Вы находитесь на странице: 1из 12

Patient’s Name: Sobia Saleem Date: 12 april,2020

Location: Home contact: 03074586446

Address: Baghbanpura_______________ Physiotherapist: Sumbal Saleem___________

BERG FUNCTIONAL BALANCE SCALE


(Adapted from Berg, K., Wood-Dauphine, S.L. and Williams, J.L. Measuring balance in the elderly: validation of an instrument. Can. J. Public
Health, 83(S2): S7-S11, 1992.)

Grading: Please mark the lowest category that applies.

1. Sitting to standing (04)


Instruction: Please stand up. Try not to use your hands for support.

(4) able to stand, no hands and stabilize independently


(3) able to stand independently using hands
(2) able to stand using hands after severaltries
(1) needs minimal assist to stand or tostabilize
(0) needs moderate to maximal assist to stand

2. Standing unsupported (04)


Instruction: Stand for two minutes without holding.

(4) able to stand safely 2 minutes


(3) able to stand 2 minutes with supervision
(2) able to stand 30 seconds unsupported
(1) needs several tries to stand 30 seconds unsupported
(0) unable to stand 30 seconds unassisted

IF SUBJECT ABLE TO STAND 2 MINUTES SAFELY, SCORE FULL MARKS FOR SITTING
UNSUPPORTED. PROCEED TO POSITION CHANGE STANDING TO SITTING

3. Sitting unsupported feet on floor (04)


Instruction: Sit with arms folded for two minutes.

(4) able to sit safely and securely 2 minutes


(3) able to sit 2 minutes under supervision
(2) able to sit 30seconds
(1) able to sit 10seconds
(0) unable to sit without support 10 seconds

4. Standing to sitting (04)


Instruction: Please sit down.

(4) sits safely with minimal use of hands


(3) controls descent by using hands
(2) uses back of legs against chair to control descent
(1) sits independently but has uncontrolled descent
1
(0) needs assistance to sit

2
5. Transfers (04)
Instruction: Please move from chair or bed and back again. One way toward a seat with armrests and one
way toward a seat without arm rests.

(4) able to transfer safely with only minor use of hands


(3) able to transfer safely with definite need of hands
(2) able to transfer with verbal cueing and/or supervision
(1) needs one person to assist
(0) needs two people to assist or supervise to be safe

6. Standing unsupported with eyesclosed (04)


Instruction: Close your eyes and stand still for 10 seconds.

(4) able to stand 10 seconds safely


(3) able to stand 10 seconds with supervision
(2) able to stand 3 seconds
(1) unable to keep eyes closed 3 seconds but stays steady
(0) needs help to keep from falling

7. Standing unsupported with feettogether (04)


Instruction: Place your feet together and stand without holding.

(4) able to place feet together independently and stand 1 minute safely
(3) able to place feet together independently and stand for 1 minute with supervision
(2) able to place feet together independently but unable to hold for 30 seconds
(1) needs help to attain position but able to stand 15 seconds feet together
(0) needs help to attain position and unable to hold for 15 seconds

THE FOLLOWING ITEMS ARE TO BE PERFORMED WHILE STANDING UNSUPPORTED.

8. Reaching forward with outstretchedarms (04)


Instruction: Lift arm to 90 degrees. Stretch out your fingers and reach forward as far as you can. (Examiner
places a ruler at end of fingertips when arm is at 90 degrees. Fingers should not touch the ruler while
reaching forward. The recorded measure is the distance forward that the fingers reach while the subject is in
the most forward lean position.)

(4) can reach forward confidently >10 inches


(3) can reach forward >5 inchessafely
(2) can reach forward >2 inchessafely
(1) reaches forward but needs supervision
(0) needs help to keep from falling

9. Pick up object from the floor_(04)


Instruction: Pick up the shoe/slipper which is placed in front of your feet.

(4) able to pick up slipper safely and easily


(3) able to pick up slipper but needs supervision
(2) unable to pick up but reaches 1-2 inches from slipper and keeps balance independently
(1) unable to pick up and needs supervision while trying
(0) unable to try/needs assist to keep from falling
10. Turning to look behind/over left and rightshoulders (04)
Instruction: Turn to look behind you over/toward your left shoulder. Repeat to the right.

(4) looks behind from both sides and weight shifts well
(3) looks behind one side only; other side shows less weight shift
(2) turns sideways only but maintains balance
(1) needs supervision when turning
(0) needs assist to keep from falling
11. Turn 360degrees (04)
Instruction: Turn completely around in a full circle. Pause. Then turn a full circle in the other direction.

(4) able to turn 360 safely in <4 seconds each side


(3) able to turn 360 safely one side only in <4 seconds
(2) able to turn 360 safely but slowly
(1) needs close supervision or verbal cueing
(0) needs assistance while turning

DYNAMIC WEIGHT SHIFTING WHILE STANDING UNSUPPORTED.

12. Count number of times step touch measuredstool (04)


Instruction: Place each foot alternately on the stool. Continue until each foot has touched the stool four times.

(4) able to stand independently and safely and complete 8 steps in 20 seconds
(3) able to stand independently and complete 8 steps in >20 seconds
(2) able to complete 4 steps without aid with supervision
(1) able to complete >2 steps needs minimal assist
(0) needs assistance to keep from falling/unable to try

13. Standing unsupported, one foot infront (04)


Instruction: (Demonstrate to subject) Place one foot directly in front of the other. If you feel that you cannot
place your foot directly in front, try to step far enough ahead that the heel of your forward foot is ahead of the
toes of the other foot.

(4) able to place foot tandem independently and hold 30 seconds


(3) able to place foot ahead of other independently and hold 30 seconds
(2) able to take small step independently and hold 30 seconds
(1) needs help to step but can hold 15 seconds
(0) loses balance while stepping or standing

14. Standing on oneleg (03)


Instruction: Stand on one leg as long as you can without holding.

(4) able to lift leg independently and hold >10 seconds


(3) able to lift leg independently and hold 5-10 seconds
(2) able to lift leg independently and hold = or >3seconds
(1) tries to lift leg; unable to hold 3 seconds but remains standing independently
(0) unable to try or needs assist to prevent fall

TOTALSCORE: 55/56
BESTest
Balance Evaluation – Systems Test
Fay Horak PhD Copyright 2008

TEST NUMBER/SUBJECT CODE : DPT-660 DATE : 12 april,2020

EXAMINER NAME: Sumbal Saleem

EXAMINER Instructions for BESTest


1. Subjects should be tested with flat heeled shoes or with shoes and socksoff.
2. If subject must use an assistive device for an item, score that item one categorylower

Tools Required
 Stop watch
 Measuring tape mounted on wall for Functional Reachtest
 Approximately 60 cm x 60 cm (2 X 2 ft) block of 4-inch, medium-density, Tempur®foam
 10 degree incline ramp (at least 2 x 2 ft) to standon
 Stair step, 15 cm (6 inches) in height for alternate stairtap
 2 stacked shoe boxes for obstacle duringgait
 2.5 Kg (5-lb) free weight for rapid armraise
 Firm chair with arms with 3 meters in front marked with tape for Get Up and Gotest
 Masking tape to mark 3 m and 6 m lengths on the floor for Get Up andGo

SUMMARY OF PERFORMANCE: CALCULATE PERCENT SCORE

Section I: 13/15 x 100= 86.67% Biomechanical Constraints


SectionII: 18/21 x 100 = 85.71% Stability Limits/Verticality
Section III: 15/18 x 100 = 83.34% Transitions/Anticipatory
Section IV 12/18 x 100 = 66.67% Reactive
Section V: 11/15 x 100 = 73.33% Sensory Orientation
Section VI: 15/21 x 100= 71.42% Stability in Gait

TOTAL: 84/108 points= 77.78% Percent Total Score


BESTest- Inter-rater Reliability
Balance Evaluation – Systems Test

Subjects should be tested with flat heeled shoes or shoes and socks off. If subject must use an assistive
device for an item, score that item one category lower. If subject requires physical assistance to perform an
item score the lowest category (0) for that item.

I.BIOMECHANICALCONSTRAINTS SECTIONI: 13/15POINTS


1. BASE OFSUPPORT (3)
(3) Normal: Both feet have normal base of support with no deformities orpain
(2) One foot has deformities and/or pain
(1) Both feet has deformities OR pain
(0) Both feet have deformities AND pain

2. COMALIGNMENT (3)
(3) Normal AP and ML CoM alignment and normal segmental postural alignment
(2) Abnormal AP OR ML CoM alignment OR abnormal segmental postural alignment
(1) Abnormal AP OR ML CoM alignment AND abnormal segmental postural alignment
(0) Abnormal AP AND ML CoM alignment

3. ANKLE STRENGTH &RANGE (2)


3) Normal: Able to stand on toes with maximal height and to stand on heels with front of feet up
(2) Impairment in either foot of either ankle flexors or extensors (i.e. less than maximum height)
(1) Impairment in two ankle groups (eg; bilateral flexors or both ankle flexors and extensors in 1 foot)
(0) Both flexors and extensors in both left and right ankles impaired (i.e. less than maximum height)

4. HIP/TRUNK LATERALSTRENGTH (2)


(3) Normal: Abducts both hips to lift the foot off the floor for 10 s while keeping trunk vertical
(2) Mild: Abducts both hips to lift the foot off the floor for 10 s but without keeping trunk vertical
(1) Moderate: Abducts only one hip off the floor for 10 s with vertical trunk
(0) Severe: Cannot abduct either hip to lift a foot off the floor for 10 s with trunk vertical or without
vertical

5. SIT ON FLOORANDSTANDUP (3) Time 3 secs


(3) Normal: Independently sits on the floor and stands up
(2) Mild: Uses a chair to sit on floor OR to standup
(1) Moderate: Uses a chair to sit on floor AND to stand up
(0) Severe: Cannot sit on floor or stand up, even with a chair, or refuses

II.STABILITYLIMITS SECTIONII 18/21POINTS


6. SITTING VERTICALITY AND LATERALLEAN
Lean Verticality
Left Right Left Right
(3) (3) Maximum lean, subject moves (3) (3) Realigns to vertical with
upper shoulders beyond body very SMALL or no
midline, very stable OVERSHOOT
(2) (2) Moderate lean, subject’s upper (2) (2) Significantly Over- or under-
shoulder approaches body midline shoots but eventually
or some instability realigns to vertical
(1) (1) Very little lean, or significant (1) (1) Failure to realign to vertical
instability
(0) (0) No lean or falls (exceeds limits) (0) (0) Falls with the eyes closed

2
7. FUNCTIONALREACHFORWARD Distance reached: ___33___cm OR 12 inches
(3) Maximum to limits: >32 cm (12.5 in)
(2) Moderate: 16.5 cm - 32 cm (6.5 – 12.5in)
(1) Poor: < 16.5 cm (6.5in)
(0) No measurable lean – or must becaught

8. FUNCTIONALREACHLATERAL Distance reached: Left ___25__ cm (_10_in) Right _25_cm( 10 in)


Left Right
(3) (3) Maximum to limit: > 25.5 cm (10 in)
(2) (2) Moderate: 10-25.5 cm (4-10 in)
(1) (1) Poor: < 10 cm (4 in)
(0) (0) No measurable lean, or must be caught

III.TRANSITIONS- ANTICIPATORYPOSTURALADJUSTMENT SECTIONIII 15/18POINTS


9. SIT TOSTAND (3)
(3) Normal: Comes to stand without the use of hands and stabilizes independently
(2) Comes to stand on the first attempt with the use of hands
(1) Comes to stand after several attempts or requires minimal assist to stand or stabilize or requires touch of
back of leg or chair
(0) Requires moderate or maximal assist to stand

10. RISE TOTOES (2)


(3) Normal: Stable for 3 sec with good height
(2) Heels up, but not full range (smaller than when holding hands so no balance requirement)
-OR- slight instability & holds for 3 sec
(1) Holds for less than 3 sec
(0) Unable

11. STAND ON ONELEG (2)


Left Time inSec:____13__ Right Time in Sec: __14_________
(3) Normal: Stable for > 20 s (3) Normal: Stable for > 20s
(2) Trunk motion, OR 10-20 s (2) Trunk motion, OR 10-20 s
(1) Stands 2-10 s (1) Stands 2-10s
(0)Unable (0)Unable

12. ALTERNATESTAIRTOUCHING (2) # of successfulsteps:__8______ Time in seconds:___12______


(3) Normal: Stands independently and safely and completes 8 steps in < 10 seconds
(2) Completes 8 steps (10-20 seconds) AND/OR show instability such as inconsistent foot placement,
excessive trunk motion, hesitation or arhythmical
(1) Completes < 8 steps – without minimal assistance (i.e. assistive device) OR > 20 sec for 8 steps
(0) Completes < 8 steps, even with assistive devise

13. STANDING ARMRAISE (3)


(3) Normal: Remains stable
(2) Visible sway
(1) Steps to regain equilibrium/unable to move quickly w/o losingbalance
(0) Unable, or needs assistance for stability
IV. REACTIVEPOSTURALRESPONSE SECTIONIV 12/18POINTS
14. IN PLACE RESPONSE -FORWARD
(3) Recovers stability with ankles, no added arms or hips motion
(2) Recovers stability with arm or hip motion
(1) Takes a step to recover stability
(0) Would fall if not caught OR requires assist OR will not attempt

15. IN PLACE RESPONSE -BACKWARD


(3) Recovers stability at ankles, no added arm / hip motion
(2) Recovers stability with some arm or hip motion
(1) Takes a step to recover stability
(0) Would fall if not caught -OR- requires assistance -OR- will not attempt

16. COMPENSATORY STEPPING CORRECTION -FORWARD


(3) Recovers independently a single, large step (second realignment step isallowed)
(2) Morethanonestepusedtorecoverequilibrium,butrecoversstabilityindependentlyOR1stepwith
imbalance
(1) Takes multiple steps to recover equilibrium, or needs minimum assistance to prevent afall
(0) No step, OR would fall if not caught, OR fallsspontaneously

17. COMPENSATORY STEPPING CORRECTION -BACKWARD


(3) Recovers independently a single, largestep
(2) More than one step used, but stable and recovers independently OR 1 step withimbalance
(1) Takes several steps to recover equilibrium, or needs minimumassistance
(0) No step, OR would fall if not caught, OR fallsspontaneously

18. COMPENSATORY STEPPING CORRECTION -LATERAL


Left Right
(3) Recovers independently with 1 step of normal (3) Recovers independently with 1 step of normal
length/width (crossover or lateral OK) length/width (crossover or lateral OK)
(2) Several steps used, but recoversindependently (2) Several steps used, but recoversindependently
(1) Steps, but needs to be assisted to prevent afall (1) Steps, but needs to be assisted to prevent afall
(0) Falls, or cannot step (0) Falls, or cannot step

V. SENSORYORIENTATION SECTIONV__________/15POINTS
19. SENSORY INTEGRATION FOR BALANCE (MODIFIEDCTSIB)
A -EYES OPEN, FIRM B -EYES CLOSED, FIRM C -EYES OPEN, FOAM D -EYES CLOSED, FOAM
SURFACE SURFACE SURFACE SURFACE
Trial1 30sec Trial1 30sec Trial1 30sec Trial1 28sec
Trial2 30sec Trial2 25sec Trial2 30sec Trial2 25sec
(3) 30s stable (3) 30s stable (3) 30s stable (3) 30s stable
(2) 30s unstable (2) 30s unstable (2) 30s unstable (2) 30s unstable
(1) < 30s (1) < 30s (1) < 30s (1) < 30s
(0) Unable (0) Unable (0) Unable (0) Unable

20. INCLINE- EYESCLOSED


Toes Up
(3) Stands independently, steady without excessive sway, holds 30 sec, and aligns with gravity
(2) Stands independently 30 SEC with greater sway than in item 19B -OR- aligns with surface
(1) Requires touch assist -OR- stands without assist for 10-20 sec
(0) Unable to stand >10 sec -OR- will not attempt independent stance
VI.STABILITYINGAIT SECTIONV 11/21POINTS
21. GAIT –LEVELSURFACE Time 8 secs.
(3) Normal: walks 20 ft., good speed (5.5 sec), no evidence of imbalance.
(2) Mild: 20 ft., slower speed (>5.5 sec), no evidence of imbalance.
(1) Moderate: walks 20 ft., evidence of imbalance (wide-base, lateral trunk motion, inconsistent step path)
– at any preferred speed.
(0) Severe: cannot walk 20 ft. without assistance, or severe gait deviations OR severe imbalance

22. CHANGE IN GAITSPEED


(3) Normal: Significantly changes walking speed without imbalance
(2) Mild: Unable to change walking speed without imbalance
(1) Moderate: Changes walking speed but with signs of imbalance,
(0) Severe: Unable to achieve significant change in speed AND signs of imbalance

23. WALK WITH HEAD TURNS –HORIZONTAL


(3) Normal: performs head turns with no change in gait speed and good balance
(2) Mild: performs head turns smoothly with reduction in gait speed,
(1) Moderate: performs head turns with imbalance
(0) Severe: performs head turns with reduced speed AND imbalance AND/OR will not move head within
available range while walking.

24. WALK WITH PIVOTTURNS


(3) Normal: Turns with feet close, FAST (< 3 steps) with good balance.
(2) Mild: Turns with feet close SLOW (>4 steps) with good balance
(1) Moderate: Turns with feet close at any speed with mild signs of imbalance
(0) Severe: Cannot turn with feet close at any speed and significant imbalance.

25. STEPOVEROBSTACLES Time 9 sec


(3) Normal: able to step over 2 stacked shoe boxes without changing speed and with good balance
(2) Mild: steps over 2 stacked shoe boxes but slows down, with good balance
(1) Moderate: steps over shoe boxes with imbalance or touches box.
(0) Severe: cannot step over shoe boxes AND slows down with imbalance or cannot perform with
assistance.

26. TIMED “GET UP&GO” Get Up &Go:Time 12sec


(3) Normal: Fast (<11 sec) with good balance
(2) Mild: Slow (>11 sec with good balance)
(1) Moderate: Fast (<11 sec) with imbalance.
(0) Severe: Slow (>11 sec) AND imbalance.

27. Timed “Get Up & Go” WithDualTask DualTask:Time 13 sec


(3)Normal:Nonoticeablechangebetweensittingandstandingintherateoraccuracyofbackwardscounting and no
change in gaitspeed.
(2) Mild: Noticeable slowing, hesitation or errors in counting backwards OR slow walking (10%) in dual task
(1) Moderate: Affects on BOTH the cognitive task AND slow walking (>10%) in dual task.
(0) Severe: Can’t count backward while walking or stops walking while talking
of imbalance.
(0) Severe impairment: Cannot walk 20’ without assistance, severe gait deviations or
imbalance.
TinettiAssessmentTool: Balance

Patient’sName: Sobia Saleeem Date: 12 april,2020

Location: home Rater: Sumbal Saleem

Initial Instructions: Subject is seated in a hard, armless chair. The following maneuvers are
tested.

Task Description of Balance Possible Score


1. SittingBalance Leans or slides in chair =0 1
Steady, safe =1
2. Arises Unable without help =0 2
Able, uses arms to help =1
Able without using arms =2
3. Attempts toarise Unable without help =0 2
Able, requires > 1 attempt =1
Able to rise, 1 attempt =2
4. Immediatestanding Unsteady (swaggers, moves feet, trunk sway) =0 2
balance Steady but uses walker or other support =1
(first 5 seconds) Steady without walker or other support =2
5. StandingBalance Unsteady =0 2
Steady but wi de stance (medial heels > 4 =1
inches apart) and uses cane or other support
Narrow stance without support =2
6. Nudged (subject at Begins to fall =0 1
max position with feet Staggers, grabs, catches self =1
as close together as Steady =2
possible, examiner
pushes lightly on
subject’s sternumwith
palm of hand 3 times.
7. Eyes closed(at Unsteady =0 1
maximum position #6) Steady =1
8. Turning 360degrees Discontinuous steps =0 2
Continuous steps =1
Unsteady (grabs, swaggers) =0
Steady =1
9. SittingDown Unsafe (misjudged distance, falls into chair) =0 2
Uses arms or not a smooth motion =1
Safe, smooth motion =2
Balance 15
Score:
TinettiAssessmentTool: Gait

Patient’sName: Sobia Saleem Date: 12 april,2020

Location: Home Rater: Sumbal Saleem

Initial Instructions: Subject stands with examiner, walks down hallway or across the room, first at
“usual” pace, then back at “rapid, but safe” pace (using usual walking aids).

Task Description of Gait Possible Score


10. Initiation of gait Any hesitancy or multiple attempts to start =0 O
(immediately after told No hesitancy =1
to “go”)
11. Step lengthand a. Right swing foot does not pass left stance =0
height foot withstep
b. Right foot passes left stancefoot =1 1
c. Right foot does not clear floor completely =0
withstep
d. Right foot completely clearsfloor =1
1
e. Left swing foot does not pass right stance =0
foot withstep
=1
f. Left foot passes right stancefoot 1
=0
g. Left foot does not clear floor completely with
step =1
h. Left foot completely clearsfloor 1
12. StepSymmetry Right and left step length not equal (estimate) =0 1
Right and left step appear equal =1
13. StepContinuity Stopping or discontinuity between steps =0 1
Steps appear continuous =1
14. Path (estimated in Marked deviation =0 2
relation to floor tiles, Mild/moderate deviation or uses walking aid =1
12-inch diameter; Straight without walking aid =2
observe excursion of
1 foot over about10
feet of the course).
15. Trunk Marked sway or uses walking aid =0 2
No sway but flexion of knees or back, orspreads =1
arms out while walking
No sway, no flexion, no use of arms, and no use of =2
walking aid
16. WalkingStance Heels apart =0 1
Heels almost touching while walking =1
Gait Score: 11

Balance + Gait Score: 26