A Retrospective Analysis of Post-Stroke Berg Balance Scale Scores: How Should Normal and At-Risk Scores Be Interpreted?

Abstract

Purpose: The Berg Balance Scale (BBS) is a performance-based measure of standing balance commonly used by clinicians working with individuals poststroke. Performance on the BBS can be influenced by compensatory strategies, but measures derived from two force plates can isolate compensatory strategies and thus better indicate balance impairment. This study examined BBS scores that reflect ''normal'' and disordered balance with respect to dual force-plate measures of standing balance in individuals post-stroke. Methods: BBS and force-plate measures were extracted from 75 patient charts. Individuals were classified by BBS score with respect to (1) age-matched normative values and (2) values that suggested increased risk of falls. Multiple analysis of variance was used to examine the effect of group assignment on force-plate measures of standing balance. Results: Individuals with BBS scores within and below normative values did not differ in force-plate measures. Individuals with BBS scores below the falls risk cutoff loaded their affected leg less than individuals with BBS scores above the cutoff. There were no other differences in force-plate measures between these two groups. Conclusions: BBS scores indicating either normal or disordered balance function are not necessarily associated with normal or disordered quiet standingbalance control measured by two force plates. This finding suggests that the BBS may reflect a capacity for compensation rather than any underlying impairments.Key Words: balance; Berg Balance Scale; force-plate measures; stroke. RÉ SUMÉObjectif : l'é chelle de Berg est un outil de mesure de l'é quilibre debout fré quemment utilisé par les cliniciens traitant des personnes ayant subi un AVC. Des straté gies compensatoires peuvent influencer le score Berg, mê me si les mesures obtenues de deux plateformes de force peuvent isoler les straté gies compensatoires et ainsi mieux dé tecter les troubles d'é quilibre. L'objectif de cette é tude é tait d'examiner les scores Berg indiquant un é quilibre « normal » et un trouble d'é quilibre parallè lement aux doubles mesures des plateformes de l'é quilibre debout de personnes ayant subi un AVC. Mé thodologie : on a extrait le score Berg et les mesures des plateformes de 75 dossiers mé dicaux de patients. On a classé les personnes selon leur score Berg en tenant compte (1) des valeurs normatives apparié es selon l'â ge et (2) des valeurs suggé rant un risque accru de chutes. On a ré alisé une analyse de variance multivarié e pour examiner l'effet de la ré partition des groupes sur les mesures de l'é quilibre debout obtenues à l'aide des plateformes. Ré sultats : les personnes ayant obtenu un score Berg é gal ou infé rieur aux valeurs normatives n'ont pas obtenu de mesures diffé rentes sur les plateformes. Les personnes ayant obtenu un score Berg sous le seuil de risque de chute mettaient moins de charge sur la jambe touché e que les personnes ayant obtenu un score Berg au-dessus du seuil. Il n'y avait aucune autre diffé rence dans les mesures des...

The effects of Ai Chi for balance in individuals with chronic stroke: a randomized controlled trial

“…We further analyzed the decrease of fall risk in both groups. The latest cutoff score of increased fall risk in stroke was set at 49 (score ≦ 49) 35 . Changing from BBS ≦ 49 to BBS > 49 indicated the decreased fall risk.…”

Evaluation of balance functions using temporo-spatial gait analysis parameters in patients with brain lesions

“…First, the BBS has both floor and ceiling effects 8 , 9 . Second, its inter-rater reliability is lower when assessing post-stroke individuals who score in the mid-range of the scale 8 , 10 . Third, the BBS score may be a poor predictor of post-stroke falls 8 , 11 – 13 .…”

“…Second, its inter-rater reliability is lower when assessing post-stroke individuals who score in the mid-range of the scale 8 , 10 . Third, the BBS score may be a poor predictor of post-stroke falls 8 , 11 – 13 . Finally, the score can improve without any actual improvement in the physiological function of standing balance 8 , 12 , 13 .…”

“…Third, the BBS score may be a poor predictor of post-stroke falls 8 , 11 – 13 . Finally, the score can improve without any actual improvement in the physiological function of standing balance 8 , 12 , 13 . Therefore, this score may not reflect the degree of motor function improvement after rehabilitation.…”

“…Using a 5-point ordinal scale, from 0 to 4, the individual is scored based on the ability to maintain and perform the functional task 6 .However, despite its apparent clinical utility, the BBS has some limitations that may complicate the interpretation of its scores and therefore discourage its use in guiding treatment planning for individuals with brain lesions. First, the BBS has both floor and ceiling effects 8,9 . Second, its inter-rater reliability is lower when assessing post-stroke individuals who score in the mid-range of the scale 8,10 .…”