Berg Balance Scale (BBS)
14-item clinician-administered measure of balance to assess risk for falls in older community-dwelling adults.
Creator
Dr. Katherine Berg, PhDInstructions
The Berg Balance Scale is a performance-based measure of static and dynamic balance, administered by a trained clinician.
Equipment needed:
Stopwatch or watch with a second hand
Ruler or tape measure
Two standard chairs (one with armrests, one without)
Step or stool of average step height
Slipper or small object to place on the floor.
Demonstrate each task and/or give the instructions as written.
Score the LOWEST category that applies to the patient's performance.
In most items the patient is asked to maintain a position for a set time; deduct points if the time or distance requirements are not met, if the patient's performance warrants supervision, or if the patient touches an external support or receives assistance from the examiner.
Berg Balance Scale Items
Introduction
The Berg Balance Scale (BBS) is a 14-task performance test that measures a person’s balance and helps identify fall risk. Physical therapist Katherine Berg, PhD, and colleagues developed it in 1989 at McGill University in Montreal. It’s a 14-item objective measure that assesses static balance and fall risk in adults. It’s used most often with older adults and people with neurological conditions such as stroke, Parkinson’s disease, and multiple sclerosis. It’s a standard tool in physical and occupational therapy, both for screening and for tracking progress during rehabilitation. Unlike a questionnaire, the BBS is completed by a clinician who watches the patient perform each task.
What it assesses: The 14 tasks reflect everyday movements, progressing from easier to harder: sitting to standing, standing unsupported, sitting unsupported, standing to sitting, transfers between chairs, standing with eyes closed, standing with feet together, reaching forward with an outstretched arm, picking up an object from the floor, turning to look behind, turning a full circle, alternately placing each foot on a step or stool, standing with one foot in front of the other, and standing on one leg. The test takes about 15–20 minutes and uses simple equipment: two chairs (one with armrests), a ruler, a stopwatch, and a step or stool. Patients can’t use a walking aid during testing, and a clinician should stand close by to guard against falls.
How it’s scored: Each task is rated from 0 to 4. A score of 0 means the person is unable to do the task or requires assistance, and 4 means they complete it independently and safely, meeting the time or distance standard. The scoring criteria for each level are specific to each task, so follow the official instructions. The 14 scores are added for a total from 0 to 56. A score of 56 indicates functional balance.
Results
BBS Score (≥45): Fall Risk NOT Increased
BBS Score (<45): Fall Risk Increased
How results are interpreted: Lower scores indicate poorer balance and higher fall risk. Multiple studies have identified different cutoff ranges for assessing fall risk. Researchers have proposed various cutoff scores, typically ranging from 40 to 50. This includes specific suggested cutoff points for patients with a history of falls (Shumway-Cook, 1997) or with stroke (Simpson, 2011). This tool adheres to the original study’s cutoff of <45 to indicate a higher risk of falls (Berg, 1989).
Strengths and limitations: The BBS is quick, inexpensive, and backed by decades of research. Strong, level I evidence in a clinical practice guideline supports its use to assess changes in static and dynamic sitting and standing balance. It has some limitations. People with good balance often score at or near the maximum, so it may miss mild balance problems in active adults. Patients with advanced Parkinson’s disease (Hoehn & Yahr stages 4–5) can’t complete it, since an assistive device can’t be used during testing, and for vestibular disorders, the BBS may not be the best measure for identifying fall risk. It’s best used as part of a full fall risk assessment, along with fall history, medications, vision, and other mobility tests.
All questions & possible results
Berg Balance Scale Items
1. Sitting to standing — "Please stand up. Try not to use your hands for support."
Select one option:
- Able to stand without using hands and stabilise independently
- Able to stand independently using hands
- Able to stand using hands after several tries
- Needs minimal aid to stand or to stabilise
- Needs moderate or maximal assist to stand
2. Standing unsupported — "Please stand for two minutes without holding on."
Select one option:
- Able to stand safely for 2 minutes
- Able to stand 2 minutes with supervision
- Able to stand 30 seconds unsupported
- Needs several tries to stand 30 seconds unsupported
- Unable to stand 30 seconds unsupported
3. Sitting with back unsupported but feet supported on floor or stool — "Please sit with arms folded for 2 minutes."
Select one option:
- Able to sit safely and securely for 2 minutes
- Able to sit 2 minutes under supervision
- Able to sit 30 seconds
- Able to sit 10 seconds
- Unable to sit without support for 10 seconds
4. Standing to sitting — "Please sit down."
Select one option:
- Sits safely with minimal use of hands
- Controls descent by using hands
- Uses back of legs against the chair to control descent
- Sits independently but has uncontrolled descent
- Needs assistance to sit
5. Transfers — "Please move from this chair to the other seat and back." (one chair with armrests, one without)
Select one option:
- Able to transfer safely with minor use of hands
- Able to transfer safely with definite need of hands
- Able to transfer with verbal cueing and/or supervision
- Needs one person to assist
- Needs two people to assist or supervise to be safe
6. Standing unsupported with eyes closed — "Please close your eyes and stand still for 10 seconds."
Select one option:
- Able to stand 10 seconds safely
- Able to stand 10 seconds with supervision
- Able to stand 3 seconds
- Unable to keep eyes closed 3 seconds but stays steady
- Needs help to keep from falling
7. Standing unsupported with feet together — "Place your feet together and stand without holding on."
Select one option:
- Able to place feet together independently and stand 1 minute safely
- Able to place feet together independently and stand 1 minute with supervision
- Able to place feet together independently but unable to hold for 30 seconds
- Needs help to attain the position but able to stand 15 seconds with feet together
- Needs help to attain the position and unable to hold for 15 seconds
8. Reaching forward with outstretched arm while standing — "Lift your arm to 90 degrees, stretch out your fingers and reach forward as far as you can."
Select one option:
- Can reach forward confidently more than 25 cm (10 inches)
- Can reach forward more than 12 cm (5 inches) safely
- Can reach forward more than 5 cm (2 inches) safely
- Reaches forward but needs supervision
- Loses balance while trying, or requires external support
9. Picking up an object from the floor from a standing position — "Pick up the shoe/slipper in front of your feet."
Select one option:
- Able to pick up the slipper safely and easily
- Able to pick up the slipper but needs supervision
- Unable to pick up but reaches 2–5 cm (1–2 inches) from the slipper and keeps balance independently
- Unable to pick up and needs supervision while trying
- Unable to try, or needs assist to keep from losing balance or falling
10. Turning to look behind over left and right shoulders while standing
Select one option:
- Looks behind from both sides with good weight shift
- Looks behind one side only; other side shows less weight shift
- Turns sideways only but maintains balance
- Needs supervision when turning
- Needs assist to keep from losing balance or falling
11. Turning 360 degrees — "Turn completely around in a full circle, pause, then turn a full circle in the other direction."
Select one option:
- Able to turn 360 degrees safely in 4 seconds or less in both directions
- Able to turn 360 degrees safely in 4 seconds or less on one side only
- Able to turn 360 degrees safely but slowly
- Needs close supervision or verbal cueing
- Needs assistance while turning
12. Placing alternate foot on step or stool while standing unsupported — "Place each foot alternately on the step/stool until each foot has touched the step/stool four times."
Select one option:
- Able to stand independently and safely and complete 8 steps in 20 seconds
- Able to stand independently and complete 8 steps in more than 20 seconds
- Able to complete 4 steps without aid, with supervision
- Able to complete more than 2 steps; needs minimal assist
- Needs assistance to keep from falling, or unable to try
13. Standing unsupported with one foot in front — "Place one foot directly in front of the other and hold."
Select one option:
- Able to place foot tandem independently and hold 30 seconds
- Able to place foot ahead of the other independently and hold 30 seconds
- Able to take a small step independently and hold 30 seconds
- Needs help to step but can hold 15 seconds
- Loses balance while stepping or standing
14. Standing on one leg — "Stand on one leg as long as you can without holding on."
Select one option:
- Able to lift leg independently and hold more than 10 seconds
- Able to lift leg independently and hold 5–10 seconds
- Able to lift leg independently and hold 3 seconds or more
- Tries to lift leg, unable to hold 3 seconds, but remains standing independently
- Unable to try, or needs assist to prevent a fall
Possible results
BBS Score (<45): Fall Risk Increased
Higher scores indicate better balance.
Multiple studies have identified different cutoff ranges for assessing fall risk. Researchers have proposed various cutoff scores, typically ranging from 40 to 50. This includes specific suggested cutoff points for patients with a history of falls (Shumway-Cook, 1997) or with stroke (Simpson, 2011).
This tool adheres to the original study’s cutoff of <45 to indicate a higher risk of falls (Berg, 1989).
BBS Score (≥45): Fall Risk NOT Increased
Higher scores indicate better balance.
Multiple studies have identified different cutoff ranges for assessing fall risk. Researchers have proposed various cutoff scores, typically ranging from 40 to 50. This includes specific suggested cutoff points for patients with a history of falls (Shumway-Cook, 1997) or with stroke (Simpson, 2011).
This tool adheres to the original study’s cutoff of <45 to indicate a higher risk of falls (Berg, 1989).
Citation
Berg K, Wood-Dauphinee S, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health. 1992;83 Suppl 2:S7-11.
Literature
Berg K, Wood-Dauphinee S, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health. 1992;83 Suppl 2:S7-11.
https://utppublishing.com/doi/10.3138/ptc.41.6.304Bogle Thorbahn LD, Newton RA. Use of the Berg Balance Test to predict falls in elderly persons. Phys Ther. 1996 Jun;76(6):576-83; discussion 584-5.
https://pubmed.ncbi.nlm.nih.gov/8650273/La Porta F, Caselli S, Susassi S, Cavallini P, Tennant A, Franceschini M. Is the Berg Balance Scale an internally valid and reliable measure of balance across different etiologies in neurorehabilitation? A revisited Rasch analysis study. Arch Phys Med Rehabil. 2012 Jul;93(7):1209-16.
https://pubmed.ncbi.nlm.nih.gov/22521926/Alghadir AH, Al-Eisa ES, Anwer S, Sarkar B. Reliability, validity, and responsiveness of three scales for measuring balance in patients with chronic stroke. BMC Neurol. 2018 Sep 13;18(1):141.
https://pubmed.ncbi.nlm.nih.gov/30213258/Shumway-Cook A, Gruber W, Baldwin M, Liao S. The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults. Phys Ther. 1997 Jan;77(1):46-57.
https://pubmed.ncbi.nlm.nih.gov/8996463/
Related evaluations
Marx Activity Rating Scale
Assess knee function & activity level, such as patients with knee ligament injuries (commonly ACL tears) or post surgery
Dr. Robert G. Marx, MDRoland-Morris Disability Questionnaire
Measures functional disability and activity limitations in patients with low back pain.
Dr. Martin Roland, MDFoot and Ankle Disability Index (FADI)
Assess functional limitations of those with a variety of foot and ankle conditions
Dr. RobRoy Martin, PhD, PT, CSCSAmerican Shoulder and Elbow Surgeons (ASES) Shoulder Score
15-item assessment of shoulder pain and functional limitations in activities of daily living.
Dr. Robin R. Richards, MD, FRCSC, FAAOS, FAOAFoot and Ankle Ability Measure (FAAM)
Assesses functional limitations and disability related to foot and ankle conditions in daily activities and sports.
Dr. Jesse Van Swearingen, PhD, PT, FAPTAHip Disability & Osteoarthritis Outcomes Score Joint Replacement (HOOS JR)
6-item hip survey to evaluate outcomes after total hip arthroplasty; scoring pain, and function.
Dr. Stephen Lyman, PhDKnee Injury & Osteoarthritis Outcomes Score for Joint Replacement (KOOS JR)
7-item knee survey to evaluate outcomes after total knee arthroplasty; scoring pain, stiffness and function.
Dr. Stephen Lyman, PhDAlso from EVAL Foundation
Alcohol Use Disorders Identification Test - C (AUDIT-C)
A 3-item tool to screen for unhealthy alcohol use in patients who may not be alcohol-dependent.
Dr. Katharine Bradley, MD, MPHAlcohol Use Disorders Identification Test (AUDIT)
A 10-item tool to screen for hazardous alcohol use, harmful use, and alcohol dependence.
World Health Organization Collaborative ProjectBehavioral Activity Rating Scale (BARS)
A 1-item rating scale to quantify a patient's level of agitation in acute care or psychiatric settings.
CAGE Alcohol Questionnaire
4-item questionnaire that can indicate potential problems with alcohol use.
Drug Abuse Screening Test (DAST-10)
A patient self-report questionnaire to screen for problematic drug use (excluding alcohol/tobacco).
Dr. Harvey A. Skinner, Ph.D.General Anxiety Disorder (GAD-7)
Measure severity of anxiety
Dr. Robert L. Spitzer, MDGeneralized Anxiety Disorder 2-item (GAD-2)
2-item anxiety screening tool derived from the first two questions of the GAD-7
Dr. Robert Spitzer, MDGeriatric Depression Scale (GDS-15)
Identifies possible depression in older adults.
Dr. Jerome A. Yesavage, MD