The Berg Balance Scale is a measure used by physical therapists to assess the quality of a patient’s balance. The Berg Balance Scale can help provide objective data on the severity of balance deficits in transferring (moving between locations or surfaces), reaching, bending, turning, and standing, and can help determine whether a patient is at increased risk of falling.
This article explains the Berg Balance Scale, what it measures, and why physical therapists use it.
what is this
The Berg Balance Scale is a measure used to assess the quality of a patient’s balance while sitting and standing. This test is usually done by a physical therapist (health care professional who provides treatment to maintain, enhance, or restore movement and physical function in people with impaired abilities). It grades the severity of balance deficits (areas in need of improvement) in patients with poor balance and decreased lower body stability.
Poor balance can be caused by a variety of reasons, including:
- Aging and related muscle weakness
- sedentary lifestyle
- Injuries affecting the ankle, knee, or hip
- Conditions that can cause muscle weakness in the legs, such as arthritis or spinal stenosis
- Neurological disorders that affect strength and balance, such as stroke, Parkinson’s disease, and multiple sclerosis (MS)
- Sensory loss from peripheral neuropathy (damage to nerves outside the brain and spinal cord)
how does this work
The Berg Balance Scale is an exam assessment consisting of 14 questions with a total score of 56. Test raters can rate items between 0 and 4 based on the quality of motion observed for each item.
The physical therapist will ask the patient to perform the following activities while observing the patient’s quality of balance to rate the following activities:
- Transition from sitting to standing without using your arms
- Stand unsupported for two minutes
- Sit unsupported for two minutes
- Transition from standing to sitting without using your arms
- Standing pivot transfers from one chair to another
- Stand with eyes closed for 10 seconds
- Stand with your feet together for a minute
- Extend arm forward 10 inches
- Retrieve an object from the floor
- Left and right shoulders turn and look back
- Rotate 360 degrees clockwise and counterclockwise in four seconds or less
- Place one foot on a stool and alternate feet four times in 20 seconds or less, for a total of eight
- Stand on both feet, one foot in front, hold for 30 seconds
- Stand on one foot for more than 10 seconds
Test raters will rate each of the 14 tasks based on the quality of the patient’s movements and their ability to maintain balance. A score of 0 indicates that the patient is unable to complete the task or requires extensive assistance to complete the task, while a score of 4 indicates that the patient is able to perform the task safely without the assistance of others.
A lower score will be given if the patient can only partially complete the task but cannot meet the time requirement or needs some physical assistance to assist.
The Berg Balance Scale is an objective method of assessing balance deficits in patients seeking physical therapy services. It allows the therapist to understand the patient’s functional limitations in order to develop ways of helping.
The Berg Balance Scale can reveal how patients exhibit balance problems, including standing still, moving up and down, having their support base challenged, changing positions, shifting, or eliminating visual input (for example, their eyes are closed).
Weakness in one or both legs can affect a patient’s ability to balance and maintain stability when changing positions and standing in a weight-bearing position. Common muscle groups that can be weak and cause balance deficits include:
- Quadriceps, stretch the knees and provide stability to each leg
- gluteus maximuswhich helps stabilize the lower body by stretching the hips
- gluteus mediusit stabilizes the pelvis and helps maintain balance as the center of gravity shifts and the support base narrows
In order to develop a care plan and obtain authorization for treatment services covered by insurance companies, physical therapists must develop individualized goals for each patient. One of the most important aspects of a physical therapy goal is that it must be measurable. Evaluating balance can be difficult to track objectively, so the Berg Balance Scale test can provide a useful numerical score that can track improvement over time.
The Berg Balance Scale is also an outcome measure and can be a useful indicator of a patient’s risk of falls. A lower Berg Balance Scale score is associated with an increased risk of falls according to the following scoring guidelines:
- 0-20 points: High risk of falling
- 21-40 points: Moderate fall risk
- 41–56 points: Low risk of falling
By scoring patients on the Berg Balance Scale, physical therapists can further demonstrate the need for physical therapy services to address balance deficits, thereby improving overall patient safety and reducing the risk of falls. Ideally, a score over 50 is desired to improve patient safety and reduce the risk of falls.
Although the results are variable, to demonstrate a real change in functional balance following a physiotherapy intervention, a change of at least 4-7 points on the Berg Balance Scale is required.
Unlike the Tinetti test, another balance assessment tool, the Berg Balance Scale has no gait (how a person walks) component and cannot provide information about a patient’s homeostasis (the ability to remain standing and stable) while walking.
Therefore, the Berg Balance Scale is only suitable for standing balance and transition movements. If the patient reports more difficulty maintaining balance when walking, and better stability when transferring and standing, the Tinetti test may be a more appropriate outcome measure to assess balance and track progress over time.
Because a patient’s balance quality is difficult to quantify, the Berg Balance Scale can be a useful tool to help provide objective data indicating balance problems and fall risk. This information is useful to patients, physical therapists, doctors, and insurance companies in helping to demonstrate the need for skilled physical therapy. It also helps track a person’s progress during treatment.