Modified Balance Evaluation Score

1

Your Modified Balance Evaluation Score represents a sum of various qualities of balance function. In particular, addressing both dynamic and static balance controls.The results are tabulated as a percentage. Modified Balance Evaluation Score (MBES) with values greater than 80% is considered normal. Please see your medical practitioner or Vestibular Rehabilitation Therapist if the MBES is less than 80%.

2

Your Dynamic Gait Score is This is the ability to move. ( A higher score greater than 80% is regarded as good Balance)

3

Your Sensory Orientation Score isThis is the ability to utilise other senses to support balance. ( A higher score greater than 80% is regarded as good Balance)

4

Your Anticipatory control Score isThis represents that ability to be aware and take action to potential changes to balance. ( A higher score greater than 80% is regarded as good Balance)

5

Name* This field is required.

First Name

Last Name

6

Email* This field is required.

example@example.com

7

1. Sit to Stand: “Cross your arms across your chest. Try not to use your hands unless you must. Do not let your legs lean against the back of the chair when you stand. Please stand up now.”0- Requires assistance to 2- Stand independently

8

2. Rise to toes: “Place your feet shoulder-width apart. Place your hands on your hips. Try to rise as high as you can onto your toes. Try to hold this pose for at least 3 seconds. Look straight ahead. Rise now.0- Less than 3 seconds to 2-Longer than 3 seconds.

9

3. Stand on one leg: “Look straight ahead. Keep your hands on your hips. Lift your leg off of the ground behind you without touching or resting your raised leg upon your other standing leg. Stay standing on one leg as long as you can. Look straight ahead. Lift now. Perform 2 trials with both sides.”0-Unable to perform to 2- Can perform and greater than 20 seconds.

10

4. Stand with both eyes open: “Place your hands on your hips. Place your feet together until almost touching. Look straight ahead. Be as stable and still as possible. The aim is to be stable for more than 30 seconds.”0- Unable to perform to 2- Can perform and greater than 30 seconds

11

5. Stance on the perturbed platform with eyes closed: “Step onto the foam or perturbed surface (like a folded beach towel). Place your hands on your hips. Place your feet together until almost touching. Be as stable and still as possible. The time starts when eyes are closed.”0- Unable to perform to 2- Can perform and greater than 30 seconds

12

6. Stance on the inclined platform: “Step onto the incline ramp. Please stand on the incline ramp with your toes toward the top. Place your feet a shoulder-width apart and have your arms down at your sides. The time begins when you close your eyes.”0- Unable to perform to 2- Can perform and greater than 30 seconds

13

7. Altered walk speed: “Begin walking at your normal speed. Then randomly change your speed to walk as fast and slow alternately for 20-30 steps.”0- Unbalanced with change of speed to 2- Significantly changes walking speed without imbalance

14

8. Walk with head turns: “Begin walking at your normal speed. Then alternately and randomly turn your head to the RIGHT and LEFT while attempting to keep yourself walking in a straight line.”0- Unbalanced with head turning to 2- Significantly changes walking speed without imbalance

15

9. Walk with obstacles: “Begin walking at your normal speed. When you get to the box, step over it, not around it and keep walking.”0- Unable to step around or step over a box to 2- Confidently able to control balance

16

Are you a current or plan to be a client of Brainstorm Rehabilitation?* This field is required.

Yes

No

Maybe