Balance Assessment Scoresheet


Patient name:  ________________________________________  Date:  _____________

Test

Score

Sitting Balance
     Leans or slides in chair (0)   Steady, safe (1)

 

Arises
     Unable without help (0)   Able, uses arms to help (1)   Able without using arms (2)

 

Attempts to Arise
     Unable without help (0)   Able, requires >1 attempt (1)   Able to arise, 1 attempt (2)

 

Immediate Standing Balance (first 5 seconds)
     Unsteady (swaggers, moves feet, trunk sway) (0)
     Steady, but uses walker or other support (1)
     Steady without walker or other support (2)

 

Standing Balance
     Unsteady (0)
     Steady, but wide stance (medial heels >4" apart) & uses cane or other support (1)
     Narrow stance without support (2)

 

Nudged - examiner pushes lightly on patient's sternum with palm of hand 3 times
     Begins to fall (0)   Staggers, grabs, catches self (1)   Steady (2)

 

Eyes closed
     Unsteady (0)   Steady (1)

 

Turning 360 degrees
     Discontinuous steps (0)   Continuous (1)   Unsteady (grabs, staggers) (0)   Steady (1)

 

Sitting down
     Unsafe (misjudged distance, falls into chair) (0)
     Uses arms or not a smooth motion (1)
     Safe smooth motion (2)

 

TOTAL SCORE (minimum = 0 maximum = 16)

 



Assessment by (printed name/signature):  ____________________________________


Form copyright 2004.  Robert S. Stall, MD / Stall Geriatrics.  All Rights Reserved.
Assessment tool by Mary Tinetti MD.