Balance and falls
Berg Balance Scale
The Berg Balance Scale assesses static and dynamic balance through fourteen everyday tasks, each scored 0 to 4, giving a total out of 56. It takes 15 to 20 minutes, needs no training and only basic equipment, and its developers linked scores below 45 with greater falls risk.
What it measures
Fourteen tasks of increasing difficulty, from sitting unsupported to standing on one leg. Each is scored 0 (unable) to 4 (independent and safe). It measures what a person can hold and control — not how they react to being pushed, which is reactive balance and needs a separate test.
The full item list runs: sitting to standing, standing unsupported, sitting unsupported, standing to sitting, transfers, standing with eyes closed, standing with feet together, reaching forward with outstretched arm, retrieving an object from the floor, turning to look behind, turning 360 degrees, placing alternate foot on a stool, tandem stance, and standing on one leg.
How we use it
We score the BBS at admission, at the midpoint of a programme and at discharge. It is the measure we use to document falls risk objectively, because a family asking whether it is safe for someone to go home needs a number and a threshold, not a reassurance.
What the score does and does not tell you
A score of 45 is a threshold, not a switch 1. Someone at 44 is not in danger and someone at 46 is not safe. The number is most useful as a change over time in the same patient, measured by the same assessor, using the same chair and the same footwear.
Key facts
| Abbreviation | BBS |
|---|---|
| Number of items | 14 |
| Score range | 0–56 (higher = better balance) |
| Time to administer | 15–20 minutes |
| Training required | No formal training required |
| Cost | Free (equipment cost only) |
| Equipment | Stopwatch · Chair with armrests · Chair without armrests · Step or stool · Ruler · The patient's usual footwear |
| Domains | Static balance · Dynamic balance · Transfers · Reaching · Turning |
| ICF domain | Activity |
| Age range | Adult 18–64 and older adult 65+ |
| Populations | Stroke · Parkinson's disease · Multiple sclerosis · Brain injury · Spinal cord injury · Older adults · Vestibular disorders · Amputation |
| Languages | Available in several languages |
Psychometrics by population
The same instrument behaves differently in different conditions. A cut-off established in older adults does not transfer to Parkinson's disease, and a minimal detectable change from one study does not apply to another population.
| Population | Cut-off | MDC / MCID | Reliability | Validity |
|---|---|---|---|---|
| Older adults (mixed) | Below 45 indicates greater falls risk (Berg 1992) | MDC varies with baseline score; larger change is required at mid-range scores than near the ceiling | Excellent inter-rater and intra-rater reliability reported | Good concurrent validity against the Timed Up and Go and gait speed |
| Stroke | Thresholds around 45 are also applied in stroke, with lower scores predicting dependent ambulation | MDC 6.9 points in acute stroke; 2.5 to 4.7 points across chronic stroke studies (Rehabilitation Measures Database) | Excellent test–retest reliability | Strong correlation with Fugl-Meyer balance items |
| Parkinson's diseaseCeiling effects are reported in early-stage disease; a more demanding measure may be needed | — | — | — | — |
| Vestibular disordersLimited usefulness — the scale does not challenge the vestibular system enough to reveal deficits | — | — | — | — |
Things to be careful about
- Ceiling effect in higher-functioning patients, particularly early Parkinson’s disease
- Does not assess reactive balance — the recovery from an unexpected push
- Interpretation of cut-offs differs by population and by study; the same number does not carry the same risk everywhere
Forms and downloads
Berg Balance Scale — scoring form
The scale is freely available. A printable scoring sheet will be published here once reviewed by our clinical team.
Availability depends on the instrument's licence.
Frequently asked questions
What does a Berg Balance Scale score below 45 mean?
Below 45 out of 56 is the threshold the scale’s developers linked with greater falls risk 1. It is a threshold, not a switch: someone at 44 is not in danger and someone at 46 is not safe. The number is most useful as a change over time in the same patient, measured by the same assessor, using the same chair and the same footwear.
How long does the Berg Balance Scale take?
Fifteen to twenty minutes for all fourteen tasks. It needs no formal training and only basic equipment — two chairs, one with armrests and one without, a step, a ruler, a stopwatch and the patient’s usual footwear.
Does the Berg score decide whether it is safe to go home?
It is one input, not the decision. What it does is document falls risk objectively, because a family asking whether it is safe for someone to go home needs a number and a threshold rather than a reassurance. The discharge decision also weighs the home environment, who is there during the day, and how the person manages stairs and bathrooms specifically.
Does the Berg test balance when someone is pushed?
No. It measures what a person can hold and control, not how they recover from an unexpected push — that is reactive balance and it needs a separate test. This is a real gap, because many falls happen exactly in that reactive moment.
Why does the same chair and the same footwear matter?
Because they change the result. Chair height, armrests and shoes all affect several of the fourteen items, so a score recorded in different conditions is not comparable with the previous one. We keep the equipment and the assessor constant across admission, midpoint and discharge for this reason.
Sources
- Berg K, Wood-Dauphinee S, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument — Canadian Journal of Public Health (1992)
- Rehabilitation Measures Database — Berg Balance Scale record — Shirley Ryan AbilityLab (2020)
Topic
Related instruments
- Rehabilitation outcomeFunctional Independence Measure (FIM)The FIM is an 18-item scale scoring how much assistance a person needs across thirteen motor and five cognitive tasks.
- Daily livingBarthel IndexThe Barthel Index is a ten-item scale of independence in daily activities, scored from 0 to 100 in five-point increments.
- EnduranceSix-minute walk testThe six-minute walk test records the distance a person can walk in six minutes on a flat, measured course.
