- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together, we are the most
famous physical therapists on the internet.
- In our opinion, of course, Bob.
- Brad, today we're going to talk about
the Berg Balance Scale.
I've also seen it called the Berg Balance Test.
- Sure.
- We're gonna go through it, developed by Katherine Berg.
We think she's from Canada
because the first time I saw it published,
it was in a Canadian journal.
So, eh?
- I think she is a little German though, but maybe not.
- Oh, Berg, yeah. That Berg could be.
All right, let's go ahead and get started here.
What do you need for equipment first, Brad?
Let's go over that.
- Sure.
- You're gonna need some type of stepping stool,
which you can't see right now, but like usually
with a six inch step.
You'll see that a little later.
You need a chair with arms, chair without arms.
You need a slipper.
You need a stopwatch,
and you need a ruler taped to the wall,
which we're gonna reveal later.
All right, let's go ahead and get started, Brad-
- Okay.
- With this equipment, and there's fourteen
different steps we gotta take here,
and we're gonna start off with number one.
- And this is gonna reveal your risk for falling?
- Your risk for falling, yeah.
Did I even say that? This is a test, by the way,
this is a test for measuring your risk for falling.
We use it a lot on the elderly, don't we?
- You bet. Yep.
- And it's very,
very good at picking out details
on someone who might fall.
We'll show you that at the end.
- Whether you need a cane, a walker, a wheelchair,
it can help that out.
- Right. It can bring that down.
All right, the first instruction is
you're gonna start with a chair with no arms.
I want you to go ahead, please stand up,
and try not to use your arms for support.
- Okay? So my hands will be here.
- Right. And the score is
he gets a perfect score of four points
if he's able to do that.
Otherwise, there's different variations of that.
You can read those on the test.
Now the next one is standing unsupported.
So now Brad, you could have stayed standing actually,
and stand for two minutes without holding onto something.
That's where I'd use the stopwatch.
And I would time him.
Obviously. I'm not gonna go for two minutes.
And if he needs supervision, by the way,
you don't have a belt on do you, Brad?
Oh yes he does.
- Oh yeah.
- That's the one thing we wanna remember,
is when you're a therapist and if you're doing this,
is safety comes first.
And so I always have a belt on them.
I'm always close. They talked about being close
to a wall, so they could hold onto that.
But I don't really like that idea.
They'll just fall against the wall then.
So, I'd rather have that I'm gonna be close
and you can hang onto 'em.
- Feet or shoulder width apart?
- Shoulder width apart is fine. Yep.
All right, if they're able to stand for the two minutes
you can actually skip the next one,
which is measuring their balance in a chair,
but let's pretend that you didn't pass this one, Brad.
Yep. So we're gonna go ahead and have you sit.
Scoot forward a little bit on the chair,
and please sit with your arms folded for two minutes.
- This is number three?
- This is number three. Again, variations on this.
If you don't pass it, you maybe can do it for 10 seconds.
Okay. Now standing to sit,
which is kind of a weird order,
but go ahead and stand up again.
And I want you to please sit down,
and again, we're looking to see
is he able to do so without using his arms?
Good. And that's a flop actually, and that's gonna-
he's gonna lose some points based on that.
Let's go to number five.
Now you're gonna have two chairs.
You're gonna have a chair with arms
and a chair without arms.
And I want you to transfer-
you can start with either one, actually,
you can start.
Why don't you start, you're gonna transfer
to this one over here.
And I noticed you used your arms there.
And now you're gonna go back again.
And again, in both cases he used his arms.
You can try to use it, you know,
try to do it without using your arms.
All right, now you're gonna go ahead and stand up, Brad.
And we're gonna have you stand with your feet,
just normal width apart,
and gonna see if you can stand with your eyes closed
for ten seconds.
Yeah, you can face this way.
Again, I'm close.
You know, again, very- how many points he's gonna get.
"Needs help, keep from falling."
I would say this, you're able to stand ten seconds
with supervision if you're swaying.
So, alright. Now standing unsupported with feet together.
Now,
Brad, on your feet right now with a lot of people
what we have found if you're in the clinic a lot,
there's a lot of people that can't keep-
put their feet all the way together.
Can they, because of their knees?
- Right, if they've got their knees valgus,
or their knees are-
- [Bob] Even varus, too.
- Yep.
- [Bob] So, that means if they're bowed in or bowed out.
- Their knees touched before their feet here.
- [Bob] Right. So if they can't touch,
the first thing you try to do is maybe see
if they can put their heels together like that.
'Cause sometimes they can do that.
Otherwise you just put 'em as close together as possible.
And you're gonna see if they can do this for one minute.
Okay.
- [Brad] And on all of these,
if you're not able to meet the requirement
you can read through the level of points they get.
And it'll describe to you where to check and get-
- By the way, this is obviously- this is a video
not only for professionals,
but it's also if you have a family member
that's at a high risk for falling,
or that's been falling,
you might go to your local therapist and say,
"Hey, could you do the bird test on them?"
- Exactly.
- And that way you're gonna kind of know
what they're all testing when you do it, so.
All right, reaching forward.
Now we get to reveal the yard stick, Brad.
- We have more than just a 'famous PT' here.
- Yeah. Famous PT.
- We have-
- All right. So what Brad's gonna do is
he's gonna line up so that his fingertip or knuckles,
one of the two whichever one you want, Brad.
Okay, he's going knuckles.
And that's right on the, you know,
number one of the yard stick.
And I want him to reach forward as far as possible,
without- you shouldn't rotate the trunk.
- Right.
- And your fingers should not touch the ruler.
And obviously you shouldn't lose your balance either.
- And feet squared off.
- Yeah. Have we seen all this okay?
Yeah, I think so. It looks good.
All right, Brad, why don't you go ahead
and reach forward as far as you can.
- You're kind of wobbly here, Bob.
- And if he goes past ten inches, which he is doing,
then he gets the full four points.
Very good, Brad.
- All right.
- All right. Now you're gonna pick up
an object from the floor, from a standing position.
And usually we like a slipper,
'cause that's obviously something very practical.
And then quite often you're gonna see a person doing that.
And you can see we have the shoe there.
And again, I would want to be very close
to the patient here when you're doing this one.
I might even have a hand on the belt to be honest with you.
- [Brad] Sure. You bet I would too.
- [Bob] And go ahead and have 'em bend forward.
Pick it up.
Good. You know, if he needs supervision,
or if he's unable to pick it up,
and you know, there's different variations on
how many points he's gonna get.
Very nice, Mr. Heineck.
- [Brad] Thank you, Mr. Schrupp.
- [Bob] As you might have noticed
we don't have our camera person today.
But we're working on it.
- Yeah, we can do this by ourself, Bob.
We are good.
- Alright, the next one, Brad, go ahead and stand up.
All right, now I'm gonna show you what to do.
You're gonna turn completely around in a full circle.
So I'm gonna have you stand,
and this is one you should demonstrate to the patient,
I just think it's the best way to do it.
Turn all the way around.
Pause. And then turn all the way around the other way.
Okay?
- Okay. So what direction do I go first?
- Either way.
- Okay.
- And what we're looking for is
can you do it in four seconds or less.
Now, if he does one direction in four seconds or less,
he gets, you know, three points.
If he does both, he gets four points.
Then you pause and you go the other direction.
- And if they reach out to touch something-
- Yeah, obviously they're gonna lose some points.
- Yeah.
- All right. The next one is,
we're gonna now use the step stool.
Now I'm gonna go ahead and jump on the camera here.
But I'm gonna also demonstrate this one to the person first.
And you want to just go down real quick, Brad.
- [Brad] Alright.
- Now what they have to do is eight steps
in twenty seconds, so.
(counting) One, two, three, four, five, six, seven, eight.
And I would demonstrate it first
and then have the person try.
Which, I think we don't need to have you try it, Brad,
'cause you just saw it, so-
- [Brad] And that's a six inch step?
- [Bob] A six inch step. Yep.
- [Brad] Okay.
- Okay.
Looks good.
All right, then we're gonna have you stand
unsupported, Brad.
Oh, this is one-two.
Can I just describe it to you?
- Sure.
- [Bob] 'Cause I'll take the camera again, Brad.
You're gonna stand with one foot
in tandem in front of the other.
Why don't you face one direction, Brad.
- [Brad] So it's gonna be-
- [Bob] You wanna face that way?
- [Brad] Yeah. I'm gonna do it both ways.
- [Bob] Okay.
- [Brad] This way. So you can see that
and then from the side view.
- [Bob] Right.
- [Brad] Like you're walking the line.
- [Bob] Yeah. And it's right in front of the other.
Now, if you can't do that, the next thing would be is
if he could put one foot ahead of the other.
Yeah. No, off to the side even a little bit.
Yeah. Just one foot ahead or the other, that's it.
- [Brad] Stay here?
- [Bob] Yeah. Do you wanna do that
to the side again, Brad? Or not?
You wanna show that to the side?
- [Brad] Oh, that's what you're saying, yeah.
- [Bob] Yeah. Like that, okay.
And the next- and if he's not able to do that,
the next step would be if he could just take
a small step ahead. Like that, exactly.
And if he's unable to do that
then it would be that we have to actually help him
take the small step forward,
but he still can hold it for fifteen seconds.
- [Brad] So you're saying actually,
physically move that foot forward?
- [Bob] I would would say maybe even-
- [Brad] To balance, yeah.
- [Bob] I balance you to help you get there.
- [Brad] And once I'm there-
- [Bob] Once you're there,
but you can hold it for fifteen seconds.
All right. Then the last one is standing on one leg.
- [Brad] Oh!
- [Bob] Either leg.
And you wanna make sure with this,
is when he stands on one leg
that he's not holding the leg up
against the other one for support.
- [Brad] So we want it out suspended, but not touching.
- [Bob] Right.
- [Brad] Yeah, that helps when you get to touch.
- [Bob] Now.
I go back up here again, now that is it. That's the test.
All right, Brad, so that was the test.
On the next video we're gonna interpret
the results of the test, Brad,
because it's kind of involved.
I don't wanna add it to this video.
- But you get a score of zero to fifty-six.
- Zero to fifty-six, yeah.
- And those numbers we'll tell you what those numbers-
- Each one means something.
So you wanna look at the next video for the interpretation.
- All righty then!