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Berg Balance Scale (BBS)
Availability
Please visit this website for more information about the instrument: Berg Balance Scale
 
Please click here for more information on the Pediatric Modification of the Berg Balance Scale.
Classification
NeuroRehab Supplemental - Highly Recommended
Recommendations for Use: Indicated for studies requiring a measure of balance.
 
Supplemental - Highly Recommended: Huntington's Disease (HD)
Recommendations for Use: Indicated for studies requiring a measure of balance.
 
Supplemental: Cerebral Palsy (CP), Multiple Sclerosis (MS), Spinal Cord Injury (SCI); not recommended for youth <18y, and Stroke
 
Exploratory: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)
Short Description of Instrument
The Berg Balance Scale (BBS) is used to determine an individual's ability (or inability) to safely balance during a series of predetermined tasks. (Physiopedia, 2024) It is a 14 item list with each item consisting of a five-point ordinal scale ranging from 0 to 4, with 0 indicating the lowest level of function and 4 the highest level of function. It takes approximately 15-20 minutes to complete.
Comments/Special Instructions
The BBS was developed to measure balance among stroke patients and older people with impairment in balance function by assessing the performance of functional tasks. It is a valid instrument used for evaluation of the effectiveness of interventions and for quantitative descriptions of function in clinical practice and research. This test has been validated for use in individuals with SCI and has the advantage of being valuable for other neurologic populations.
 
SCI-Pediatric-Specific:
The Pediatric Berg Balance Scale has been evaluated in children aged 5-15 with known balance impairments. Shows good test-retest and inter-rater reliability. Child must be able to follow directions. It has not been evaluated specifically for children with SCI.
Scoring and Psychometric Properties
Scoring: A five-point scale, ranging from 0-4. "0" indicates the lowest level of function and "4" the highest level of function. Total Score = 0-56. Score of 41-56 = low fall risk, 21-40 = medium fall risk, 0-20 = high fall risk.
 
Psychometric Properties: Overall, the BBS appears to be a reliable tool used to measure outcomes. Berg et al demonstrated that the inter-rater reliability ICC was .99. The BBS may have a ceiling effect and is insensitive to individuals with very high levels of balance.
Rationale/Justification
Strengths: The BBS is appropriate for community dwelling elderly people, individuals that have suffered a stroke, and the elderly population with balance difficulties.
 
Weaknesses: Conradsson and colleagues (2007) demonstrated that a change of 8 BBS points is required to reveal a genuine change in function between two assessments among older people who are dependent in ADL and living in residential care facilities.
 

NeuroRehab-Specific: This is a gold standard measure that, although having clear ceiling effects, is widely used, and has known cutoff values for fall risk. It often correlates highly with FGA and with Mini-BESTest. This test is often more appropriate for lower-functioning persons where balance during walking is not the primary concern/focus.
References
Key References:
Berg K, Wood-Dauphinee S, Williams JI and Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada. 1989;41:304-311.
 
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-S11.
 
Conradsson M, Lundin-Olsson L, Lindelof N, Littbrand H, Malmqvist L, Gustafson Y, Rosendahl E. Berg balance scale: intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities. Phys Ther. 2007;87(9):1155-1163.
 
Additional References:
Arora T, Oates A, Lynd K, Musselman KE. Current state of balance assessment during transferring, sitting, standing and walking activities for the spinal cord injured population: A systematic review. J Spinal Cord Med. 2018;5:1-14.
 
Bogle Thorbahn LD & Newton RA. Use of the Berg Balance Test to predict falls in elderly persons. Phys Ther. 1996;76(6):576-583; discussion 584-575.
 
Jorgensen V, Opheim A, Halvarsson A, Franzen E, Roaldsen KS. Comparison of the Berg Balance Scale and the Mini-BESTest for Assessing Balance in Ambulatory People with Spinal Cord Injury: Validation Study. Phys Ther. 2017;97(6):677-687.
 
Physiopedia. Berg Balance Scale. Accessed 11 January 2024. Available from: https://www.physio-pedia.com/Berg_Balance_Scale.
 
Huntington's Disease-Specific References:
Busse ME, Wiles CM, Rosser AE. Mobility and falls in people with Huntington's disease. J Neurol Neurosurg Psychiatry. 2009 Jan;80(1):88-90.
 
Mestre TA, Busse M, Davis AM, Quinn L, Rodrigues FB, Burgunder JM, Carlozzi NE, Walker F, Ho AK, Sampaio C, Goetz CG, Cubo E, Martinez-Martin P, Stebbins GT; Members of the MDS Committee on Rating Scales Development. Rating Scales and Performance-based Measures for Assessment of Functional Ability in Huntington's Disease: Critique and Recommendations. Mov Disord Clin Pract. 2018 May 9;5(4):361-372.
 
SAH-Specific References:
Berg K, Wood-Dauphinee S, Williams JI. The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995;27(1):27-36.
 
Nakamura DM, Holm MB, Wilson A. Measures of Balance and Fear of Falling in the Elderly: a review. Phys Occup Ther Geriatr. 1998;15(4):17-32.
 
Whitney SL, Poole JL, Cass SP. A review of balance instruments for older adults. Am J Occup Ther. 1998;52(8):666-671.
 
Zwick D, Rochelle A, Choksi A, Domowicz J. Evaluation and treatment of balance in the elderly: A review of the efficacy of the Berg Balance Test and Tai Chi Quan. NeuroRehabil. 2000;15(1):49-56.
 
SCI-Specific Reference:
Wirz M, Muller R, Bastiaenen C. Falls in persons with spinal cord injury: validity and reliability of the Berg Balance Scale. Neurorehabil Neural Repair. 2010;24(1):70-77.
 
SCI-Pediatric-Specific Reference:
Franjoine MR, Gunther JS, Taylor MJ. Pediatric balance scale: a modified version of the berg balance scale for the school-age child with mild to moderate motor impairment. Pediatr Phys Ther. 2003;15(2):114-128.
 
Stroke-Specific Reference:
Moore JL, Potter K, Blankshain K, Kaplan SL, O?Dwyer LC, Sullivan JE. A Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation: A CLINICAL PRACTICE GUIDELINE. J Neurol Phys Ther. 2018 Jul;42(3):174-220.
 
Document last updated January 2024