Performance based measure of balance with 14 tasks. Tasks progress in difficulty and include functional activities related to balance while reaching, bending, transferring, and standing.
Originally developed for use with the elderly, the scale has been used in a variety of populations including stroke, Parkinson’s, multiple sclerosis, and recently SCI. Some researchers have used the BBS as the gold standard for balance in measurement studies.
The BBS is generally well received among clinicians who specialize in the area of gait and balance training.
The tool is only applicable to individuals with incomplete SCI who retain some ability to stand and walk.
It has been found to be an appropriate assessment of standing balance for these individuals as shown by its strong associations with various clinical walking evaluations.
SEM: not established for the SCI population, but for a stroke population, SEM = 2.93 for individuals who ambulate with assistance (n = 16) [Stevensen 2001, “Detecting change in patients with stroke using the Berg Balance Scale”, n = 48, patients >65 yrs of age admitted to stroke rehabilitation unit after acute stroke]
MDC: not established for the SCI population, but for a stroke population, MDC = 8.1 for individuals who ambulate with assistance (n = 16) [Stevensen 2001, see above for population and article details]
Inter-rater consistency is High for the BBS (Intraclass Correlation Coefficient = 0.998) (Srism et al. 2015; n = 83, chronic SCI, mixed injury types, mean time since injury (multiple and non-multiple fallers) = 46.72-58.70 months).
Intra-rater consistency is High for the BBS (Intraclass Correlation Coefficient = 0.97) (Tamburella et al. 2014; n = 23, 14 males, AIS D, time Since Injury (SD): 16.43 (19.03) months).
Internal consistency is High for the BBS (Information Coefficient = 0.94) (Jørgensen et al. 2017; n = 46 (32 males); AIS D = 85%, duration of injury (range): 6.5 years (1-41)).
Correlations between the BBS and the Walking Index for SCI are High (Pearson’s r = 0.89-0.92).
Correlations between the BBS and the Functional Independence Measure (FIM) are High (Pearson’s r = 0.72-0.77).
Correlations between the BBS and the FIM Locomotor Score are High (Pearson’s r = 0.86-0.89).
(Ditunno et al. 2007: n = 146, 114 males, inpatient, incomplete SCI, within 1 year post-injury)
Correlations between the BBS and the ASIA Motor Scale are low to High (ranging from Pearson’s r = 0.30 – UEMS, to Pearson’s r = 0.79 – LEMS, to Pearon’s r = 0.75 – ASIA Motor Score).
(Harkema et al. 2016: N=152, 123 male; mixed injury type, median (range) time post-SCI = 0.9 (0.1-45.2) years)
Correlations between the BBS and the Mini-BESTest scale are High (Pearon’s r = 0.899, P<0.001).
Correlations between the BBS and the Timed Up and Go (TUG) assessment are High (Pearson’s r = -0.75, P<0.001).
Correlations between the BBS and Spinal Cord Independence Measure version III (SCIM) are High (Pearson’s r = 0.88, P<0.001).
Correlations between the BBS and the Walking Index for Spinal Cord Injury version II (WISCI) are High (Pearson’s r = 0.63, P<0.001).
Correlations between the BBS and the Fall Efficiency Scale – International (FES-I) are High (Pearson’s r = -0.68, P<0.001).
Correlations between the BBS and the participants’ fear of falling are Low (Pearson’s r = -0.32, P=0.83).
Correlations between the BBS and the Quality of Life (QOL) questionnaire are Low (Pearson’s r = -0.75, P = 0.20).
(Jørgensen et al. 2017: n = 46, 32 males; AIS D = 85%, duration of injury (range) = 6.5 years (1-41))
No values were reported for the responsiveness of the QOLP-PD for the SCI population.
Significant ceiling effects (37.5% of subjects reached maximal score) and no floor effects have been reported in the Berg Balance Scale for the SCI population (Lemay & Nadeau 2010; N = 32, 25 male, AIS D mixed injury types, mean time since injury (SD) = 77.2 (44.3) days).
Standardized Response Mean:
All individuals: 0.59
(Post locomotor training; Harkema et al. 2016; N=152, 123 male; mixed injury type; median (range) time post-SCI = 0.9 (0.1-45.2) years) Number of studies reporting responsiveness data: 2
Datta S, Lorenz DJ, Morrison S, Ardolino E, Harkema SJ. A multivariate examination of temporal changes in Berg Balance Scale items for patients with ASIA Impairment Scale C and D spinal cord injuries. Arch Phys Med Rehabil 2009;90:1208-17. http://www.ncbi.nlm.nih.gov/pubmed/19577035
Ditunno JF Jr, Barbeau H, Dobkin BH, Elashoff R, Harkema S, Marino RJ, Hauck WW, Apple D, Basso DM, Behrman A, Deforge D, Fugate L, Saulino M, Scott M, Chung J, Spinal Cord Injury Locomotor Trial Group. Validity of the walking scale for spinal cord injury and other domains of function in a multicenter clinical trial. Neurorehabil Neural Repair 2007; 21: 539-550. http://www.ncbi.nlm.nih.gov/pubmed/17507642
Harkema SJ, Shogren C, Ardolino E, Lorenz DJ. Assessment of functional improvement without compensation for human spinal cord injury: extending the Neuromuscular Recovery Scale to the upper extremities. J Neurotraum 2016. Ahead of print. doi:10.1089/neu.2015.4213. http://online.liebertpub.com/doi/10.1089/neu.2015.4213
Jorgensen V, Opheim A, Halvarsson A, Franzen E, Skavberg Roaldsen K. Comparison of the berg balance scale and the mini-BESTest for assessing balance in ambulatory people with spinal cord injury: A validation study. Physical Therapy 2017;97: 677-687.
Lemay JF, Nadeau S. Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale. Spinal Cord. 2010;48(3):245-50. http://www.ncbi.nlm.nih.gov/pubmed/19773797
Srisim K, Saengsuwan J, Amatachaya S. Functional assessments for predicting a risk of multiple falls in independent ambulatory patients with spinal cord injury. J Spinal Cord Med. 2015;38(4):439-45. http://www.ncbi.nlm.nih.gov/pubmed/24621036
Tamburella F, Scivoletto G, Iosa M, Molinari M. Reliability, validity, and effectiveness of center of pressure parameters in assessing stabilometric platform in subjects with incomplete spinal cord injury: a serial cross-sectional study. J Neuroeng Rehabil. 2014;11:86. http://www.ncbi.nlm.nih.gov/pubmed/24886312