Berg Balance Scale
Berg Balance Scale has 14 items scale that was developed to measure balance among older people with impairment in balance function by assessing the performance of functional tasks.
The Berg Balance Scale score is ranging from 0 to 56 points.
The requirement tools for this scale are: a stopwatch, a ruler or a measuring tape, a chair, a step, and an object that can be picked up.
See Also: Thomas Test Hip
Berg Balance Scale Items
Berg Balance Scale consists of 14 items that the patient is asked to perform to check for balance.
|B1||Sitting to standing|
|B4||Standing to sitting|
|B6||Standing with the eyes closed|
|B7||Standing with the feet together|
|B8||Reaching forward with outstretched arm|
|B9||Retrieving object from floor|
|B10||Turning to look behind|
|B11||Turning 360 degrees|
|B12||Placing alternate foot on stool|
|B13||Standing with one foot in front|
|B14||Standing on one foot|
B1 – Sitting To Standing
The examiner asks the patient to stand up and try not to use the hand for support.
|Patient is able to stand without using hands and stabilize independently||4|
|Patient is able to stand independently using hands||3|
|Patient is able to stand using hands after several tries||2|
|Patient needs minimal aid to stand or stabilize||1|
|Patient is needs moderate or maximal assist to stand||0|
B2 – Standing Unsupported
The examiner asks the patient to stand for two minutes without holding on.
|Patient is able to stand safely for 2 minutes||4|
|Patient is able to stand 2 minutes with supervision||3|
|Patient is able to stand 30 seconds unsupported||2|
|Patient needs several tries to stand 30 seconds unsupported||1|
|Patient is unable to stand 30 seconds unsupported||0|
If the patient is able to stand 2 minutes unsupported, score full points for sitting unsupported and proceed to item 4 (Standing to sitting).
B3 – Sitting unsupported
Sitting With Back Unsupported But Feet Supported On Floor Or On A Stool. The examiner asks the patient to sit with arms folded for 2 minutes.
|Patient is able to sit safely and securely for 2 minutes||4|
|Patient is able to sit 2 minutes under supervision||3|
|Patient is able to able to sit 30 seconds||2|
|Patient is able to sit 10 seconds||1|
|Patient is unable to sit without support 10 seconds||0|
B4 – Standing To Sitting
The examiner asks the patient to sit down.
|Patient sits safely with minimal use of hands||4|
|Patient controls descent by using hands||3|
|Patient uses back of legs against chair to control descent||2|
|Patient sits independently but has uncontrolled descent||1|
|Patient needs assist to sit||0|
B5 – Transfers
Arrange chair(s) for pivot transfer. The examiner ask the patient to transfer one way toward a seat with armrests and one way toward a seat without armrests.
Two chairs (one with and one without armrests) or a bed and a chair may be used.
|Patient is able to transfer safely with minor use of hands||4|
|Patient is able to transfer safely definite need of hands||3|
|Patient is able to transfer with verbal cuing and/or supervision||2|
|Patient needs one person to assist||1|
|Patient needs two people to assist or supervise to be safe||0|
B6 – Standing Unsupported With Eyes Closed
The examiner asks the patient to close the eyes and stand still for 10 seconds.
|Patient is able to stand 10 seconds safely||4|
|Patient is able to stand 10 seconds with supervision||3|
|Patient is able to stand 3 seconds||2|
|Patient is unable to keep eyes closed 3 seconds but stays safely||1|
|Patient needs help to keep from falling||0|
B7 – Standing Unsupported With Feet Together
The examiner asks the patient to place his feet together and stand without holding on.
|Patient is able to place feet together independently and stand 1 minute safely||4|
|Patient is able to place feet together independently and stand 1 minute with supervision||3|
|Patient is able to place feet together independently but unable to hold for 30 seconds||2|
|Patient needs help to attain position but able to stand 15 seconds feet together||1|
|Patient needs help to attain position and unable to hold for 15 seconds||0|
B8 – Reaching forward with outstretched arm
The examiner asks the patient to lift arm to 90 degrees and stretch out the fingers and reach forward as far as he can.
The examiner places a ruler at the end of fingertips when arm is at 90 degrees. Fingers should not touch the ruler while reaching forward. The recorded measure is the distance forward that the fingers reach while the subject is in the most forward lean position. When possible, the patient is asked to use both arms when reaching to avoid rotation of the trunk.
|Patient can reach forward confidently 25 cm (10 inches)||4|
|Patient can reach forward 12 cm (5 inches)||3|
|Patient can reach forward 5 cm (2 inches)||2|
|Patient reaches forward but needs supervision||1|
|Patient loses balance while trying/requires external support||0|
B9 – Pick Up Object From The Floor From A Standing Position
The examiner asks the patient to pick up the shoe/slipper, which is placed in front of the patient’s feet.
|Patient is able to pick up slipper safely and easily||4|
|Patient is able to pick up slipper but needs supervision||3|
|Patient is unable to pick up but reaches 2-5 cm (1-2 inches) from slipper and keeps balance independently.||2|
|Patient is unable to pick up and needs supervision while trying||1|
|Patient is unable to try/needs assist to keep from losing balance or falling||0|
B10 – Turning to look behind
Turning To Look Behind Over Left And Right Shoulders While Standing:
The patient is asked to turn to look directly behind over toward the left shoulder, repeat to the right. The Examiner may pick an object to look at directly behind the patient to encourage a better twist turn.
|Patient looks behind from both sides and weight shifts well||4|
|Patient looks behind one side only other side shows less weight shift||3|
|Patient turns sideways only but maintains balance||2|
|Patient needs supervision when turning||1|
|Patient needs assist to keep from losing balance or falling||0|
B11 – Turn 360 Degrees
The patient is asked to turn completely around in a full circle. Pause. Then turn a full circle in the other direction.
|Patient is able to turn 360 degrees safely in 4 seconds or less||4|
|Patient is able to turn 360 degrees safely one side only 4 seconds or less||3|
|Patient is able to turn 360 degrees safely but slowly||2|
|Patient needs close supervision or verbal cuing||1|
|Patient needs assistance while turning||0|
B12 – Placing alternate foot on stool
Place Alternate Foot On Step Or Stool While Standing Unsupported:
The examiner asks the patient to place each foot alternately on the step/stool. Continue until each fool has touch the step/stool four times.
|Patient is able to stand independently and safely and complete 8 steps in 20 seconds||4|
|Patient is able to stand independently and complete 8 steps in > 20 seconds||3|
|Patient is able to complete 4 steps without aid with supervision||2|
|Patient is able to complete > 2 steps needs minimal assist||1|
|Patient needs assistance to keep from falling/unable to try||0|
B13 – Standing Unsupported One Foot In Front
The patient is asked to place one foot directly in front of the other. If the patient feels that he cannot place the foot directly in front, he tries to step far enough ahead that the heel 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 patient’s normal stride width.
|Patient is able to place foot tandem independently and hold 30 seconds||4|
|Patient is able to place foot ahead independently and hold 30 seconds||3|
|Patient is able to take small step independently and hold 30 seconds||2|
|Patient needs help to step but can hold 15 seconds||1|
|Patient loses balance while stepping or standing||0|
B14 – Standing On One Leg
The patient is asked to stand on one leg as long as he can without holding on.
|Patient is able to lift leg independently and hold > 10 seconds||4|
|Patient is able to lift leg independently and hold 5-10 seconds||3|
|Patient is able to lift leg independently and hold > 3 seconds||2|
|Patient is tries to lift leg unable to hold 3 seconds but remains standing independently.||1|
|Patient is unable to try of needs assist to prevent fall||0|
Clinical Importance of Berg Balance Test
The clinical importance of Berg Balance Scale is to predict risk of falls and assess the need for an assistive device for ambulation, such as a cane, walker, or wheelchair.
As with neurological conditions, studies have supported using the Berg Balance Scale for lower extremity amputees.
- Total Berg Balance score below 45 are associated with a higher risk of falls.
- An individual with a history of falls and a total score below 51 is highly predictive of falls.
- A score of less than 40 is associated almost with a 100% fall risk.
Need for an Assistive Device:
- A total Berg Balance score of 0-20 reflects mobility by wheelchair,
- 21 to 40 walking with assistance,
- a score of 41 to 56 walking independently
- Miranda-Cantellops N, Tiu TK. Berg Balance Testing. [Updated 2021 Nov 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK574518/
- Muir-Hunter SW, Graham L, Montero Odasso M. Reliability of the Berg Balance Scale as a Clinical Measure of Balance in Community-Dwelling Older Adults with Mild to Moderate Alzheimer Disease: A Pilot Study. Physiother Can. 2015 Aug;67(3):255-62. doi: 10.3138/ptc.2014-32. PMID: 26839454; PMCID: PMC4594811.
- Netter’s Orthopaedic Clinical Examination An Evidence-Based Approach 3rd Edition Book.