Berg Balance Scale (BBS)
The Berg Balance Scale (BBS) is a widely utilized assessment tool designed to evaluate an individual's ability to maintain balance in various situations, particularly among older adults and those with certain health conditions. This fourteen-step test helps health professionals identify a person's risk of falling by measuring their performance across increasingly challenging tasks using basic equipment like chairs and a footstool. The assessment scores range from zero to four for each activity, culminating in a maximum score of fifty-six, with higher scores indicating greater independence in balance.
Developed in 1989 by physical therapist Katherine Berg, the BBS provides clinicians with a standardized and objective way to assess balance, crucial for implementing safety measures and interventions. Individuals scoring below a certain threshold are identified as at risk of falls, prompting further evaluation and potential adjustments in care. While the original test can take about twenty minutes to complete, a shorter version has been introduced to accommodate patients who may find prolonged testing arduous. Overall, the BBS serves as an essential tool in promoting safety and mobility in vulnerable populations.
On this Page
Berg Balance Scale (BBS)
The Berg balance scale(BBS) is a test used by medical professionals to assess a person's ability to remain steady on his or her feet in various situations. It is used to help determine how well older people are able to stand or move without falling and to assess their risk of falling. The fourteen-step test uses basic equipment and can be applied even if the person is not capable of standing. It provides a convenient and readily available assessment tool that can be used in clinical or home settings.
Background
Older people and those with certain health conditions can have problems maintaining their balance when walking, sitting, or moving in certain ways, such as reaching for an object. There are a number of factors that contribute to this. The inability to maintain balance can lead to injuries and chronic health problems.
The ability to maintain balance requires a number of parts of the body to work well and to work together. Bones, joints, and muscles need to have the strength and coordination to help the body maintain its position. Vision must be sound enough to guide the person's movements. The nervous system must be able to send proper signals to other parts of the body. The heart and circulatory system have to be working well enough to ensure the other parts of the body are getting enough oxygen. The inner ear also works to help the body maintain balance. Many medical conditions that affect one or more of these systems can cause a person to have trouble with balance.
This particularly becomes a problem for people as they age. Although balance problems are not an inevitable part of aging, older people are more likely to have developed other health conditions that affect balance. These can include osteoarthritis that weakens bones and joints, heart disease that affects the circulatory system's ability to provide oxygen, and vision problems that limit sight. Stroke patients and those with conditions such as Parkinson's disease are also more likely to lose their balance and fall. Being able to tell which patients are at greater risk of falling allows physical and occupational therapists and other clinicians to help the patient adapt to and minimize that risk.
The Berg balance scale was developed in 1989 to fill a need for a standardized and objective way to measure the ability of older adults to maintain their balance in various settings. It is named after Katherine Berg, a physical therapist who developed the scale as part of her doctoral thesis. It has since become one of the most widely used assessments of its kind.
Overview
The Berg balance scale measures the patient's ability to maintain balance while completing fourteen activities that are increasingly more challenging. The test uses two chairs, one with arms and one without, a footstool or step stool, a yardstick, a watch or stopwatch, and a 15 foot (4.5 meter) clear walkway. With these items, the clinician can conduct an impartial assessment of the patient's ability to balance while sitting, standing, moving between these positions, bending, reaching, standing on one foot, and turning. The patient is scored from zero to four on each activity based on exactly how well each task is completed.
For example, to complete the first step of the assessment, the clinician will ask the patient to stand up from a seated position. The patient will be asked to avoid using the chair for support if possible. A patient who can get up and into a standing position independently will be scored a four. A patient who can stand independently using hands on the chair will be scored a three. A patient who can stand using hands but needs several tries to reach a standing position will be scored a two. A person who can stand with some slight assistance from the clinician receives a score of one. A person who requires moderate or full assistance to stand will receive a score of zero.
Each of the activities will be scored in a similar manner, with the highest scores going to the person who can complete the activity independently. Increasingly lower scores are awarded for those who need various forms of assistance. The patient can achieve a maximum score of fifty-six. A person who achieves a score of forty-one to fifty-six is considered to be fully independent when it comes to balance issues. A person with a score of twenty-one to forty is considered to be able to walk with assistance. Those who score between zero and twenty are usually considered to be wheelchair-bound.
Although those who score as low as forty-one are considered independent, those who score below forty-five are considered to be at greater risk of falling. However, for those who already have fallen, a score below fifty-one indicates a greater risk of falling, while those who have not already fallen but have a score below forty-two are also at greater risk. Nearly everyone with a score below forty is considered to be at a 100 percent risk of falling at some point.
Knowing a patient's fall risk enables medical professionals to take steps to keep the patient safe. Various pieces of medical equipment can be used, such as bars on beds or near toilets and tubs to help a patient stand safely from a sitting position, lift chairs that assist the patient in rising from soft furniture, and walkers or canes to help maintain balance while walking. Depending on the reason for the balance difficulty, some patients may be able to progress to a lower level of assistance or to no assistance at all. For instance, a stroke patient who has physical therapy may eventually require less assistance being mobile.
Around 2006, efforts were made to develop a shorter form of the Berg balance test. The original test, while very effective and easy to administer, can take about twenty minutes to complete. This can be too tiring for people dealing with other health issues and also consumes a great deal of time for the clinician. A shorter version of the Berg balance test that uses three levels of assessment instead of five and tests on seven activities instead of fourteen was developed. It has been found to be especially useful in treating stroke patients, who need to be assessed even though they may be suffering other effects of the stroke.
Bibliography
"Balance Problems." Mayo Clinic, 8 June 2020, www.mayoclinic.org/diseases-conditions/balance-problems/symptoms-causes/syc-20350474. Accessed 13 Dec. 2024.
"Berg Balance Scale." Science Direct, 2023, www.sciencedirect.com/topics/medicine-and-dentistry/berg-balance-scale. Accessed 13 Dec. 2024.
"Berg Balance Test." University of Delaware, www.thompsonhealth.com/Portals/0/‗RehabilitationServices/PT%20Mgmt%20of%20Knee/Berg‗Balance‗Test‗handout.pdf. Accessed 13 Dec. 2024.
Chou, Chia-Yeh, et al. "Developing a Short Form of the Berg Balance Scale for People with Stroke." Physical Therapy, vol. 86, no. 2, 1 Feb. 2006, pp. 195–204.
Downs, Stephen. "The Berg Balance Scale." Journal of Physiotherapy, vol. 61, no. 1, 2015, p. 46.
"Katherine Berg, PhD, PT Associate Professor." Interrai, www.interrai.org/katherine-berg.html. Accessed 13 Dec. 2024.
Muir, Susan, et al. "Use of the Berg Balance Scale for Predicting Multiple Falls in Community-Dwelling Elderly People: A Prospective Study." Physical Therapy, vol. 88, no. 4, 1 Apr. 2008, pp. 449–59.