Mini-BESTest
Mini Balance Evaluation Systems Test
Mini BEST Test, MiniBESt, Mini Balance Evaluation Systems Test
The Mini Balance Evaluation Systems Test also known as the Mini-BESTest consists of 14 items that evaluate different aspects of balance:
Each item is scored from 0 (worst) to 2 (best/normal) for a maximum of 28 total points.
The Mini-BEStest is most notably used in pathological populations, such as: Stroke, Parkinson’s disease, Multiple sclerosis (MS), Peripheral neuropathy secondary to Type 2 diabetes
Psychometrics
MCID 4 points- Early subacute stroke (Tamura et al, 2024) 4 points - Parkinson’s (Godi, 2020)
Population | MCID |
---|---|
Early subacute stroke | 4pts1 |
Parkinson’s disease | 4pts2 |
Parkinson’s Disease
King et al3 attempted to find a cut-off points of the Mini-BESTest to differentiate patients with and without postural response deficits3. When using a a cutoff of >21/28 pts, postural response deficits could be differentiated with a sensitivity of 0.89 and a specificity of 0.813.
In patients with mild PD, the results of the Mini-BESTest are highly correlated with the Berg Balance Scale (BBS) (r = 0.79, P < 0.001), while experiencing less significant ceililng effects that the BBS suffers from3.
Mini-BESTest is more effective than the Berg for predicting the motor score on the Unified Parkinson’s Disease Rating Scale (UPDRS) and for discriminating between those with and without postural response deficits as measured by the Hoehn and Yahr (H&Y) scale3.
Indications
Clinicians are saturated with potential measures of balance, so how does the Mini-BESTest fit into one’s toolkit?
In studies on patients with Parkinson’s disease3, multiple sclerosis4 and spinal cord injuries5, the Mini-BESTest had a less significant ceiling effect and higher sensitivity in detecting balance improvements compared to other balance scales like the Berg Balance Scale. This means that it is more difficult to reach the max score (ceiling) on the Mini-BESTest compared to the BBS4,5.
Thus, this test excels at finding balance impairments for higher functioning populations than the Berg Balance Scale.
Setup
Subject Conditions
Subject should be tested with flat-heeled shoes OR shoes and socks off.
Equipment
- Temper® foam (also called T-foamTM 4 inches thick, medium density T41 firmness rating)
- chair without arm rests or wheels
- Incline ramp
- Stopwatch
- A box (9” height)
- 3 meter distance measured out and marked on the floor with tape [from chair]
Scoring
The test consists of 14 items which can be scored from 0-2 points. Therefore the test has a minimum score of 0/28 and a maximum score of 28/28.
For each item, “0” indicates the lowest level of function and “2” the highest level of function.
- Assistive devices: If a subject must use an assistive device for an item, score that item one category lower.
- Physical assistance: If a subject requires physical assistance to perform an item, score “0” for that item.
Form
- Sit-to-stand
- Rise to toes
- Single leg static balance
- Compensatory stepping correction - Forward
- Compensatory stepping correction - Backward
- Compensatory stepping correction - Lateral
- Feet together, Eyes open, static balance
- Feet together, Eyes closed, static balance
- Incline (DF) Eyes closed static balance
Anticipatory
Anticipatory subsection consists of 3 items with a maximum score of 6 points.
1 Sit-to-stand
Instruction: “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.”
“Note the initiation of the movement, and the use of the subject’s hands on the seat of the chair, the thighs, or the thrusting of the arms forward.”
Score | Level | Criteria |
---|---|---|
2 | Normal | Comes to stand without use of hands and stabilizes independently |
1 | Moderate | Comes to stand WITH use of hands on first attempt |
0 | Severe | Unable to stand up from chair without assistance, OR needs several attempts with use of hands |
Item 1 Score: Not tested
2 Rise to toes
Instruction: “Place your feet shoulder width apart. Place your hands on your hips. Try to rise as high as you can onto your toes. I will count out loud to 3 seconds. Try to hold this pose for at least 3 seconds. Look straight ahead. Rise now.”
“Allow the subject two attempts. Score the best attempt. (If you suspect that subject is using less than full height, ask the subject to rise up while holding the examiners’ hands.) Make sure the subject looks at a non-moving target 4-12 feet away”
Score | Level | Criteria |
---|---|---|
2 | Normal | Stable for 3s with maximum height |
1 | Moderate | Heels up, but not full range (smaller than when holding hands), OR noticeable instability for 3s |
0 | Severe | <3s |
Item 2 Score: Not tested
3 Single leg static balance
Instruction: “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.”
To score each side separately use the trial with the longest time. To calculate the sub-score and total score use the side [left or right] with the lowest numerical score [i.e. the worse side].
Score | Level | Criteria |
---|---|---|
2 | Normal | 20s |
1 | Moderate | < 20s |
0 | Severe | Unable |
LLE | RLE | |||
---|---|---|---|---|
Trial 1 | — s | — s | ||
Trial 2 | — s | — s | ||
Final Time | — s | — s | ||
Final Score | — | — |
Item 3 Score: 0
Include the best score from the worst side.
“Allow the subject two attempts and record the times. Record the number of seconds the subject can hold up to a maximum of 20 seconds. Stop timing when the subject moves hands off of hips or puts a foot down. Make sure the subject looks at a non-moving target 4-12 feet ahead. Repeat on other side.”
Example
You have a patient who scores the following:
| Trial | Right | Left |
|-|-|-|
| Trial 1 | 17s | 19s |
| Trial 2 | 20s| 15s |
When scoring **both** legs, you would report the best score from the two trials:
| Right | Left |
|-|-|
| 20s (2/2 pt) | 19s (1/2 pt) |
When calculating the subscore or the overall score, you cannot include both legs, since each item can only be worth 2 points.
Thus, you must choose the leg with the *worse* score, in this case, it would be the left leg.
You would report this items score as follows:
| Item | Time | Score | Level |
|-|-|-|-|
| Item 3 | 19s | 1/2 pt | Moderate |
Reactive postural control
Reactive postural control subsection consists of 3 items with a maximum score of 6 points.
- Compensatory stepping correction - Forward
- Compensatory stepping correction - Backward
- Compensatory stepping correction - Lateral
4 Compensatory stepping correction - Forward
Instruction: “Stand with your feet shoulder width apart, arms at your sides. Lean forward against my hands beyond your forward limits. When I let go, do whatever is necessary, including taking a step, to avoid a fall.”
Score | Level | Criteria |
---|---|---|
2 | Normal | Recovers independently with a single, large step (second realignment step is allowed) |
1 | Moderate | More than one step used to recover equilibrium |
0 | Severe | No step, OR would fall if not caught, OR falls spontaneously |
Current Score4: 0
“Stand in front of the subject with one hand on each shoulder and ask the subject to lean forward (Make sure there is room for them to step forward). Require the subject to lean until the subject’s shoulders and hips are in front of toes. After you feel the subject’s body weight in your hands, very suddenly release your support. The test must elicit a step. NOTE: Be prepared to catch subject.”
5 Compensatory stepping correction - Backward
Instruction: “Stand with your feet shoulder width apart, arms at your sides. Lean backward against my hands beyond your backward limits. When I let go, do whatever is necessary, including taking a step, to avoid a fall.”
Be prepared to catch subject!
Score | Level | Criteria |
---|---|---|
2 | Normal | Recovers independently with a single, large step |
1 | Moderate | More than one step used to recover equilibrium |
0 | Severe | No step, OR would fall if not caught, OR falls spontaneously |
Item 5 score: 0
“Stand behind the subject with one hand on each scapula and ask the subject to lean backward (Make sure there is room for the subject to step backward.) Require the subject to lean until their shoulders and hips are in back of their heels. After you feel the subject’s body weight in your hands, very suddenly release your support. Test must elicit a step”
6 Compensatory stepping correction - Lateral
Instruction: “Stand with your feet together, arms down at your sides. Lean into my hand beyond your sideways limit. When I let go, do whatever is necessary, including taking a step, to avoid a fall.”
Be prepared to catch subject!
Score | Level | Criteria |
---|---|---|
2 | Normal | Recovers independently with a single, large step |
1 | Moderate | More than one step used to recover equilibrium |
0 | Severe | No step, OR would fall if not caught, OR falls spontaneously |
Item 6 Score: 0
Only include the score for the worst side.
Stand to the side of the subject, place one hand on the side of the subject’s pelvis, and have the subject lean their whole body into your hands. Require the subject to lean until the midline of the pelvis is over the right (or left) foot and then suddenly release your hold
Sensory orientation
Sensory orientation is a subsection with a subscore of 6 points.
- Item 7: Feet together, Eyes open, static balance
- Item 8 Feet together, Eyes closed, static balance
- Item 9 Incline (DF) Eyes closed static balance
7 Feet together, Eyes open, static balance
Instruction: “Place your hands on your hips. Place your feet together until almost touching. Look straight ahead. Be as stable and still as possible, until I say stop.”
“Record the time the subject was able to stand with feet together up to a maximum of 30 seconds. Make sure subject looks at a non-moving target 4-12 feet away.”
Score | Level | Criteria |
---|---|---|
2 | Normal | ≥30s |
1 | Moderate | <30s |
0 | Severe | Unable |
— s
Item 7 Score: 0
8 Feet together, Eyes closed, static balance
Instruction: “Step onto the foam. Place your hands on your hips. Place your feet together until almost touching. Be as stable and still as possible, until I say stop. I will start timing when you close your eyes.”
“Use medium density Temper® foam, 4 inches thick. Assist subject in stepping onto foam. Record the time the subject was able to stand in each condition to a maximum of 30 seconds. Have the subject step off of the foam between trials. Flip the foam over between each trial to ensure the foam has retained its shape.”
Score | Level | Criteria |
---|---|---|
2 | Normal | ≥30s |
1 | Moderate | <30s |
0 | Severe | Unable |
— s
Item 8 Score: 0
9 Incline (DF) Eyes closed static balance
Instruction: “Step onto the incline ramp. Please stand on the incline ramp with your toes toward the top. Place your feet shoulder width apart and have your arms down at your sides. I will start timing when you close your eyes.”
Score | Level | Criteria |
---|---|---|
2 | Normal | ≥30s |
1 | Moderate | <30s |
0 | Severe | Unable |
— s
Item 9 Score: 0
“Aid the subject onto the ramp. Once the subject closes eyes, begin timing and record time. Note if there is excessive sway.”
Dynamic gait
The dynamic gait subsection consists of 5 items and a maximum of 10 points.
- Item 10: Change in gait speed
- Item 11: Walk + Horizontal head turns
- Item 12 Gait + Pivot turns
- Item 13 Step over obstacles
- Item 14 Timed Up & Go with Dual-task
10 Change in Gait Speed
Instruction: “Begin walking at your normal speed, when I tell you ‘fast’, walk as fast as you can. When I say ‘slow’, walk very slowly.”
“Allow the subject to take 3-5 steps at normal speed, and then say “fast”. After 3-5 fast steps, say “slow”. Allow 3-5 slow steps before the subject stops walking.”
Score | Level | Criteria |
---|---|---|
2 | Normal | Significantly changes walking speed without imbalance |
1 | Moderate | Unable to change walking speed or signs of imbalance |
0 | Severe | Unable to achieve significant change in walking speed AND signs of imbalance |
Item 10 Score: 0
11 Walk + Horizontal Head Turns
Instruction: “Begin walking at your normal speed, when I say “right”, turn your head and look to the right. When I say “left” turn your head and look to the left. Try to keep yourself walking in a straight line.”
“Allow the subject to reach normal speed, and give the commands “right, left” every 3-5 steps. Score if you see a problem in either direction. If subject has severe cervical restrictions allow combined head and trunk movements.”
Score | Level | Criteria |
---|---|---|
2 | Normal | Performs head turns with no change in gait speed and good balance |
1 | Moderate | Performs head turns with reduction in gait speed |
0 | Severe | Performs head turns with imbalance |
Item 11 Current: 0
12 Gait + Pivot turns
Instruction: “Begin walking at your normal speed. When I tell you to ‘turn and stop’, turn as quickly as you can, face the opposite direction, and stop. After the turn, your feet should be close together.”
“Demonstrate a pivot turn. Once the subject is walking at normal speed, say “turn and stop.” Count the number of steps from “turn” until the subject is stable. Imbalance may be indicated by wide stance, extra stepping or trunk motion. ”
Score | Level | Criteria |
---|---|---|
2 | Normal | Turns with feet close FAST (< 3 steps) with good balance |
1 | Moderate | Turns with feet close SLOW (>4 steps) with good balance |
0 | Severe | Cannot turn with feet close at any speed without imbalance |
Item 12 Current: 0
13 Step over obstacles
Instruction: “Begin walking at your normal speed. When you get to the box, step over it, not around it and keep walking.”
“Place the box (9 inches or 23 cm height) 10 feet away from where the subject will begin walking. Two shoeboxes taped together works well to create this apparatus”
Score | Level | Criteria |
---|---|---|
2 | Normal | Able to step over box with minimal change of gait speed and with good balance |
1 | Moderate | Steps over box but touches box OR displays cautious behavior by slowing gait |
0 | Severe | Unable to step over box OR steps around box |
Item 13 Score: 0
14 Timed Up & Go with Dual-task
- 3 meter walk
- Instruction TUG: “When I say ‘Go’, stand up from chair, walk at your normal speed across the tape on the floor, turn around, and come back to sit in the chair.” Instruction TUG with Dual Task: “Count backwards by threes starting at ___. When I say ‘Go’, stand up from chair, walk at your normal speed across the tape on the floor, turn around, and come back to sit in the chair. Continue counting backwards the entire time.”
Score | Level | Criteria |
---|---|---|
2 | Normal | No noticeable change in sitting, standing or walking while backward counting when compared to TUG without Dual Task |
1 | Moderate | Dual Task affects either counting OR walking (>10%) when compared to the TUG without Dual Task |
0 | Severe | Stops counting while walking OR stops walking while counting |
Item 14 TUG Time: Not tested
Item 14 Cognitive TUG Time: Not tested
Item 14 Score: Not tested
Item 14 TUG + TUG Cog: Not tested (TUG: , Cog-TUG: , %Δ )
If the patient’s gait speed decreases more than 10% when adding the Dual Task, the score should be ↓decreased by a point.
“Use the TUG time to determine the effects of dual tasking. The subject should walk a 3 meter distance. TUG: Have the subject sitting with the subject’s back against the chair. The subject will be timed from the moment you say “Go” until the subject returns to sitting. Stop timing when the subject’s buttocks hit the chair bottom and the subject’s back is against the chair. The chair should be firm without arms. TUG With Dual Task: While sitting determine how fast and accurately the subject can count backwards by threes starting from a number between 100-90. Then, ask the subject to count from a different number and after a few numbers say “Go”. Time the subject from the moment you say “Go” until the subject returns to the sitting position. Score dual task as affecting counting or walking if speed slows (>10%) from TUG and or new signs of imbalance.”
Final Results
Item 1 STS: Not tested
Item 2 Heel Raise: Not tested
Item 3 SLB: Not tested
Anticipatory Subtotal: 0
Item 4 Forward compensatory step: Not tested
Item 5 Backward compensatory step: Not tested
Item 6 Lateral compensatory step: Not tested
Reactive Postural Control Subtotal: 0
Item 7 Static balance (Feet together + EO): Not tested (NA)
Item 8 Static balance (Feet together + EC + FOAM): Not tested (NA)
Item 9 Incline + EC Balance: Not tested (NA)
Sensory Orientation Subtotal: 0
Item 10 Change in gait speed: Not tested
Item 11 Gait + Horizontal head turns: Not tested
Item 12 Gait + Pivot: Not tested
Item 13 Step over Obstacle: Not tested
Item 14 TUG + TUG Cog: Not tested (TUG: , Cog-TUG: , %Δ: )
Dynamic Gait Subtotal: 0
Total: 0