This is an excerpt from Fallproof!-2nd Edition by Debra J. Rose.
Test Administration Instructions for the Fullerton Advanced Balance Scale
1. Stand with feet together and eyes closed
Purpose: Assess participant’s ability to use somatosensory input (i.e., ground and body position cues) to maintain upright balance while standing on a reduced base of support with vision removed
Testing procedure: Demonstrate the correct test position and then instruct the participant to move the feet independently until they are together. If some participants are unable to achieve the correct position due to lower-extremity joint impairments, encourage them to bring their heels together even though the fronts of their feet are not touching. Have participants adopt a position that will ensure their safety as they fold their arms across the chest and prepare to close the eyes. Begin timing as soon as the participant closes the eyes. Instruct participants to open the eyes if they feel so unsteady that a loss of balance is imminent.
Verbal instructions: Bring your feet together, fold your arms across your chest, close your eyes when you are ready, and remain as steady as possible until I instruct you to open your eyes.
2. Reach forward with outstretched arm to retrieve an object (pencil).
Purpose: Assess participant’s ability to lean forward to retrieve an object without altering the base of support and measure the participant’s stability limits in a forward direction
Equipment: Pencil and 12-inch (30 cm) ruler
Testing procedure: Instruct the participant to raise the preferred arm to 90 degrees and extend it with the fingers outstretched. Follow with a demonstration of the correct action. Use the ruler to measure a distance of 10 inches (25 cm) from the fingertips of the outstretched arm. Hold the object (a pencil) horizontally and level with the height of the participant’s shoulder. Instruct the participant to reach forward, grasp the pencil, and return to the initial starting position without moving the feet, if possible. (It is acceptable to raise the heels as long as the feet do not move.) If the participant is unable to reach the pencil within 2 to 3 seconds of initiating the forward lean, tell the participant that it is OK to move the feet in order to reach the pencil. Record the number of steps the participant takes in order to retrieve the pencil.
Verbal instructions: Try to lean forward, take the pencil from my hand, and return to your starting position without moving your feet from their present position. (Allow 2-3 seconds of lean time.) You can move your feet in order to reach the pencil.
3. Turn in a full circle in right and left directions
Purpose: Assess the participant’s ability to turn in a full circle in both directions without losing balance and using a minimum number of steps
Testing procedure: Verbally explain and then demonstrate the task to be performed, making sure to complete each circle in four steps or less and to pause briefly between turns. Instruct the participant (who is facing you) to turn in a complete circle in one direction, pause, and then turn in a complete circle in the opposite direction. Count the number of steps taken to complete each circle. Stop counting steps as soon as the participant is facing you after completing each turn. Allow for a small correction in foot position before a turn in the opposite direction is initiated.
Verbal instructions: Turn around in a full circle, pause, and then turn around in a full circle in the opposite direction.
4. Step up onto and over a 6-inch (15 cm) bench
Purpose: Assess participant’s ability to control COG in dynamic task situations and measure lower-body strength and bilateral motor coordination
Equipment: 6-inch (15 cm) bench with an 14- by 18-inch (36 by 46 cm) stepping surface
Testing procedure: Verbally explain and then demonstrate the step up onto and over the bench in both directions. Instruct the participant to step onto the bench with the right foot, swing the left leg directly up and over the bench, step off the other side, and then repeat the movement in the opposite direction with the left leg leading the action. While the participant performs the test, watch to see that the trailing leg does not make contact with the bench or swing around, as opposed to going directly up and over, the bench.
Verbal instructions: Step up onto the bench with your right leg, swing your left leg directly up and over the bench, and step off the other side. Repeat the movement in the opposite direction with your left leg as the leading leg.
5. Walk with feet in a tandem position
Purpose: Assess participant’s ability to dynamically control COM with an altered base of support
Equipment: Masking tape
Testing procedure: Verbally explain and demonstrate how to perform the test correctly before allowing the participant to attempt the test. Instruct the participant to tandem walk (heel to toe) on the line until you say to stop. Allow participants who are unable to achieve a tandem stance within the first two steps to repeat the test one time. The participant may elect to step forward with the opposite foot on the second attempt. Score as interruptions any instances where the participant takes one or more steps away from the line when performing the tandem walk or is unable to achieve the correct heel-to-toe position during any step taken along the course. Do not ask the participant to stop until 10 steps have been completed.
Verbal instructions: Walk forward along the line, placing one foot directly in front of the other such that the heel and toe are in contact on each step forward. I will tell you when to stop.
6. Stand on one leg
Purpose: Assess participant’s ability to maintain upright balance with a reduced base of support
Testing procedure: Instruct the participant to fold the arms across the chest, lift one leg off the floor, and maintain balance until instructed to return the foot to the floor. Begin timing as soon as the participant lifts the foot from the floor and allow 20 seconds to elapse. Stop timing if the legs touch, the raised leg contacts the floor, or the participant removes the arms from the chest before the 20 seconds are up. Allow participants who are unsure which leg to raise to perform the test once on each leg.
Verbal instructions: Fold your arms across your chest, lift one leg off the floor (without touching your other leg), and stand with your eyes open as long as you can.
7. Stand on foam with eyes closed
Purpose: Assess participant’s ability to maintain upright balance while standing on a compliant surface with the eyes closed
Equipment: Stopwatch and two Airex Balance Pads, with a length of nonslip material placed between the two pads and an additional length of nonslip material placed between the floor and the bottom pad if the test is being performed on an uncarpeted surface
Testing procedure: Following a demonstration of the task, instruct the participant to step onto the foam pads without assistance, fold the arms across the chest, and close the eyes when ready. (Be sure to demonstrate the correct standing position on the balance pads.) Make sure the position that you adopt as the test administrator ensures the safety of the participant. Position the foam pads close to a wall in all cases and in a corner of the room if the participant appears unsteady. Begin timing as soon as the eyes close. Stop the trial if the participant (a) opens the eyes before 20 seconds have elapsed, (b) lifts the arms off the chest, or (c) loses balance and requires manual assistance to prevent falling. Be sure to instruct participants to open their eyes if they feel so unsteady that a loss of balance is imminent. Have the participant step forward off the foam at the completion of the test. Provide manual assistance if needed.
Verbal instructions: Step up onto the foam and stand with your feet shoulder-width apart. Fold your arms over your chest, and close your eyes when you are ready. I will tell you when to open your eyes.
8. Jump with both feet for distance
Purpose: Assess participant’s upper- and lower-body coordination and lower-body power
Equipment: 36-inch (91 cm) ruler, masking tape
Testing procedure: Do not introduce this test item if the participant cannot perform test item 4 safely, has a diagnosis of osteoporosis, or complains of lower-body joint pain. Score a 0 on the test form and move immediately to test item 9. Otherwise, instruct the participant to perform a jump with both feet (i.e., jump with two feet and land on two feet). Demonstrate the correct movement before having the participant perform the jump. Do not jump much more than twice the length of your own feet when demonstrating the test. Use the ruler to measure the length of the participant’s foot and then multiply by 2 to determine the ideal distance to be jumped. Observe whether the participant leaves the floor with both feet and lands with both feet. Be sure to move with the participant during the performance and place your hand on the participant’s back to provide stability as soon as the feet contact the ground following the jump.
Verbal instructions: Jump as far but as safely as you can. Try and make sure that both feet leave the floor and land at the same time.
9. Walk while turning head
Purpose: Assess participant’s ability to maintain dynamic balance while walking and turning the head
Equipment: Metronome set at 100 beats per minute
Testing procedure: After demonstrating the test item, allow the participant to practice turning the head in time with the metronome while standing in place. Encourage participants to turn the head at least 30 degrees in each direction by instructing them to turn the head to look into each corner of the room. When the participant is finished practicing, instruct the person to walk forward while turning the head from side to side in time with the metronome. Begin counting steps as soon as the participant attempts to turn the head to the beat of the metronome. Observe whether the person deviates from a straight path while walking or is unable to turn the head the required distance (30 degrees) to the timing of the metronome. In most cases, the steps will be synchronized with the head turns, making the counting of 10 steps easier.
Verbal instructions: Walk forward while turning your head from side to side with each beat of the metronome. I will tell you when to stop.
10. Restore balance after backward disturbance
Purpose: Assess participant’s ability to restore balance following an unexpected perturbation
Testing procedure: Instruct the participant to stand with the back turned toward you. Extend your arm, lock your elbow, and place the palm of your hand in the middle of the participant’s back. Instruct the participant to lean back slowly against your hand until you say to stop. Quickly flex your elbow to remove your hand from the participant’s back as soon as the participant applies a sufficient amount of force against your hand to require a movement of the feet to restore balance once the hand is removed. Try to quickly release your hand while you are still giving the instructions. This release should be unexpected, so do not prepare the participant for the moment of release or allow the participant to lean too far back onto your hand before releasing it.
Verbal instructions: Slowly lean back into my hand until I ask you to stop.
This is an excerpt from Fallproof! A Comprehensive Balance and Mobility Training Program, Second Edition.