

For an initial score between 35 and 44 or between 0 and 25, the minimal detectable change is 5 points.

Original source

Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil. 1992; 73(11):1073-80.

Other references

1. 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:S7-11.

2. Shumway-Cook A, Baldwin M, Polissar NL, Gruber W. Predicting the probability for falls in community-dwelling older adults. Phys Ther. 1997; 77(8):812-9.

Specialty: Geriatrics

System: Nervous

Objective: Evaluation

Type: Scale

No. Of Items: 14

Year Of Study: 1992

Article By: Denise Nedea

Published On: May 18, 2017 · 10:53 AM

Last Checked: May 18, 2017

Next Review: May 18, 2023