Receiver operating characteristic analysis determined that a cut-off score of 40 out of 56 on the Berg Balance Scale produced the highest sensitivity (0.82) and specificity (0.67), and a cut-off score of 22 out of 40 on the Fullerton Advanced Balance Scale produced the highest sensitivity (0.85) and specificity (0.65) in predicting faller status. An effective postural balance assessment scale as a core outcome set is essential to determine the effectiveness of rehabilitation interventions. One of the most widely used outcome measures is the Berg Balance Scale (BBS) , the measurement properties of which have been analysed in detail in stroke patients by using classical test theory . Translation of the Berg Balance Scale into Spanish. The English Berg Balance Scale was translated into Spanish by a native Spanish-speaking physical therapist with advanced English language skills (Certificate of Proficiency in English. Council of Europe level C2. Cambridge English Language Assessment). Purpose Parkinson disease (PD) is one of the common causes of imbalance, and the balance assessment is necessary for treatment and rehabilitation of these patients. The Berg Balance Scale (BBS) has been the main instrument used to evaluate balance impairment. The purpose of this study is to investigate reliability and validity of the Persian translation of BBS in Parkinson disease. Methods One Center po sition of the COG can b e held brie y, but not for 10 The data collected included pre-test and post-test Berg Balance Scale (BBS) values, and complexity index (CI) values for center imal detectable change associated with these clinical instruments. Methods: A sample of 42 community dwellers (older than 65 years) with a history of falls or near falls was evaluated with the BBS and DGI. Evaluations were videotaped and later rescored by 2 experienced physical therapists. Results: The mean initial BBS was 39 points (SD = 8.9, range 17–53). Rescored mean value was 40 points W17KD. How does this Berg balance scale calculator work? This health tool is used in the clinical setting to assess balance in elderly patients and predict fall risk. The 14 item scale includes static and dynamic activities with various degrees of difficulty and different mobility requirements. The items in the Berg balance scale calculator can be found as well in the below area with instructions on how to perform each task. As a functional balance test, the BBS addresses to the following populations: ■ Brain injury; ■ Stroke; ■ Traumatic and acquired brain injury; ■ Multiple sclerosis; ■ Spinal cord injury; ■ Parkinson’s disease; ■ Osteoarthritis; ■ Orthopedic surgery; ■ Vestibular dysfunction; ■ Community dwelling elderly. While the BBS has been validated and is established as reliable measurement, there is still the concept of the ceiling and floor effect which is said to affect the reported results of the Berg scale in community dwelling older patients. When subjects score high on initial evaluations, the BBS outcome measure is compromised for the following evaluation in the case of these patients. Berg balance scale assessment instructions In order to perform the evaluation of the 14 items, the following equipment is required: 2 chairs, one with arm rests, one without arm rests, footstool, yardstick, stopwatch and a 15 ft (approx. m) walkway. The instructions from the original study, to be used in directing the subject, are as follows: At the beginning of the balance test the subject needs to be instructed about the tasks they are to be given and they need to understand that they must try to maintain their balance during the tasks. The recommendation is to deduct points progressively in case the subject doesn’t respect the requirements (of time or distance for example), performance requires supervision or the subject uses external assistance: 1. Sitting to standing – the subject is recommended not to use hands or any other means for support; 2. Standing unsupported – no support allowed for the two minutes of the test; 3. Sitting with back unsupported but feet supported on floor or on a stool – maintain position with arms folded for 2 minutes; 4. Standing to sitting – the subject must be in standing position at the beginning; 5. Transfers – chairs need to be arranged for pivot transfer and the subject asked to transfer from one to another, alternating the departure chair, once the one with arm rests and then the one without arm rests; 6. Standing unsupported with eyes closed – maintain a still position for 10 seconds; 7. Standing unsupported with feet together – performed without any support, point deducted if support is being used; 8. Reaching forward with outstretched arm while standing – arm should be lifted at 90 degrees and the subject instructed to stretch fingers and reach forward as much as possible. Rotation of the trunk should be avoided if it occurs by asking the subject to use both arms to reach; 9. Pick up object from the floor from a standing position – the object should be placed in front of the patient’s feet; 10. Turning to look behind over left and right shoulders while standing – recommendation for the assessor to hold an object for the subject to look at when they turn around for a better twist turn; 11. Turn 360 degrees – a complete full circle turn in one direction, followed by another complete turn in the other direction; 12. Place alternate foot on step/stool while standing unsupported – continue until each foot has touched the step/stool 4 times; 13. Standing unsupported one foot in front – the recommended position is one foot directly in front of the other, if this is not possible then the foot can be placed forward ahead of the toes of the other foot at a comfortable distance; 14. Standing on one leg – maintain the position for as long as possible. Score interpretation Each item in the Berg balance test is represented by a five point ordinal scale ranging from 0 to 4 points, therefore the maximum obtainable score is 56. 0 points are awarded to answers portraying the lowest level of function while 4 points are awarded to the highest level of function. According to the original study interpretation, there are three main ranges of scores: 41 – 56, 21 – 40 and 0 – 20, increasing in lack of balance for the patient and risk of falling. There is also the addition of a cut off point at 45 suggesting that patients scoring below 45 are at greater risks of fall than patients scoring 45 or above. Therefore the following results: ■ The 45 – 56 range is associated with patients who are mostly independent in their movement and have less risk of falling. ■ The 41 – 44 range is associated with patients who are mostly independent in their movement, however, present with significant risk of falling. ■ The 21 – 40 range is associated with almost 100% fall risk while the patient at the moment may be requiring assistance in performing certain activities of daily living such as walking. ■ The 0 – 20 range is associated with almost 100% fall risk and the patient is either already wheelchair bound or may be in the near future. The Shumway-Cook prediction of fall probability (with 91% sensitivity and 82% specificity) associates the following cut-offs and rules to the BBS interpretation: history of falls and BBS <51 and no history of falls but BBS < 42 are all predictive of falls. The minimal detectable change for 95% accuracy in change is set at different cut offs, depending on the range of score the patient was in at the time of the previous evaluation: ■ For an initial score of 45 – 56, MDC = 4 points; ■ For an initial score of 35 – 44, MDC = 5 points; ■ For an initial score of 25 – 34, MDC = 7 points; ■ For an initial score of 0 – 24, MDC = 5 points. References 1) Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL. (1992) Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil; 73(11):1073-80. 2) Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. (1992) Measuring balance in the elderly: validation of an instrument. Can J Public Health; 83 Suppl 2:S7-11. 3) Shumway-Cook A, Baldwin M, Polissar NL, Gruber W. (1997) Predicting the probability for falls in community-dwelling older adults. Phys Ther; 77(8):812-9. 4) Donoghue D, Physiotherapy Research and Older People (PROP) group, Stokes EK. (2009) How much change is true change? The minimum detectable change of the Berg Balance Scale in elderly people. J Rehabil Med; 41(5):343-6. 30 Apr, 2016 Body balance to ćwiczenia, które powstały z połączenia jogi, tai chi i pilatesu. Ćwiczy się do łagodnej, klimatycznej muzyki, a układ ćwiczeń zmienia się raz na kwartał. O co w tym chodzi i czy warto? “Kiedy regularnie staję na macie – pisze joginka Agnieszka Passendorfer – w moim życiu wszystko samo doskonale się układa. Mam więcej pewności siebie, podejmuję lepsze decyzje, a moje ciało czuje się i wygląda lepiej. Kiedy przestaję ćwiczyć, sprawy zaczynają się komplikować. Dlatego nie powinnam przestawać.” ( “13 lekcji jogi” – więcej tu) Mogłabym podpisać się pod tymi słowami, bo chociaż nie praktykuję jogi, to jeśli wstawiłabym w jej miejsce aktywność fizyczną jako taką, byłoby dokładnie tak samo. Zawsze byłam aktywna i jeśli zdarzają mi się momenty w życiu kiedy regularnie nie ćwiczę, po tygodniu, miesiącu, dwóch natychmiast czuję, że ta przerwa nie przyniesie niczego dobrego. Moje ciało potrzebuje ruchu. Tak samo jak tlenu, jedzenia i wody. Tak trafiłam w listopadzie na zajęcia body balance, które są uzupełnieniem mojego treningu. Body Balance skąd się wzięło i o co chodzi? Program Body Balance pochodzi z nowozelandzkiej szkoły Les Mills. Ćwiczenia opierają się na budowaniu elastyczności i wytrzymałości, pozostawiając ćwiczącemu uczucie spokoju i skupienia. Program wydaje się niewymagający i niespecjalnie trudny, ale zapewniam Was, że to tylko pozory. Kiedy zaczynamy ćwiczyć, okazuje się, że nawet te z pozoru proste pozycje mogą sprawiać nam sporo trudu. Nie zależy to wcale od poziomu wytrenowania w innej dyscyplinie, od wagi, czy typu sylwetki. Po prostu nie wszyscy jesteśmy jednakowo rozwinięci. Dzięki Body Balance wzmacniamy wszystkie grupy mięśni, poprawiamy koordynację i postawę, nabieramy elastyczności, wyciszamy się i niwelujemy stres. Dla kogo jest Body Balance? Moim zdaniem dla wszystkich, nawet jeśli nie ćwiczyliście do tej pory. Warto się wybrać, spróbować i praktykować, a na początek podejrzeć tu. Jeśli tylko traficie na rozsądnego i mądrego nauczyciela (a takich warto szukać!), będzie on podpowiadał różne warianty pozycji, które każdy może wykonać. Nie będziesz mistrzem na pierwszym treningu, dlatego warto korzystać z sugestii prowadzącego i słuchać swojego ciała. Postęp będzie! I to szybciej niż Ci się wydaje! Co jeszcze można zyskać? Body balance, jakie efekty? Dla mnie osobiście najistotniejsza jest wartość dodana do ruchu, a ta dzieje się… w głowie. Chociaż ćwiczenia czujesz ciałem, to przecież wszystko się łączy! Mocne nogi, na których pewnie stoisz przydają się nie tylko w pozycji wojownika, ale i w życiu. Wiesz, że możesz na sobie polegać. W pozycji tancerza czujesz jak trudno być czasem w równowadze i balansie. A przecież w życiu tak samo jak stojąc na jednej nodze ciągle musimy ją łapać! Ćwiczysz mięśnie, swoją wytrzymałość, czujesz jak nogi się trzęsą, a jednak stoisz! Nawet gdy upadniesz, to się podniesiesz! Czy to nie jest wspaniała lekcja zaufania do siebie i polegania na własnej mocy? Ćwiczcie Kochani i budujcie swoją pewność siebie także przez ciało. To cudowny i skuteczny sposób. A gdyby mnie, znów, kiedyś przyszło do głowy zaprzestać treningów, kopnijcie mnie proszę w cztery litery. Na zachęta jedna z playlist do posłuchania: Assesses risk of fall and balance impairment in elderly frail patients with static and dynamic tasks. Below the calculator there is more information on the activities in the assessment and how they should be scored. Balance scale items This is a 14-item scale used to assess balance in elderly patients and predict fall risk. The elderly population to which the scale addresses to includes conditions such as stroke, traumatic and acquired brain injury, spinal cord injury, multiple sclerosis, osteoarthritis, Parkinson’s disease or vestibular dysfunction. The balance test created by Berg et al. in 1992, consists of both static and dynamic activities, with varying difficulty and requiring different degrees of mobility. At the beginning of the test, the assessor should explain the tasks to be given and make sure the subject understands that the main aim is to maintain balance throughout the tasks. The equipment required for the evaluation is: ■ Two chairs, one with arm rests, one without arm rests; ■ Footstool; ■ Yardstick; ■ Stopwatch; ■ Available 15 ft (approx. m) walkway. The following table introduces the items in the scale and their accompanying instructions: Berg balance scale item Instruction 1. Sitting to standing The subject must not use hands or other support. 2. Standing unsupported No support is allowed for two minutes. 3. Sitting with back unsupported but feet supported on floor or on a stool The subject must maintain position with arms folded for 2 minutes. 4. Standing to sitting The subject must be in standing position at the beginning. 5. Transfers Chairs are to be arranged for pivot transfer and the subject asked to transfer from one to another, alternatively. 6. Standing unsupported with eyes closed The subject must maintain a still position for 10 seconds. 7. Standing unsupported with feet together The action must be performed without support. 8. Reaching forward with outstretched arm while standing Arm must be lifted at 90 degrees and the subject instructed to stretch fingers and reach forward as much as possible. 9. Pick up object from the floor from a standing position The object to be picked must be placed in front of the subject’s feet. 10. Turning to look behind over left and right shoulders while standing Assessment of the twist turn action. 11. Turn 360 degrees Assessment of a complete full circle turn in one direction, followed by another complete turn in the opposite direction. 12. Place alternate foot on step/stool while standing unsupported The action must be performed until each foot has touched the step/stool 4 times. 13. Standing unsupported one foot in front If this is not possible, the foot can be placed forward ahead of the toes of the other foot. 14. Standing on one leg The subject must maintain their position for as long as possible. The Berg scale has been validated and is being used in practice as a reliable measurement ever since. However, there is discussion of a ceiling and floor effect which may distort the reported results of the Berg scale in community dwelling elderly. When a patient scores high on an initial evaluation, the BBS outcome measure may be compromised for subsequent evaluations even if the status of the patient does not change dramatically. Result interpretation Each of the 14 items in the Berg balance test is assessed on a five point ordinal scale (from 0 to 4 points). The lowest level of function is awarded 0 points whilst the highest level of function is awarded 4 points. The recommendation is to deduct points progressively when the subject is not able to follow the instruction and when performance requires supervision or the subject has to use external assistance. In the original study interpretation, the maximum obtainable score is 56 and there are four ranges of scores. Patients scoring below 45 are at a greater risk of fall than patients scoring 45 or above. The table below introduces the score ranges and their interpretation: Berg score (points) Interpretation 45 - 56 Patient is mostly independent in their movement and carries a low risk of falling. 41 - 44 Patient is mostly independent in their movement but carries a significant risk of falling. 21 - 40 Patient may require assistance performing some of the tasks in the balance test and in general, activities of daily living. There is a 100% fall risk. 0 – 20 The patient is wheelchair bound at the moment or may be in the future and carries a 100% fall risk. The Shumway-Cook prediction of fall probability (with 91% sensitivity and 82% specificity) provides two different cut off points (below which the fall risk is imminent), depending on whether the patient has a history of falls: ■ History of falls and BBS <51; ■ No history of falls and BBS <42. According to the original study, the minimal detectable change for 95% accuracy in change differs at different cut offs. When the initial score was between 45 and 56 the MDC is at 4 points. For an initial score between 25 and 34, the MDC is 7 points. For an initial score between 35 and 44 or between 0 and 25, the minimal detectable change is 5 points. Original source Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil. 1992; 73(11):1073-80. Other references 1. Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health. 1992; 83 Suppl 2:S7-11. 2. Shumway-Cook A, Baldwin M, Polissar NL, Gruber W. Predicting the probability for falls in community-dwelling older adults. Phys Ther. 1997; 77(8):812-9. Review . 2018 Dec;104(4):383-394. doi: Epub 2018 Feb 15. Affiliations PMID: 29945726 DOI: Review The Berg Balance Scale as a clinical screening tool to predict fall risk in older adults: a systematic review C A Lima et al. Physiotherapy. 2018 Dec. Abstract Background: The Berg Balance Scale (BBS) is often used in clinical practice to predict falls in the older adults. However, there is no consensus in research regarding its ability to predict falls. Objective: To verify whether the BBS can predict falls risk in older adults. Data source: Manual and electronic searches (Medline, EMBASE, CINAHL, Ageline, Lilacs, Web of Science, Cochrane Library and PEDro) were conducted using blocks of words (older adults, falls, BBS, study design) and their synonyms, with no language restrictions and published since 1989. Study selection criteria: Prognostic studies or clinical trials were used to assess the BBS and falls history. Data extraction and data synthesis: In this narrative synthesis, two independent assessors extracted data from articles and a third reviewer provided consensus, in case of disagreement. The methodological quality was assessed using the Quality In Prognosis Studies tool. Results: 1047 studies were found and 8 studies were included in this review. The mean BBS score was high, regardless of the history of falls. Three studies presented cut-off scores for BBS, ranging from 45 to 51 points. Two studies reported a difference in the BBS score between fallers and non-fallers. Studies presented low to moderate risk of bias. Limitations: Unfeasible to conduct a meta-analysis due the heterogeneity of included studies. Conclusion: The evidence to support the use of BBS to predict falls is insufficient, and should not be used alone to determine the risk of falling in older adults. Systematic review registration number: PROSPERO CRD42016032309. Keywords: assessment; balance; falls; older adults; prediction. Copyright © 2018. Published by Elsevier Ltd. Similar articles Usefulness, assessment and normative data of the Functional Reach Test in older adults: A systematic review and meta-analysis. Rosa MV, Perracini MR, Ricci NA. Rosa MV, et al. Arch Gerontol Geriatr. 2019 Mar-Apr;81:149-170. doi: Epub 2018 Dec 7. Arch Gerontol Geriatr. 2019. PMID: 30593986 Determining Risk of Falls in Community Dwelling Older Adults: A Systematic Review and Meta-analysis Using Posttest Probability. Lusardi MM, Fritz S, Middleton A, Allison L, Wingood M, Phillips E, Criss M, Verma S, Osborne J, Chui KK. Lusardi MM, et al. J Geriatr Phys Ther. 2017 Jan/Mar;40(1):1-36. doi: J Geriatr Phys Ther. 2017. PMID: 27537070 Free PMC article. Review. The Mini-Balance Evaluation Systems Test (Mini-BESTest) Demonstrates Higher Accuracy in Identifying Older Adult Participants With History of Falls Than Do the BESTest, Berg Balance Scale, or Timed Up and Go Test. Yingyongyudha A, Saengsirisuwan V, Panichaporn W, Boonsinsukh R. Yingyongyudha A, et al. J Geriatr Phys Ther. 2016 Apr-Jun;39(2):64-70. doi: J Geriatr Phys Ther. 2016. PMID: 25794308 Participation restriction, not fear of falling, predicts actual balance and mobility abilities in rural community-dwelling older adults. Allison LK, Painter JA, Emory A, Whitehurst P, Raby A. Allison LK, et al. J Geriatr Phys Ther. 2013 Jan-Mar;36(1):13-23. doi: J Geriatr Phys Ther. 2013. PMID: 22790588 [Comparison of the performance-oriented mobility assessment and the Berg balance scale. Assessment tools in geriatrics and geriatric rehabilitation]. Schülein S. Schülein S. Z Gerontol Geriatr. 2014 Feb;47(2):153-64. doi: Z Gerontol Geriatr. 2014. PMID: 23619708 Review. German. Cited by Assessing the risk for falls among Portuguese community-dwelling stroke survivors. Are we using the better tools? Observational study. Pimenta C, Correia A, Alves M, Virella D. Pimenta C, et al. Porto Biomed J. 2022 Jun 17;7(3):e160. doi: eCollection 2022 May-Jun. Porto Biomed J. 2022. PMID: 35801217 Free PMC article. Association between Fear of Falling and Seven Performance-Based Physical Function Measures in Older Adults: A Cross-Sectional Study. Huang WW, Mao HF, Lee HM, Chi WC. Huang WW, et al. Healthcare (Basel). 2022 Jun 19;10(6):1139. doi: Healthcare (Basel). 2022. PMID: 35742190 Free PMC article. Effectiveness and Usability of a Novel Kinect-Based Tailored Interactive Fall Intervention System for Fall Prevention in Older People: A Preliminary Study. Kim T, Xiong S. Kim T, et al. Front Public Health. 2022 May 31;10:884551. doi: eCollection 2022. Front Public Health. 2022. PMID: 35712291 Free PMC article. Clinical Trial. Effectiveness and Acceptability of e- and m-Health Interventions to Promote Physical Activity and Prevent Falls in Nursing Homes-A Systematic Review. Diener J, Rayling S, Bezold J, Krell-Roesch J, Woll A, Wunsch K. Diener J, et al. Front Physiol. 2022 May 20;13:894397. doi: eCollection 2022. Front Physiol. 2022. PMID: 35669573 Free PMC article. The Effectiveness of Traditional Chinese Yijinjing Qigong Exercise for the Patients With Knee Osteoarthritis on the Pain, Dysfunction, and Mood Disorder: A Pilot Randomized Controlled Trial. Zhang S, Guo G, Li X, Yao F, Wu Z, Zhu Q, Fang M. Zhang S, et al. Front Med (Lausanne). 2022 Jan 11;8:792436. doi: eCollection 2021. Front Med (Lausanne). 2022. PMID: 35087846 Free PMC article. Publication types MeSH terms LinkOut - more resources Full Text Sources ClinicalKey Elsevier Science Other Literature Sources scite Smart Citations Medical MedlinePlus Health Information

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