The Berg Balance Test (BBT) is a standardized clinical assessment tool used globally by healthcare professionals to evaluate an individual’s ability to maintain balance. The test is a reliable method for measuring both static balance, which is stability while stationary, and dynamic balance, which is stability during movement. Developed initially for older adults, the BBT provides an objective measure of functional mobility. This assessment is widely recognized as a standard for quantifying balance impairment across various patient populations, including those recovering from stroke or managing conditions like Parkinson’s disease.
What the Berg Balance Test Measures
The primary purpose of the BBT is to quantify a person’s functional balance abilities and determine the potential risk of falling. The assessment consists of 14 separate tasks that mirror common activities encountered in daily life. These tasks range in difficulty from simple actions like sitting unsupported to more challenging movements such as standing on one foot. Each task is scored on a five-point scale from zero to four, resulting in a total possible score of 56 points. A lower score on the BBT indicates poorer balance function and a higher probability of experiencing a fall. The results help physical therapists track a patient’s progress over time and establish appropriate goals for rehabilitation programs.
Rules for Using Assistive Devices
The standardized protocol for the Berg Balance Test prohibits the use of assistive devices. The BBT is designed to assess an individual’s unaided functional balance, meaning the test is performed without the use of canes, walkers, crutches, or other mobility aids. This restriction is necessary to maintain the test’s standardization and validity for predicting fall risk.
If a patient relies on an assistive device for a task, or if the assessor must intervene to prevent a fall, the item is automatically scored as zero. This lowest score reflects the individual’s inability to perform the task independently and safely. Allowing the use of a device would fundamentally alter the test’s original purpose, which is to measure the risk of falling based on a person’s intrinsic balance capabilities.
Using an assistive device would compromise the interpretation of the final score, making it impossible to compare the result to established normative data. The cut-off scores that predict fall risk, such as the widely accepted score of 45, are based on performance without external support. Therefore, the assessment must strictly adhere to the no-device rule. This constraint ensures the score reflects the true extent of the patient’s balance deficit in the absence of mechanical support.
Clinical Alternatives to the Berg Test
For patients who rely heavily on an assistive device for mobility, the BBT is often not the most appropriate assessment tool because they would score poorly due to the no-device rule. In these cases, clinicians frequently select alternative balance and mobility assessments that are either designed for or permit the use of walking aids. These alternative tests provide a more accurate and clinically useful measure of a patient’s safe functional mobility.
Timed Up and Go (TUG) Test
One common alternative is the Timed Up and Go (TUG) test. The TUG measures the time a person takes to rise from a chair, walk a short distance, turn, return, and sit down again. This test specifically allows the patient to use their customary walking aid, focusing on the speed and efficiency of their functional mobility.
Tinetti Performance-Oriented Mobility Assessment (POMA)
Another option is the Tinetti Performance-Oriented Mobility Assessment (POMA), which assesses gait and balance separately, offering a more nuanced picture of mobility. The POMA includes items that evaluate the ability to walk and maintain position while allowing for the use of an assistive device when necessary. Selecting these alternatives is a practical clinical decision when a patient’s balance impairment is severe, ensuring the assessment accurately reflects functional capacity and helps guide treatment planning.