The BBS is a performance based measure of balance. Tasks are of progressing difficulty and include functional activities related to balance while reaching, bending, transferring, and standing. Originally developed for use with the elderly, the scale has been used in a variety of populations including stroke, Parkinson’s, multiple sclerosis, and recently SCI. Some researchers have used the BBS as the gold standard for balance in criterion validity studies (Liston & Brouwer, 1996; Tyson & DeSouza, 2004).

Number of items: 14

Procedure/Administration: The BBS is an observer rated measure. The rater observes the patient perform each of the tasks while ensuring the individual does not fall.

How scored: Each of the 14 tasks are rated on a 5-point scale from 0 (cannot perform) to 4 (normal performance). Total scores range from 0 (severely impaired balance) to 56 (excellent balance). Some tasks are rated according to the quality of the performance of the task, while others are evaluated by the time required to complete the task.

Interpretability: Results from studies of older adults suggest the follow cut points: 0-20 = wheelchair bound; 21-40 = walking with assistance; and 41-56 = independent. Scores below 41 are suggested to indicate increased risk of falling. Change scores >7 are said to be clinically relevant in studies of older adults. This interpretation has not been validated with SCI populations.

Acceptability: The BBS is generally well received among clinicians who specialize in the area of gait and balance training. The tool is only applicable to individuals with incomplete SCI who retain some ability to stand and walk. It has been found to be an appropriate assessment of standing balance for these individuals as shown by its strong associations with various clinical walking evaluations

Languages: English, Italian, Turkish, Brazilian-Portuguese, German, Korean, and Dutch.

Usability: The BBS is limited to those patients with SCI who have some form of standing and/or ambulatory capacity.

Time to administer: Approximately 20 minutes (in relative well functioning older adults). In general the time required is inversely related to the lower extremity ability of the individual.

Time to score: N/a

Training required: Raters are typically health professional with knowledge of balance and trained to assign ratings.

Availability: www.aahf.info/pdf/Berg_Balance_Scale.pdf.

Equipment required: 2 standard chairs (1 with arms and 1 without), a stop watch, step or stepstool, and a ruler

Summary: N/a

Psychometric Summary:

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• Berg K, Wood-Dauphinee S, Williams JI, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada 1989; 41(6): 304-311.
• Lemay JF, Nadeau S. Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale. Spinal Cord advance online publication, 22 September 2009; doi: 10.1038/sc.2009.119.
• Liston RA, Brouwer BJ. Reliability and validity of measures obtained from stroke patients using the Balance Master. Arch Phys Med Rehabil 1996; 77: 425-430.
• Tyson SF, DeSouza LH. Development of the Brunel Balance assessment: a new measure of balance disability post stroke. Clin Rehabil 2004; 18: 801-810.
• 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: 70-77.