BERG BALANCE TEST
Name: __________________________________ Date: ___________________
Age: ____ Sex: ____ Diagnosis: ______________________
Contact no.: _________________ Address: ______________________________
Location: ________________________________ Rater: ___________________
Interpretation
0–20 : Wheelchair bound
21–40 : Walking with assistance
41–56 : Independent
S.N.
Item Description
Date
Score [0-4]
1
Sit to stand
2
Standing Unsupported
3
Sitting Unsupported
4
Standing to sitting
5
Transfers
6
Standing with eyes closed
7
Standing with feet together
8
Reaching forward with outstretched arms
9
Retrieving object from ground
10
Turning to look behind
11
Turning 360 degrees
12
Placing alternate foot on stool
13
Standing with one foot in front
14
Standing on one foot
Total
