What Is the Berg Balance Scale?

The Berg Balance Scale is a measure used by a physical therapist to assess the quality of a patient’s balance. The Berg Balance Scale can help provide objective data about the severity of balance deficits with transfers (moving between places or surfaces), reaching, bending, turning, and standing, and is useful to help determine if a patient is at an increased risk of falls. 

This article explains the Berg Balance Scale, what it measures, and why physical therapists use it.

What It Is

The Berg Balance Scale is a measure used to assess the quality of balance in patients when sitting and standing. The test is most often completed by a physical therapist (a healthcare professional who provides therapy to preserve, enhance, or restore movement and physical function in people whose abilities are impaired). It grades the severity of balance deficits (areas that need improvement) in patients who have poor balance and decreased lower-body stability. 

Poor balance can result from a variety of causes, including:

• Aging and associated muscle weakness
• Sedentary (inactive) lifestyle
• Injuries that affect the ankles, knees, or hips
• Conditions that can cause weakness in the leg muscles, such as arthritis or spinal stenosis
• Neurological conditions that affect strength and balance, such as strokes, Parkinson’s disease, and multiple sclerosis (MS)
• Sensory loss from peripheral neuropathy (damage to the nerves outside the brain and spinal cord)

How It Works

The Berg Balance Scale is an examination assessment comprised of 14 questions, with a total score out of 56 points. The test scorer can score items between 0 and 4 based on the quality of movement observed with each of the items.

A physical therapist will ask the patient to perform the following activities while observing the patient’s balance quality to score the following activities:

• Transitioning from sitting to standing without use of arms
• Standing unsupported​ for two minutes
• Sitting unsupported​ for two minutes
• Transitioning from standing to sitting​ without use of arms
• Stand pivot transfer from one chair to another
• Standing with eyes closed​ for 10 seconds
• Standing with feet together​ for one minute
• Reaching forward 10 inches with an outstretched arm
• Retrieving an object from the floor
• Turning to look behind​ over the right and left shoulders
• Turning 360 degrees in a circle clockwise and counterclockwise in four seconds or less 
• Placing one foot on a stool​, alternating feet four times for a total of eight times in 20 seconds or less
• Standing in tandem stance with one foot in front​ of the other for 30 seconds
• Standing on one foot for more than 10 seconds

The test scorer will grade patients on each of the 14 tasks based on the quality of the patient's movements and their ability to maintain their balance. A score of 0 indicates that a patient is unable to complete the task or requires significant assistance to complete it, while a score of 4 indicates that a patient is able to complete the task safely without assistance from another person.

If a patient can only perform part of a task but is unable to satisfy the time requirements or requires some physical assistance to help, a lesser score will be given.

Uses

The Berg Balance Scale is an objective way of assessing balance deficits in patients seeking physical therapy services. It allows the therapist to understand the patient's functional limitations in order to develop ways to help.

The Berg Balance Scale can reveal in what ways a patient demonstrates problems with balance, including standing still, with movement up and down, when base of support is challenged, with changing positions, with transfers, or when visual input is eliminated (for example, their eyes are closed).

Weakness in one or both legs can affect a patient’s balance and ability to maintain stability while changing positions and standing in weight-bearing positions. Common muscle groups that can be weak and cause balance deficits include:

• Quadriceps, which extend the knee and provide stability to each leg
• Gluteus maximus, which helps to stabilize the lower body by extending the hip
• Gluteus medius, which stabilizes the pelvis and helps to maintain balance when weight shifting and when base of support is narrowed

In order to develop a plan of care and get authorization for covered services from insurance companies for treatment, physical therapists must create individualized goals for each patient. One of the most important aspects of a physical therapy goal is the fact that it must be measurable. Assessing balance can be difficult to track in objective terms, so the Berg Balance Scale test can provide a useful numerical score that can be tracked for improvement over time. 

The Berg Balance Scale is also an outcome measure that can be a useful indicator of a patient's risk of falls. A lower score on the Berg Balance Scale is correlated with an increased risk of falls according to the following scoring guidelines:

• 0–20 points: High risk of falls
• 21–40 points: Moderate risk of falls
• 41–56 points: Low risk of falls

By scoring a patient on the Berg Balance Scale, a physical therapist can further justify the need for physical therapy services to address balance deficits in order to improve overall patient safety and decrease the risk for falls. In ideal circumstances, a score over 50 is desired to improve patient safety and decrease fall risk.

While results are variable, a change of at least 4–7 points on the Berg Balance Scale is needed in order to demonstrate a true change in functional balance following physical therapy intervention.

Unlike another balance assessment tool, the Tinetti test, the Berg Balance Scale does not have a gait (how a person walks) component and cannot provide information about a patient's dynamic balance (the ability to remain standing and stable) while walking.

Because of this, the Berg Balance Scale has its limitations for standing balance and transitional movements only. If a patient reports having more difficulty maintaining balance while walking and has better stability with transfers and when standing still, the Tinetti test may be a more appropriate outcome measure to use to assess balance and track progress over time.

A Word From Verywell

Because the quality of a patient’s balance can be hard to quantify, the Berg Balance Scale can be a useful tool to help provide objective data indicating balance problems and risk for falls. This information can be useful to patients, physical therapists, physicians, and insurance companies to help justify needs for skilled physical therapy. It is also useful in tracking a person's progress over time with treatment.