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Readings

 

BERG BALANCE SCALE

 

  I. Purpose
 The Berg’s utility includes grading different patients’ balance abilities, monitor functional balance over time and to evaluate patients’ responses to treatment.

 II. Content
 The Berg is a test of 14 items; it is performance based and has a scale of 0-4 for each item (higher score for independent performance) with a maximum score of 56.
The Berg is considered the gold standard assessment of balance with good intra-rater reliability and inter-rater reliability and good internal validity.

 III. Assessment:

    1. Sitting to standing
    INSTRUCTIONS: Please stand up. Try not to use your hands 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 to stabilize 

    0 needs moderate or maximal assist to stand

 

2. Standing unsupported
INSTRUCTIONS: Please stand for two minutes without holding

  4 able to stand safely for 2 minutes 

  3 able to stand for 2 minutes with supervision

  2 able to stand for 30 seconds unsupported

  1 needs several tries to stand for 30 seconds unsupported

  0 unable to stand for 30 seconds unassisted

 

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 for 2 minutes under supervision

  2 able to sit for 30 seconds

  1 able to sit for 10 seconds

  0 unable to sit without support for 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 use 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 steady 

 0 needs help to keep from falling

 

7. Standing unsupported with feet together

INSTRUCTIONS: Place your feet together and stand without holding4 able to place feet independently and stand for 1 minute safely

 4 able to stand 10 seconds safely 

 3 able to place feet together and stand for 1 minute with supervision

 2 able to place feet together independently to hold for 30 seconds

 1 need help to attain position but able to stand 15 seconds feet together

 0 needs help to attain and unable to hold for 15 seconds

 

8. Reaching forward with outstretched arm while standing
INSTRUCTIONS: Lift arm to 90º. Stretch out your fingers and reach forward as far as you can. (Examiner places a ruler at end of fingertips when arm is at 90º. Fingers should not touch the ruler while reaching forward). The recorded measure is the distance forward that the finger reaches 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 confidentially >25 cm (10 inches)

 3 can reach forward >12.5 cm safely (5 inches)

 2 can reach forward >5cm 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, reaches 2-5cm (1-2 inches) from slipper, keeps balance

 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, turn to other side demonstrates 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 in 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 >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

 

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

 

14. 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 ≥ 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)

 
 IV. Interpretation of Berg Scores

 Please take note that these values are based on the Berg score alone and the patient mobilising without the assistance of a walking device. They do not take into account other falls risk factors:

• A score of 45 or less indicates a greater risk of falls

• In the range of 56-54 each 1 point drop was associated with a 3-4% increase in falls risk

• In the range of 54-46 each point drop was associated with a 6-8% falls risk

• Below 36 falls risk is close to 100%


 REFERENCES

 Wood-Dauphinee S, Berg K, Bravo G, Williams JI: The Balance Scale: Repsonding 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.


  

HOW’S YOUR BALANCE?

 

  Balance is an essential function of the locomotor system. It is often ignored but no less important than flexibility, strength, endurance, or aerobic fitness. Balance is an important part of the rehabilitation of certain injuries. It is also important part of injury prevention programs in runners and walkers. Balance training has been shown to improve strength in the hips and legs and is less time consuming than strength training programs. It’s also important to note that in the past few years research has shown that people with weaker hip muscles tend to get more leg and low back injuries. Poor balance in healthy individuals may be due to previous injuries that were not properly rehabilitated, muscle imbalance, poor sensation coming from the sole of your feet, or other causes. Balance depends on the somatosensory, vestibular and visual systems. The somatosensory system gets sensory information for balance from the soles of the feet, the neck, and the lumbar spine for inputs. If two of the previously mentioned systems are not working properly, our balance will be affected. One way to test balance in healthy people is with the single leg standing balance test.Single-leg standing balance test. Begin with eyes open and practice once or twice on each side. Then by looking straight ahead close your eyes and try maintaining your balance. Failure occurs if the foot touches the opposite leg, hopping occurs, the other foot touches the floor, or the arms touch something for support. You have 3 chances on each side to reach your best time.

  Depending of your age you should be able to stand on one leg, eyes closed for a minimum of the following length of time:

20-49 year of age→ 24.2 seconds

50-59 year of age→ 21.0 seconds

60-69 year of age→ 10.2 seconds

70-79 year of age→ 4.3 seconds

  If you can’t reach these times it may be important for you to get assessed to determine the cause of your poor balance and prevent injuries. One easy exercise to work on your balance is to try holding your balance on one leg for 30 seconds. Perform the routine three to four times per leg twice daily until you can comfortably keep balance for 30 seconds. After that proceed with your eyes closed until you reach 30 seconds again.


 Dr. Steve Pelletier, B.Sc., D.C. ♦ Centrum Chiropractic Clinic ♦ (613) 830-4080 ♦
http://www.inbalancechiro.ca/