Berg Balance Scale (BBS)

Purpose of the measure

The Berg Balance Scale (BBS) quantitatively assesses balance in older adults.

Available versions

The BBS was published in 1989 by Berg, Wood-Dauphinee, Williams and Maki.

Features of the measure

Items:
In this 14-item scale, patients must maintain positions and complete moving tasks of varying difficulty. In most items, patients must maintain a given position for a specified time.

Scoring:
Patients receive a score from 0-4 on their ability to meet these balance dimensions. A global score can be calculated out of 56. A score of 0 represents an inability to complete the item, and a score of 56 represents the ability to independently complete the item.

  • 0-20 on the BBS represents balance impairment;
  • 21-40 on the BBS represents acceptable balance;
  • 41-56 on the BBS represents good balance.

Subscales:
None typically reported.

Equipment:
Only simple and easily accessible equipment is needed to complete the BBS. This includes a ruler, stopwatch, chair, and a step or stool. Also, the patients will require enough room to move 360 degrees.

Training:
No special training is required to administer the BBS. It has been deemed highly reliable when administered by individuals with no formal training on the administration of the scale.

However, it is important to note that in order to ensure the safety of the patient, the BBS should only be administered by individuals with knowledge on how to safely manage those with stroke. The BBS is a risky assessment where a patient could fall if not supervised by someone with stroke expertise.

Time:
The scale takes approximately 10-15 minutes to complete. The patient must be directly observed to assess whether the task was completed.

Alternative forms of the BBS
  • A short form of the BBS (BBS-3P), which is composed of 7 items, has been developed (Chou, Chien, Hsueh, Sheu, Wang, & Hsieh, 2006).
  • The BBS-3P was found to be psychometrically similar (including test reliability, validity, and responsiveness) to the original BBS for people with stroke.
  • The BBS-3P takes less than 10 minutes to complete and requires only a chair and an object that the patient can retrieve from the floor. The BBS-3P is scored based on 3 levels: unable to complete the task, partially completes task, and able to complete the task. The 7 items included in the BBS-3P are: reaching forward with outstretched arm, standing with eyes closed, standing with one foot in front, turning to look behind, retrieving object from floor, standing on one foot, and changing from a sitting to standing position.
  • Compared with the original BBS, the BBS-3P is a quick and simple measure to complete in either a clinical or a research setting.
Client suitability

Can be used with:

Patients with stroke who understand spoken or written language who will find the items challenging.

The BBS was originally designed as a quantitative measure of balance and risk for falls in community-dwelling elderly patients. It has been shown to be a reliable and valid measure of balance in the elderly client with stroke.

Should not be used in:

  • More active elderly post-stroke patients.
  • Post-stroke patients who are younger.
    There may be a ceiling effect with these patients, in that the items may not be sufficiently challenging to measure higher-level balance such as walking outdoors.
  • Severely affected patients such as patients who cannot leave a seated position.
    There may be a floor effect with these patients, as there is only one item assessing balance in the seated position.

Instead, you may wish to consider the Postural Assessment Scale for Stroke Patients (PASS), which was designed as a balance assessment for patients with stroke that is applicable for all patients, even those with the most severe postural performance (Benaim, Pérennou, Villy, Rousseaux, & Pelissier, 1999).

Mao, Hsueh, Tang, Sheu, and Hsieh (2002) compared the psychometrics of the BBS to those of the balance subscale of the Fugl-Meyer Assessment and the Postural Assessment Scale for Stroke Patients in 123 patients with stroke up to 180 days after stroke onset and found that the FM-B and BBS showed a significant floor or ceiling effect at some days after stroke points, whereas the PASS did not show these effects.

In what languages is the measure available?
  • Translated and validated in Portuguese (Miyamoto, Lombardi, Berg, Ramos, & Natour, 2004).
  • Translated and validated in French (Institut de réadaptation de Montréal).
  • Translated (not yet validated) in: Iceland, Norway, Sweden, Denmark, Finland, Italy, the Netherlands, Poland, Korea, Japan, Spain, and Hong Kong and Germany.