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Brunel Balance Assessment

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Purpose

The BBA assesses functional balance for people with a wide range of abilities, specifically for use post-stroke. It is suitable for use in the clinical setting. Can be used hospital bedside, treatment area, or client’s home.

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Instrument Details

Acronym BBA

Area of Assessment

Balance – Non-vestibular

Cost

Free

Diagnosis/Conditions

  • Brain Injury
  • Stroke Recovery

Populations

Key Descriptions

  • 12 point hierarchical ordinal scale (pass/fail).
  • Score ranges from 0/12 (lowest) to 12/12 (highest).
  • Hierarchical test, individual can pass or fail each item.
  • 3 chances to pass each item. When patient is unable to pass after 3 tries, the test is completed.
  • Test administration instructions found in BBA manual (see link above).

Number of Items

12

Equipment Required

  • Plinth or suitable seating
  • Ruler
  • Step up block 7.5-10 cm high
  • Stopwatch
  • Tape to mark 5m walkway
  • 2 stools/chairs

Time to Administer

10 minutes

Required Training

Reading an Article/Manual

Instrument Reviewers

Initially reviewed by Katie Hays, PT, DPT and the TBI EDGE taskforce of the Neurology Section of the APTA in 5/2012.

ICF Domain

Activity

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute (CVA < 2 months post) (SCI < 1 month post) (Vestibular < 6 weeks post)

Subacute (CVA 2 to 6 months) (SCI 3 to 6 months)

Chronic (> 6 months)

StrokEDGE

UR

UR

UR

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient Rehabilitation

Home Health

StrokEDGE

UR

UR

UR

UR

UR

TBI EDGE

LS

LS

LS

LS

LS

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependent

Severely Dependent

TBI EDGE

NR

LS

LS

LS

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

StrokEDGE

No

No

No

Not reported

TBI EDGE

No

No

No

Not reported

Considerations

New tool, all psychometric testing performed by same group, so it is unknown how reproducible the results are.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Stroke

back to Populations

Minimal Detectable Change (MDC)

Stroke: (Tyson and DeSouza, 2004; n=92, broken down into 3 groups for reliability (n=37), scalability (n=80), and validity testing (n=55; mean age=67.4(12.84) years; median time since stroke=9 weeks)

  • MDC= 1 point (out of 12), due to hierarchical scale

Minimally Clinically Important Difference (MCID)

Chronic Stroke: (Tyson and DeSouza, 2004)

  • MCID=1 level (1/12) due to hierarchical scale

Test/Retest Reliability

Chronic Stroke: (Tyson and DeSouza, 2004)

  •  Excellent test-retest reliability (K=1) 100% agreement

Interrater/Intrarater Reliability

Chronic Stroke: (Tyson and DeSouza, 2004)

  • Excellent inter-rater reliability (K=1) 100% agreement
  • Testing performed by 2 testers. One person administered the test instructions while the second rater observed and rated.

Internal Consistency

Chronic Stroke: (Tyson and DeSouza, 2004)

  • Excellent internal consistency (Cronbach’s alpha=0.93)

Criterion Validity (Predictive/Concurrent)

Acute Stroke: (Tyson et al, 2007; n=102 participants, mean age 70.7(12.6) years; mean time since stroke 21 (5) days; 75 participants completed 3 month follow-up)

  • Balance disability was strongest predictor of function in acute stages (r2= 30-85%)

Chronic Stroke: (Tyson and DeSouza, 2004)

  • Excellent correlation with Motor Assessment Scale (sitting section) (rs =0.83)
  • Excellent correlation with Berg Balance Test (rs =0.97)
  • Excellent correlation with Rivermead Mobility Index (rs= 0.95).

Bibliography

Pollock, C., Eng, J., et al. (2011). "Clinical measurement of walking balance in people post stroke: a systematic review." Clinical Rehabilitation 25(8): 693-708. Find it on PubMed

Tyson, S. F. and Connell, L. A. (2009). "How to measure balance in clinical practice. A systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions." Clinical Rehabilitation 23(9): 824-840. Find it on PubMed

Tyson, S. F. and DeSouza, L. H. (2004). "Development of the Brunel Balance Assessment: a new measure of balance disability post stroke." Clinical Rehabilitation 18(7): 801-810. Find it on PubMed

Tyson, S. F., Hanley, M., et al. (2007). "The relationship between balance, disability, and recovery after stroke: predictive validity of the brunel balance assessment." Neurorehabilitation & Neural Repair 21(4): 341-346. Find it on PubMed

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