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Questions and Answers
What score indicates a patient can stand independently and safely complete 8 steps in 20 seconds?
What score indicates a patient can stand independently and safely complete 8 steps in 20 seconds?
What is the maximum duration a patient must hold their foot in a tandem position to score 4?
What is the maximum duration a patient must hold their foot in a tandem position to score 4?
If a patient can only hold a standing position on one leg for 3 seconds, what score would they receive?
If a patient can only hold a standing position on one leg for 3 seconds, what score would they receive?
What does a score of 1 indicate regarding the patient's ability to lift their leg?
What does a score of 1 indicate regarding the patient's ability to lift their leg?
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What is the highest score a patient can achieve when standing unsupported for 2 minutes?
What is the highest score a patient can achieve when standing unsupported for 2 minutes?
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What is required for a patient to receive a score of 3 in the tandem foot placement task?
What is required for a patient to receive a score of 3 in the tandem foot placement task?
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If a patient requires assistance to keep from falling, what score do they receive?
If a patient requires assistance to keep from falling, what score do they receive?
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Which statement about sitting with back unsupported is true?
Which statement about sitting with back unsupported is true?
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To score a 2 in the standing unsupported task, what is the minimum task completion required?
To score a 2 in the standing unsupported task, what is the minimum task completion required?
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During the standing to sitting assessment, what does a score of 2 indicate?
During the standing to sitting assessment, what does a score of 2 indicate?
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What does a score of 0 signify regarding a patient’s performance?
What does a score of 0 signify regarding a patient’s performance?
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In the transfers assessment, what is essential for arranging the chairs?
In the transfers assessment, what is essential for arranging the chairs?
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What does a score of 1 in the sitting to standing item indicate?
What does a score of 1 in the sitting to standing item indicate?
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How long is a patient instructed to sit with arms folded during the sitting with back unsupported assessment?
How long is a patient instructed to sit with arms folded during the sitting with back unsupported assessment?
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Which scoring reflects a patient who needs several tries to stand unsupported for 30 seconds?
Which scoring reflects a patient who needs several tries to stand unsupported for 30 seconds?
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What is the scoring for a patient who is unable to sit without support for 10 seconds?
What is the scoring for a patient who is unable to sit without support for 10 seconds?
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What score indicates that a patient needs help to keep from falling during the standing unsupported test with eyes closed?
What score indicates that a patient needs help to keep from falling during the standing unsupported test with eyes closed?
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How long must a patient stand with their feet together to achieve a score of 4?
How long must a patient stand with their feet together to achieve a score of 4?
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What does it mean if a patient can reach forward 5 cm safely during the reaching forward test?
What does it mean if a patient can reach forward 5 cm safely during the reaching forward test?
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Which score indicates a patient can independently place their feet together but cannot maintain the position for 30 seconds?
Which score indicates a patient can independently place their feet together but cannot maintain the position for 30 seconds?
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What is the maximum score a patient can receive for picking up an object from the floor safely and easily?
What is the maximum score a patient can receive for picking up an object from the floor safely and easily?
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What indicates that a patient requires supervision when trying to pick up an object from the floor?
What indicates that a patient requires supervision when trying to pick up an object from the floor?
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In the turning test, what constitutes a perfect score of 4?
In the turning test, what constitutes a perfect score of 4?
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What does a score of 3 signify in the context of turning to look behind over the shoulder?
What does a score of 3 signify in the context of turning to look behind over the shoulder?
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For the alternately placing foot on step test, what does a score of 0 indicate?
For the alternately placing foot on step test, what does a score of 0 indicate?
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In the reaching forward test, if the patient loses balance while trying to reach, what score would they receive?
In the reaching forward test, if the patient loses balance while trying to reach, what score would they receive?
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What does a score of 1 mean in the standing unsupported test with eyes closed?
What does a score of 1 mean in the standing unsupported test with eyes closed?
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What is the implication of a score of 2 when attempting to stand unsupported with feet together?
What is the implication of a score of 2 when attempting to stand unsupported with feet together?
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What indicates a patient can stand unsupported with supervision for 10 seconds?
What indicates a patient can stand unsupported with supervision for 10 seconds?
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What does it mean if a patient cannot reach even 2 cm from the slipper?
What does it mean if a patient cannot reach even 2 cm from the slipper?
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Study Notes
Berg Balance Scale (BBS) Items
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Item 1: Sitting to Standing:
- Patient sits in a standard height chair (18-20 inches) with armrests.
- Instructions: Stand up, avoid hand support.
- Scoring: 4 = independent standing, 3 = hand support, 2 = hand support after tries, 1 = minimal aid, 0 = moderate/maximal assist.
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Item 2: Standing Unsupported:
- Patient stands quietly with feet shoulder-width apart on a solid surface.
- Examiner uses a stopwatch.
- Instructions: Stand for 2 minutes unsupported.
- Scoring: 4 = 2 minutes, 3 = 2 minutes with supervision, 2 = 30 seconds, 1 = several tries for 30 seconds, 0 = unable to stand 30 seconds. If able to stand 2 minutes, score full points for sitting unsupported and proceed to Item 4.
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Item 3: Sitting Back Unsupported:
- Patient sits with back unsupported, feet supported on the floor or stool.
- Examiner uses a stopwatch.
- Instructions: Sit with arms folded for 2 minutes.
- Scoring: 4 = 2 minutes, 3 = 2 minutes with supervision, 2 = 30 seconds, 1 = 10 seconds, 0 = unable to sit 10 seconds without support.
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Item 4: Standing to Sitting:
- Patient stands in front of a chair with armrests.
- Instructions: Sit down.
- Scoring: 4 = safe sitting w/ minimal hands, 3 = controlled descent using hands, 2 = leg support to control, 1 = independent but uncontrolled, 0 = assistance needed.
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Item 5: Transfers:
- Two chairs (one with armrests, one without) or chair and bed.
- Instructions: Transfer from chair with armrests to a chair without armrests, and repeat.
- Scoring: 4 = minor hand use, 3 = definite hand use, 2 = verbal cues and/or supervision, 1 = one person assist, 0 = two-person assist/supervision.
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Item 6: Standing Unsupported with Eyes Closed:
- Patient stands quietly.
- Examiner uses a stopwatch.
- Instructions: Close eyes and stand still for 10 seconds.
- Scoring: 4 = 10 seconds, 3 = 10 seconds with supervision, 2 = 3 seconds, 1 = unable to maintain eyes closed 3 seconds but stays, 0 = assistance needed.
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Item 7: Standing Unsupported with Feet Together:
- Patient stands with feet together.
- Examiner uses a stopwatch.
- Instructions: Stand with feet together, without holding on for 1 minute.
- Scoring: 4 = 1 minute, 3 = 1 minute with supervision, 2 = 30 seconds, 1 = needs help to position but can stand 15 seconds with feet together, 0 = needs help to position and cannot maintain 15 seconds.
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Item 8: Reaching Forward with Outstretched Arm While Standing:
- Patient stands with arms at 90-degree shoulder flexion, fingers outstretched.
- Examiner holds a ruler at the end of the fingers.
- Instructions: Reach forward as far as possible without trunk rotation or losing balance.
- Scoring: 4 = 25 cm (10 in), 3 = 12 cm (5 in), 2 = 5 cm (2 in), 1 = supervision needed, 0 = loses balance/support needed.
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Item 9: Picking Up Object From Floor:
- A slipper/shoe is placed near the patient's feet.
- Instructions: Pick up the slipper/shoe.
- Scoring: 4 = safe and easy, 3 = supervision needed, 2 = reaches 2-5 cm (1-2 in) from slipper, 1 = supervision needed to pick up, 0 = unable to try/needs assistance.
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Item 10: Turning to Look Behind:
- Patient stands, Examiner assesses rotation and weight shift.
- Instructions: Turn to look behind you over left and right shoulders.
- Scoring: 4 = turns and shifts well, 3 = one side only, 2 = sideways turn maintained, 1 = supervision needed, 0 = assistance needed.
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Item 11: Turning 360 Degrees:
- Patient stands quietly.
- Examiner uses a stopwatch.
- Instructions: Turn completely around in a full circle, then repeat in the other direction.
- Scoring: 4 = 4 seconds or less, 3 = safely on one-side in 4 seconds, 2 = safe slow turn, 1 = supervision/cues needed, 0 = assistance needed.
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Item 12: Placing Alternate Foot on Step/Stool:
- A 7¾-9 inch step stool is used.
- Instructions: Alternately place each foot on the step/stool four times.
- Scoring: 4 = independent, 8 steps in 20 seconds, 3 = >20 seconds, 2 = 4 steps without assistance, 1 = >2 steps w/minimal assist, 0 = assistance needed/unable to try.
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Item 13: Standing Unsupported with One Foot in Front:
- Instructions: Place one foot directly in front of the other, with the forward heel ahead of the rear foot's toes. Step width should not exceed shoulder-width.
- Scoring: 4 = tandem position, 30 seconds, 3 = forward position,30 seconds, 2 = small step, 30 seconds, 1 = helps to step, 15 seconds, 0 = lost balance.
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Item 14: Standing on One Leg:
- Instructions: Stand on one leg, without touching standing leg, as long as possible.
- Scoring: 4 = >10 seconds, 3 = 5-10 seconds, 2 = ≥ 3 seconds, 1 = tries but cannot hold for 3 seconds, 0 = cannot try/assistance needed.
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Description
Test your understanding of the Berg Balance Scale (BBS) items, which assess a patient's balance and fall risk. This quiz covers procedures, scoring criteria, and specific balance tasks to evaluate individuals' mobility levels. Perfect for students and professionals in healthcare fields.
