/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/questionnaires/,

/clinical/cckm-tools/content/questionnaires/name-97228-en.cckm

201605147

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Questionnaires

4-Stage Balance Test

4-Stage Balance Test - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires








Patient: Date: Time: AM/PM
The 4-Stage Balance Test
Purpose: To assess static balance
Equipment: A stopwatch
Directions: There are four progressively more challenging
positions. Patients should not use an assistive device (cane or
walker) and keep their eyes open.
Describe and demonstrate each position. Stand next to the patient,
hold his/her arm and help them assume the correct foot position.
When the patient is steady, let go, but remain ready to catch the
patient if he/she should lose their balance.
If the patient can hold a position for 10 seconds without moving
his/her feet or needing support, go on to the next position.
If not, stop the test.
Instructions to the patient: I’m going to show you four positions.
Try to stand in each position for 10 seconds. You can hold your
arms out or move your body to help keep your balance but
don’t move your feet. Hold this position until I tell you to stop.
For each stage, say “Ready, begin” and begin timing.
After 10 seconds, say “Stop.”
See next page for detailed patient instructions and
illustrations of the four positions.
For relevant articles, go to: www.cdc.gov/injury/STEADI
Centers for Disease
Control and Prevention
National Center for Injury
Prevention and Control







Instructions to the patient:
1. Stand with your feet side by side. Time: __________ seconds
2. Place the instep of one foot so it is
touching the big toe of the other foot. Time: __________ seconds
3. Place one foot in front of the other,
heel touching toe. Time: __________ seconds
4. Stand on one foot. Time: __________ seconds
An older adult who cannot hold the tandem stance for at least 10 seconds
is at increased risk of falling.
Notes: