Overview of Berg Balance Testing
The Berg Balance Scale is a tool that doctors use to measure balance in patients. This test was developed by Katherine Berg in 1989 and was initially meant for older adults, with most people tested being around 73 years old. It looks at how well a person can maintain their balance while moving (dynamic balance) and when standing still (static balance). The test involves doing 14 different tasks that involve movement.
At first, the Berg Balance Scale was primarily used for people recovering from strokes. However, it’s now trusted and used for patients with a broad range of health conditions. This includes neurological issues like Parkinson’s disease, multiple sclerosis, traumatic brain injury, and also conditions that result in the loss of a lower limb.
The Berg Balance Scale also helps to estimate the risk of a patient falling, the potential results of such a fall, and predicting how long a patient may need to stay at an inpatient rehabilitation center after a fall or other mobility-related issues. The test is quick to perform and can be easily done in different settings.
Anatomy and Physiology of Berg Balance Testing
Balance is what allows us to move and do everyday activities. There are two types of balance: static and dynamic. Static balance means you can maintain your body’s center of gravity when you’re not moving. Dynamic balance means you can keep the same center of gravity while you are moving.
Balance isn’t just about your body’s physical nature. It involves multiple areas of the body like muscles, thinking abilities (cognition), and the sense of touch and feelings (somatosensory). If you have issues in any of these areas, for example, because of a sickness that affects the nerves (neurological diseases), it can affect your balance.
Many things can hurt your balance, it depends on your health condition. Some people might face issues due to weak muscles, problems with coordinated movement (motor coordination), difficulties in thinking or understanding (poor cognition), or issues in processing sensory information (poor sensory organization). These issues can become worse with neurological conditions.
For people who have lost a leg (amputees), their walk (gait) is significantly affected. Research has shown that the better their balance, the better they can walk and the better quality of life they have.
In diseases like Parkinson’s, it is seen that people can’t maintain stability in their posture. This affects their balance and can lead to difficulty in moving independently and reducing their physical abilities.
Why do People Need Berg Balance Testing
In simpler terms, balance problems are quite common in people over 65. For people who have had a stroke, it’s very beneficial to have their balance evaluated.
The evaluation of the balance is helpful for older adults, and people with neurological conditions like stroke, multiple sclerosis, traumatic brain injury, Parkinson’s disease, peripheral neuropathies (damage to the nerves outside of the brain and spinal cord), and other health conditions that may affect walking, such as people who have had a leg amputated.
The test used to assess balance is called the Berg Balance Scale. This test has shown to be highly reliable, both when the same person does the test or when different people perform the test.
In a review of this test applied to individuals with various neurological conditions – including recent stroke, multiple sclerosis, cognition issues, and Parkinson’s disease – administered in different settings such as inpatient therapy, outpatient therapy, outpatient clinics, and home visits. The results were found to be reliable 98% of the time, within a 95% confidence interval (the range within which we can be 95% sure the true value lies).
When a Person Should Avoid Berg Balance Testing
This test does not check how quickly you walk or how well you walk. Also, the test has its limits. Sometimes, it might show extremely high or low results, which may result in failing to notice changes in your balance. There’s also a slight variation in how the test is carried out depending on who is conducting it, especially when explaining what exactly needs to be done during the test.
Equipment used for Berg Balance Testing
This test is pretty quick to do, usually taking between 15 to 20 minutes. It’s also simple, needing just a few basic items: a stopwatch, a ruler or measuring tape, a chair, a step, and something that can be picked up. Plus, the instructions for the test have been translated into different languages such as Italian, Turkish, and French, making it accessible to more people.
Who is needed to perform Berg Balance Testing?
Any healthcare worker who has received the appropriate training can do the test. This includes nurses who look after your health, physical therapists who help you move better, occupational therapists who help you with daily skills, and doctors. All of these professionals can run the test accurately and reliably.
How is Berg Balance Testing performed
This test is simple to administer and anyone can download it or fill it out online. It includes 14 different mobility tasks, all of which are divided into three categories: sitting balance, standing balance, and dynamic balance. The tasks are different in terms of how challenging they are.
For the ‘sitting balance’ category, you’ll be assessed on your ability to sit without any support. For ‘standing balance’, you’ll have to perform several tasks; standing without any support, standing with your eyes closed, standing with both feet together, standing on one foot, turning to look behind you, grabbing an item from the ground, extending your arms forward while standing and finally placing one foot in front of the other. The ‘dynamic balance’ category involves moving around; standing up from a seated position, sitting down, moving around and turning 360 degrees, and stepping one foot onto a step.
Each task is scored on a scale of 0-4 with a maximum total score of 56. Typically, if you can’t do a task at all, you’ll get a score of 0, but if you manage to complete a task without any help, you’ll get a 4. The score can also be affected by how long it takes you to do a task, how long you can maintain a certain position, or when you need sideline supervision or extra assistance. For example, if a task is done slower than expected, or more supervision or assistance is needed, or an assistive device (like a walking cane) is used, then fewer points are given.
Now, each of these 14 tasks comes with specific instructions. Let’s take the task ‘standing unsupported with eyes closed’ as an example. You’ll be asked to close your eyes and stand still for 10 seconds. If you can stand for 10 seconds safely, you’ll be given a score of 4, if you can stand for 10 seconds with supervision, you’ll score 3, if you can stand for 3 seconds, you’ll score 2, if you can’t keep your eyes closed for 3 seconds but you’re still safe, you’ll score 1, and if you need help to prevent you from falling, you’ll score 0.
The idea here is to evaluate your balance ability in different situations. Your healthcare provider will guide you through the process and assess your performance to ensure your safety during the test.
What Else Should I Know About Berg Balance Testing?
A certain scale is used by healthcare workers to help them predict and prevent falls, especially in the elderly. These falls can lead to serious problems like broken bones or infections. This tool is also used to guess how long a person needs to stay in a recovery center and unique types of centers they might benefit from.
Bad balance can reduce the quality of one’s life and make daily tasks difficult. It can also increase the chance of falling. The total score after the balance test can inform about the risk of falls. Generally, scores lower than 45 suggest a high risk of falling. If someone has previously fallen and scores lower than 51, they are extremely likely to fall again. If someone scores less than 40, there’s almost a 100% chance they’ll fall.
Moreover, the test can help doctors to decide if a person needs a supportive ambulation device, like a cane, walker, or wheelchair. A total score of 0-20 signifies the mobility by wheelchair, a score between 21 and 40 suggests walking with assistance, and a score from 41 to 56 means walking without help. This is beneficial when deciding what type of equipment a patient needs and a treatment plan that focuses on enhancing persons mobility abilities. Those with lower scores may need more training with wheelchairs and safe transfers.
People with neurological disorders or amputees can also benefit from this scale. There’s a high risk of falling for individuals with amputations, with over half having experienced falls in the past year. This balance test’s results can be compared to those for neurological conditions that impact balance. However, sometimes the scores might be lower than expected because prosthetic devices, if used, can interfere with results if the person has difficulty controlling the device.
It’s crucial to understand a person’s risk of falling as the higher the risk, the lower their scores on this balance scale.
