Objective Balance

Grading Scale &

Outcome Measures
Taylor Mills
Central Michigan University
Introduction and Definitions

 Goal of presentation is to learn about a scale to objectively describe static

and dynamic balance
 Identify risk factors to predict falls
 Review outcome measures specifically for assessing balance

 Balance: “the ability to keep the body’s center of mass (COM) within the
limits of the base of support (BOS)”1
 Static Balance: “ability to stand unsupported controlling the center of mass
when the base of support does not change”1
 Dynamic Balance: “ability to weight shift, controlling the center of mass
within the base of support”1
Purpose of Using
Objective Balance Scales

 Documentation:
 Communicate between
therapists
 Set specific, objective goals
 Show progress in therapy
 Reimbursement
 Objective: Balance Grading Scale2

https://blog.summit-education.com/wp-content/uploads/Charts-for-Fall-Prevention-Strategies.pdf
 Objective: Balance Grading Scale2

https://blog.summit-education.com/wp-content/uploads/Charts-for-Fall-Prevention-Strategies.pdf
 Other Tools to Assess Balance
Berg Balance Score1,3-5
Timed Up and Go (TUG) Test1,3,4
Tinetti Performance-Oriented Mobility Assessment (POMA) 1,3,4
Balance Evaluation Systems Test (BESTest)/ Mini-BESTest1,3,4
Single Leg Stance Test1,3
Short Performance Battery (SPB)4,5
Gait Speed Tests4,6
Clinical Test of Sensory Integration in Balance (CTSIB)1
Community Balance and Mobility Scale1
Romberg Test3
Informal Observations1

 Berg Balance Score and Mini-BESTest ranked two of the best balance tests based on
reliability, validity, and feasibility.5
 Single Leg Stance test was one of the most commonly utilized measures in one study
when surveying physiotherapists1
Risk Factors to Assess
 Underlying Systems to Assess Balance1
 Motor Systems: strength,
coordination
 Sensory Systems: Vision,
vestibular, sensation
 Cognitive Contributions:
attention, fear, confidence

 Other Considerations:6,7
 Orthostatic Hypotension
 Medications
 Incontinence
 Home Environment/Safety Concerns
The Role of a Physical Therapist7,8
References
 1 Sibley KM, Straus SE, Inness EL, Salbach NM, Jaglal SB. Balance assessment practices and use of
standardized balance measures among Ontario physical therapists. Phys Ther. 2011;91(11):1583-1591.
doi: 10.2522/ptj.20110063.
 2 Objective: Balance Grading Review. https://blog.summit-education.com/wp-
content/uploads/Charts-for-Fall-Prevention-Strategies.pdf . Accessed March 20, 2020.
 3 Nnodim JO, Yung RL. Balance and its clinical assessment in older adults- a review. J Geriatr Med
Gerontol. 2015;1(1):003. doi:10.23937/24695858/1510003 .
 4 Soubra R, Chkeir A, Novella JL. A systematic review of thirty-one assessment tests to evaluate
mobility in older adults. BioMed Research International. 2019;1354362. doi: 10.1155/2019/1354362.
 5 Sibley KM, Howe T, Lamb SE, et al. Recommendations for a core outcome set for measuring
standing balance in adult populations: a consensus-based approach. PLOS One. 2015;10(3):e0120568.
doi:10.1371/journal.pone.0120568.
 6 Halvarsson A, Franzen E, Stahle A. Balance training with multi-task exercises improves fall-related
self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a
randomized controlled trial. Clinical Rehabilitation. 2015;29(4):365-375. doi:
10.1177/02692155/4544983 .
 7 Andrea Abruskin. Physical Therapy Guide to Balance Problems. Choose PT.
https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-balance-
problems#.VT54S9JViko. Published February 4, 2015. Accessed March 21, 2020.
 8 Centers for Disease Control and Prevention. Home and Recreational Safety. Important Facts about
Falls. https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html. Published February
10, 2017. Accessed March 20, 2020.