Balance is a fundamental motor skill that allows people to remain upright, perform coordinated movements, and move safely. In rehabilitation settings, balance assessment tests become an essential tool for detecting functional deficits, planning personalized therapeutic strategies, and preventing complications such as falls. Several studies indicate that a proper balance assessment helps anticipate risks and improve treatment adherence, especially in vulnerable populations such as older adults or people with neurological sequelae.
Why is it important to assess balance in rehabilitation?
Balance assessment allows for the precise identification of altered aspects of postural control. A person with balance disorders may experience difficulty walking, maintaining posture, or reacting to changes in their environment. This directly impacts their independence and quality of life. According to Horak et al. (2001), appropriate intervention based on balance assessment tests can significantly reduce the risk of falls, which is especially relevant for elderly patients, people with stroke, or spinal cord injuries.
Assessing balance not only detects physical deficits but also psychological aspects such as fear of falling, which negatively impacts functional recovery. Furthermore, these tests allow for monitoring treatment progress and making informed clinical decisions.
Berg Scale (Berg Balance Scale – BBS)
The Berg Scale is one of the most validated clinical tools for assessing balance in adults and geriatric patients. This scale consists of 14 items designed to measure an individual's ability to maintain balance during everyday functional tasks, such as rising from a chair, reaching objects, or standing with eyes closed. Each task is scored on a scale of 0 to 4, with a maximum score of 56. A score below 45 is considered to be associated with a high risk of falls (Berg et al., 1992).
Its application does not require complex equipment, making it a highly accessible tool in clinical settings. Furthermore, its high test-retest reliability has been demonstrated in numerous studies. The Berg Scale has been widely used in patients with Parkinson's disease, stroke, multiple sclerosis, among others, and allows for the measurement of subtle changes in postural stability over time.
Tinetti Scale (Performance-Oriented Mobility Assessment – POMA)
Another fundamental tool in the assessment of balance is the Tinetti scale, also known as POMA. This test assesses both balance and gait. It is divided into two sections: one dedicated to assessing balance with nine items, and another focused on gait with seven items. The total score is 28 points, with scores below 19 indicating a high risk of falls (Tinetti et al., 1986).
The Tinetti Scale allows for observation of aspects such as the patient's initiation into walking, symmetry, stride length, and the confidence with which they make turns or stops. It also analyzes how the individual responds to minor imbalances, making it a very useful test in the geriatric setting. Unlike the Berg Scale, the Tinetti Scale offers a more dynamic view of functional mobility, complementing diagnosis and therapeutic planning.
Assessment of standing and sitting
In many patients with severe disabilities, balance must be assessed in static positions such as standing and sitting, where the physical demands are different but equally relevant. In standing, one of the most commonly used tests is the Romberg test, which evaluates the patient's ability to remain upright with their eyes open and then closed. Its purpose is to detect alterations in the vestibular and proprioceptive systems.
Another important test is the Functional Reach Test, which measures the maximum distance a person can reach forward without losing balance. This test has been shown to be a good indicator of anterior-posterior stability and correlates with fall risk (Duncan et al., 1990).
Regarding sitting, there are specific tests for people who cannot stand. The Trunk Control Test (TCT), for example, assesses trunk control and the ability to perform lateral or rotational movements from a sitting position. These tests are essential for patients with spinal cord injuries, neuromuscular diseases, or in the early stages of post-stroke.
Exercises with robots and new technologies
Advances in rehabilitation robotics have opened up a new field in balance assessment. Thanks to motion sensors, stabilometric platforms, and artificial intelligence algorithms, it is possible to obtain objective, real-time measurements of a patient's postural performance. These tools allow for the design of personalized programs and provide immediate feedback during therapy.
A prominent example is that of the company Inrobics, which develops advanced rehabilitation software combining social robotics with artificial intelligence. Its technology enables interactive sessions of active exercise and therapeutic games focused on balance, both in sitting and standing positions. The robots can automatically adjust the difficulty of the exercises according to the patient's performance and record their clinical progress with great precision. According to Sanz et al. (2022), this methodology increases motivation and improves treatment adherence, which is crucial for patients with long rehabilitation stays.
Conclusion
Balance assessment in rehabilitation is a fundamental tool for optimizing the therapeutic process and preventing complications. Clinical scales such as those of Berg and Tinetti have demonstrated great validity and practical utility, especially in geriatric or neurological settings. However, their integration with new technologies, such as therapeutic robots and motion analysis systems, offers a more comprehensive and precise approach tailored to the individual needs of each patient. The combination of traditional techniques and innovative resources represents the future of balance-focused functional rehabilitation.
