Assessment of Impaired Balance

Initial Screening Approach

The American Academy of Otolaryngology-Head and Neck Surgery recommends using rapid screening questions to identify balance impairment, including "Have you fallen in the past year?", "Do you feel unsteady when standing or walking?", and "Are you worried about falling?" 1
A "yes" to any question requires formal balance testing, as suggested by the American Academy of Otolaryngology-Head and Neck Surgery and the Mayo Clinic 1, 2

The Mayo Clinic recommends using the Timed Up and Go (TUG) test as a primary screening tool, with a time >12 seconds indicating increased fall risk and warranting comprehensive balance evaluation 1
The TUG test measures functional mobility, with the patient rising from a chair, walking 3 meters, turning, returning, and sitting, and a time >12 seconds indicating increased fall risk, as validated by the American Heart Association and the Mayo Clinic 1, 4
The Berg Balance Scale is a 14-item criterion-based assessment that evaluates static and dynamic balance, with scores 0-56 (higher = better performance), and a score <41 indicating need for assistive device, as recommended by the American Stroke Association and the Alzheimer's Association 3, 6

The American Stroke Association recommends assessing gait evaluation, motor examination, sensory testing, and vestibular function as essential elements to assess in patients with impaired balance 7, 6
The American Heart Association suggests that walking speed categories, including <0.4 m/s = household ambulation only, 0.4-0.8 m/s = limited community ambulation, and >0.8 m/s = community ambulation, can be used to evaluate fall risk 3, 5

The Mayo Clinic recommends systematically evaluating modifiable contributors to fall risk, including pain, shoes, cognitive impairment, hypotension, eyesight, medications, and environmental hazards, using the P-SCHEME approach 1, 5, 6, 9

The American Stroke Association suggests that computerized posturography can be used to differentiate sensory contributions (visual, vestibular, somatosensory) and provide objective, quantifiable data in complex cases 8, 2

The American Stroke Association recommends recording subjective symptoms and onset timing, vital signs including orthostatic blood pressure, specific balance test scores with dates, gait aid requirements, and fall history with circumstances for comprehensive assessment 7, 5, 1, 2