Several easy-to-administer tests are validated for evaluating balance problems and fall risks. These tests can be administered in the examination room or at the bedside. They provide additional information on the extent of the patient’s balance problems. The equipment needed to administer these tests are a timing device (a watch with a second hand will do; a stopwatch is better), a line on the floor, and a standard chair with arms.
The sharpened Romberg’s test (tandem stance) assesses lateral stability. In the tandem stance, the patient places one foot in front of the other, heel touching toe, with his or her eyes closed. A patient who is not able to maintain this position for more than 10 seconds is at increased risk for falls.
The unipedal balance test is used to detect subtle balance impairments. The patient is asked to stand on one foot with the other foot raised 2 inches off the floor and not touching the other ankle or foot. Increased fall risk is associated with an inability to remain in that position for at least 5 seconds.
The timed 360-degree turn test assesses dynamic balance. The patient is asked to turn in a circle while taking steps. An inability to complete the maneuver in less than 4 seconds indicates an increased risk of falling. A similar test is the 180-degree turn test, where the number of steps the patient needs to turn halfway around is counted. Staggering during the turn, an inability to pivot during the turn, using five or more steps to complete the turn, or taking 3 seconds or longer to accomplish the turn are indicative of problems in turning while walking.
The five times sit to stand test is used to assess lower extremity strength. The patient is asked to rise from a standard chair, with arms folded across the chest, five times consecutively. The ability to rise from a chair requires vision, proprioception, balance, and sensorimotor skills. An inability to complete the maneuver, standing and sitting back down in less than 14 seconds, indicates an increased level of disability.
The tandem walk test can be administered if space allows. The patient walks heel-to-toe in a straight line and the number of missed steps is counted. Typically a measured distance is used, varying from 3 to 10 meters. A missed step is defined as heel not touching toe, stepping off the line, loss of balance, or requiring support. Fall risk increases with a higher number of missed steps or an inability to complete the test.
Gait tests should be administered to test slow and fast gait speed. The patient is asked to walk a measured distance at his or her usual pace, using a cane or walker if necessary. The patient is then asked to walk the same distance as fast as he or she can. The patient’s ability to increase gait speed indicates an ability to respond to environmental changes and task demands such as crossing the street or reacting to the sudden appearance of an obstacle.
