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Berg Balance Scale (NM#800047)

Berg Balance Scale (NM#800047) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires



Patient Name

DOB:

MR #


NM#800047 (Rev. 08/09/16) Worksheet Only - Not a Medical Record Document

UW Health uwhealth.org
(University of Wisconsin Hospitals and Clinics Authority)
BALANCE SCALE



ITEM DESCRIPTION SCORE (0-4)

Sitting to standing ___________
Standing unsupported ___________
Sitting unsupported ___________
Standing to sitting ___________
Transfers ___________
Standing with eyes closed ___________
Standing with feet together ___________
Reaching forward with outstretched arm ___________
Retrieving object from floor ___________
Turning to look behind ___________
Turning 360 degrees ___________
Placing alternate foot on stool ___________
Standing with one foot in front ___________
Standing on one foot ___________

*references on page 4
Total: ___________

GENERAL INSTRUCTIONS
Please demonstrate each task and/or give instructions as written. When scoring, please record the lowest response category
that applies for each item.
In most items, the subject is asked to maintain a given position for a specific time. Progressively more points are deducted if
the time or distance requirements are not met, if the subject’s performance warrants supervision, or if the subject touches an
external support or receives assistance from the examiner. Subject should understand that they must maintain their balance
while attempting the tasks. The choices of which leg to stand on or how far to reach are left to the subject. Poor judgment will
adversely influence the performance and the scoring.

Equipment required for testing is a stopwatch or watch with a second hand, and a ruler or other indicator of 2, 5, and 10
inches (5,12.5 and 25 cm). Chairs used during testing should be a reasonable height. Either a step or a stool of average step
height may be used for item #12.

1. SITTING TO STANDING
INSTRUCTIONS: Please stand up. Try not to use your hand for support.
( ) 4 Able to stand without using hands and stabilize independently
( ) 3 Able to stand independently using hands
( ) 2 Able to stand using hands after several tries
( ) 1 Needs minimal aid to stand or stabilize
( ) 0 Needs moderate or maximal assist to stand


2. STANDING UNSUPPORTED
INSTRUCTIONS: Please stand for two minutes without holding on.
( ) 4 Able to stand safely for 2 minutes
( ) 3 Able to stand 2 minutes with supervision
( ) 2 Able to stand 30 seconds unsupported
( ) 1 Needs several tries to stand 30 seconds unsupported
( ) 0 Unable to stand 30 seconds unsupported

If a subject is able to stand 2 minutes unsupported, score full points for sitting unsupported. Proceed to item #4.



Patient Name

DOB:

MR #


NM#800047 (Rev. 08/09/16) Worksheet Only - Not a Medical Record Document

UW Health uwhealth.org
(University of Wisconsin Hospitals and Clinics Authority)
BALANCE SCALE


3. SITTING WITH BACK UNSUPPORTED BUT FEET SUPPORTED ON FLOOR OR ON A STOOL
INSTRUCTIONS: Please sit with arms folded for 2 minutes.
( ) 4 Able to sit safely and securely for 2 minutes
( ) 3 Able to sit 2 minutes under supervision
( ) 2 Able to sit 30 seconds
( ) 1 Able to sit 10 seconds
( ) 0 Unable to sit without support 10 seconds


4. STANDING TO SITTING
INSTRUCTIONS: Please sit down
( ) 4 Sits safely with minimal use of hands
( ) 3 Controls descent by using hands
( ) 2 Uses back of legs against chair to control descent
( ) 1 Sits independently but has uncontrolled descent
( ) 0 Needs assistance to sit


5. TRANSFERS
INSTRUCTIONS: Arrange chair(s) for a pivot transfer. Ask subject to transfer one way toward a seat with armrests and one
way toward a seat without armrests. You may use two chairs (one with and one without armrests) or a bed and a chair.
( ) 4 Able to transfer safely with minor use of hands
( ) 3 Able to transfer safely definite need of hands
( ) 2 Able to transfer with verbal cueing and/or supervision
( ) 1 Needs one person to assist
( ) 0 Needs two people to assist or supervise to be safe


6. STANDING UNSUPPORTED WITH EYES CLOSED
INSTRUCTIONS: Please close your eyes and stand still for 10 seconds.
( ) 4 Able to stand 10 seconds safely
( ) 3 Able to stand 10 seconds with supervision
( ) 2 Able to stand 3 seconds
( ) 1 Unable to keep eyes closed 3 seconds but stays safely
( ) 0 Needs help to keep from falling


7. STANDING UNSUPPORTED WITH FEET TOGETHER
INSTRUCTIONS: Place your feet together and stand without holding.
( ) 4 Able to place feet together independently and stand 1 minute safely
( ) 3 Able to place feet together independently and stand 1 minute with supervision
( ) 2 Able to place feet together independently and to hold for 30 seconds
( ) 1 Needs help to attain position but able to stand 15 seconds feet together
( ) 0 Needs help to attain position and unable to hold for 15 seconds









Patient Name

DOB:

MR #


NM#800047 (Rev. 08/09/16) Worksheet Only - Not a Medical Record Document

UW Health uwhealth.org
(University of Wisconsin Hospitals and Clinics Authority)
BALANCE SCALE

8. REACHING FORWARD WITH OUTSTRETCHED ARM WHILE STANDING
INSTRUCTIONS: Lift arm to 90 degrees. Stretch out your fingers and reach forward as far as you can. (Examiner places a
ruler at end of fingertips when arm is at 90 degrees. Fingers should not touch the ruler while reaching forward. The recorded
measure is the distance forward that the fingers reach while the subject is in the most forward lean position. When possible,
ask subject to use both arms when reaching to avoid rotation of the trunk.)
( ) 4 Can reach forward confidently >25 cm (10 inches)
( ) 3 Can reach forward >12.5 cm safely (5 inches)
( ) 2 Can reach forward >5 cm safely (2 inches)
( ) 1 Reaches forward but needs supervision
( ) 0 Loses balance while trying/requires external support


9. PICK UP OBJECT FROM THE FLOOR FROM A STANDING POSITION
INSTRUCTIONS: Pick up the shoe/slipper, which is placed in front of your feet.
( ) 4 Able to pick up slipper safely and easily
( ) 3 Able to pick up slipper but needs supervision
( ) 2 Unable to pick up but reaches 2-5 cm (1-2 inches) from slipper and keeps balance independently
( ) 1 Unable to pick up and needs supervision while trying
( ) 0 Unable to try/needs assist to keep from losing balance or falling


10. TURNING TO LOOK BEHIND OVER LEFT AND RIGHT SHOULDERS WHILE STANDING
INSTRUCTIONS: Turn to look directly behind you over toward left shoulder. Repeat to the right. (Examiner may pick an
object to look at directly behind the subject to encourage a better twist turn.)
( ) 4 Looks behind from both sides and weight shifts well
( ) 3 Looks behind one side only other side shows less weight shift
( ) 2 Turns sideways only but maintains balance
( ) 1 Needs supervision when turning
( ) 0 Needs assist to keep from losing balance or falling


11. TURN 360 DEGREES
INSTRUCTIONS: Turn completely around in a full circle. Pause. Then turn a full circle in the other direction.
( ) 4 Able to turn 360 degrees safely in 4 seconds or less
( ) 3 Able to turn 360 degrees safely one side only 4 seconds or less
( ) 2 Able to turn 360 degrees safely but slowly
( ) 1 Needs close supervision or verbal cueing
( ) 0 Needs assistance while turning


12. PLACING ALTERNATE FOOT ON STEP OR STOOL WHILE STANDING UNSUPPORTED
INSTRUCTIONS: Place each foot alternately on the step/stool. Continue until each foot has touched the step/stool four
times.
( ) 4 Able to stand independently and safely and complete 8 steps in 20 seconds
( ) 3 Able to stand independently and complete 8 steps in > 20 seconds
( ) 2 Able to complete 4 steps without aid with supervision
( ) 1 Able to complete > 2 steps needs minimal assist
( ) 0 Needs assistance to keep from falling/unable to try






Patient Name

DOB:

MR #


NM#800047 (Rev. 08/09/16) Worksheet Only - Not a Medical Record Document

UW Health uwhealth.org
(University of Wisconsin Hospitals and Clinics Authority)
BALANCE SCALE

13. STANDING UNSUPPORTED ONE FOOT IN FRONT
INSTRUCTIONS: (DEMONSTRATE TO SUBJECT) Place one foot directly in front of the other. If you feel that you cannot
place your foot directly in front, try to step far enough ahead that the heel of your forward foot is ahead of the toes of the
other foot. (To score 3 points, the length of the step should exceed the length of the other foot and the width of the stance
should approximate the subject’s normal stride width.)
( ) 4 Able to place foot tandem independently and hold 30 seconds
( ) 3 Able to place foot ahead of other independently and hold 30 seconds
( ) 2 Able to take small step independently and hold 30 seconds
( ) 1 Needs help to step but can hold 15 seconds
( ) 0 Loses balance while stepping or standing


STANDING ON ONE LEG
INSTRUCTIONS: Stand on one leg as long as you can without holding.
( ) 4 Able to lift leg independently and hold >10 seconds
( ) 3 Able to lift leg independently and hold 5-10 seconds
( ) 2 Able to lift leg independently and hold = or > 3 seconds
( ) 1 Tries to lift leg unable to hold 3 seconds but remains standing independently.
( ) 0 Unable to try or needs assist to prevent fall


Total Score: ______________/ (Maximum = 56)


*References
Wood-Dauphinee S, Berg K, Bravo G, Williams JI: The Balance Scale: Responding to clinically meaningful changes.
Canadian Journal of Rehabilitation 10: 35-50,1997

Berg K, Wood-Dauphinee S, Williams JI: The Balance Scale: Reliability assessment for elderly residents and patients with
an acute stroke. Scand J Rehab Med 27:27-36, 1995

Berg K, Maki B, Williams JI, Holliday P, Wood-Dauphinee S: A comparison of clinical and laboratory measures of postural
balance in an elderly population. Arch Phys Med Rehabil 73: 1073-1083, 1992

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

Berg K, Wood-Dauphinee S, Williams JI, Gayton D: Measuring balance in the elderly: preliminary development of an
instrument. Physiotherapy Canada 41:304-311, 1989