Gabby Kulikowski

Assessment Project

The Kool Balance Scale (KBS)

Section 1: Description of Rating Scale

  1. The purpose of this rating scale is for physical therapists to measure balance among elderly adults with impairment in balance function by the assessment of their performance of simple, functional tasks. It is a very effective way to measure balance in a clinical setting.
  2. The general population of the patients that will be assessed are older adults, 65 or older, and generally with physical impairment problems such as acquired brain injury, arthritis, multiple sclerosis, Parkinson’s disease, spinal cord injury, stroke, and traumatic brain injury. The elderly assessed have falling instances that occur on a regular basis.
  3. I would use this rating scale for pretest evaluation of therapy and for post-test evaluation of therapy so that I can assess how much the patient’s balance has improved after rehabilitation. It is important that I use this for pre and post-test so that not only can I identify how much the patient has improved individually, but also if this type of assessment would be beneficial to use on other patients of the same age and with the same physical impairments.
  4. I have selected this scale in order to improve balance in older adults because at the age of 65 and older balance is lost normally or do to other complications, such as the physical impairments that I had mentioned above. It is, again, very important to restore balance and functional mobility of the elderly population so that they will live a longer and healthier life and their quality of life will be improved.
  5. There are 14 static and dynamic exercises that are used to assess the balance in the older adult population varying in difficulty. The item score ranges are from 0 to 4, recorded by the observer. “0” indicates the lowest level of function and “4” indicates the highest level of function. The highest total score that an individual can receive is 40. There are three ranges in order to assess the individual. If a patient scores a 25-40, then they have a low fall risk. If the patient scores a 5-21, then the patient has a medium fall risk. Lastly if the patient scores a 0-4, then the patient has a high fall risk. A change of 8 points is required to show a significant change in function between 2 tests, in this case pre and post-test evaluation.
  6. The test administer does not need to be certified, but a specialist would be preferred, such as a physical therapist. All they would need to know is the logistics of the specific exercises, how to do them, what a perfect exercise should look like, they should carry out the test in a 15 to 20 minute time frame, and they should be able to work with simple equipment. The equipment required for this assessment is a stop watch, chair with arm rests, measuring tape or a ruler, and object to pick up off of the floor, a step stool, and a paper and pencil.
  7. As stated previously, if the patient were to score between 0-4, they are at high risk for fall so I would design an intense rehabilitation program for the individual so that I can help them achieve a higher score by making them stronger. If they were to score in the medium range, I would design a rehabilitation program for them that was not as intense as someone who had scored lower, but a program with a good amount of difficulty so they too could improve their balance. Considering that the patient will already have had a script written by their doctor for them to come as see me as their physical therapist, regardless of the score I will not need another script because they will already have the appropriate amount of visits handled by their insurance and their doctor. This would be considered summative evaluation because I would test my patients before and after, allowing for me to compare the two assessments and draw conclusions for their health.

Section 2: Actual Rating Scale

The Kool Balance Scale

Name: ______Date: ______

Rater: ______

ITEM DESCRIPTIONSCORE (0-4)

  1. Sitting to standing______
  2. Standing unsupported______
  3. Standing to sitting______
  4. Transfers______
  5. Standing with eyes closed______
  6. Standing with feet together______
  7. Picking up object from floor______
  8. Turning 360 degrees______
  9. Standing with one foot in front______
  10. Standing on one foot______

Total______

1. SITTING TO STANDING

INSTRUCTIONS: Stand up without the use of hands for support.

( ) 4able to stand without using hands and stabilize independently

( ) 3able to stand but using hands

( ) 2able to stand but using hands after multiple tries

( ) 1needs minimal aid to stand or stabilize

( ) 0needs moderate or maximal assistance to stand

2. STANDING UNSUPPORTED

INSTRUCTIONS: Stand for two minutes without holding on.

( ) 4able to stand safely for 2 minutes

( ) 3able to stand 2 minutes with supervision

( ) 2able to stand 30 seconds without the help of assessor

( ) 1needs several tries to stand for 30 seconds

( ) 0unable to stand 30 seconds without assistance

3. STANDING TO SITTING

INSTRUCTIONS: Sit down normally.

( ) 4sits safely with minimal use of hands

( ) 3sits safely by using hands

( ) 2sits safely with use of back of legs against chair

( ) 1sits down but uses anything as an aid to sit down

( ) 0cannot sit without assistance from personnel

4. TRANSFERS

INSTRUCTIONS: Arrange chair(s) for pivot transfer. Patient is to transfer one way toward a seat with armrests and one way toward a seat without armrests.

( ) 4able to transfer safely with minor use of hands

( ) 3able to transfer safely but needs hands

( ) 2able to transfer but needs a person to assist

( ) 1needs two people to assist

( ) 0cannot transfer at all

5. STANDING UNSUPPORTED WITH EYES CLOSED

INSTRUCTIONS: Close eyes and stand still for 10 seconds.

( ) 4able to stand 10 seconds safely

( ) 3able to stand 10 seconds with supervision maximal supervision

( ) 2able to stand 5 seconds

( ) 1unable to keep eyes closed and balanced for 3 seconds

( ) 0needs help to keep from falling/cannot balance with eyes closed

6. STANDING UNSUPPORTED WITH FEET TOGETHER

INSTRUCTIONS: Stand feet together, without holding on to anything.

( ) 4able to place feet together independently and stand 1 minute safely

( ) 3able to place feet together independently and stand 1 minute with supervision

( ) 2able to place feet together independently but unable to hold for 30 seconds

( ) 1needs help to attain position but able to stand 15 seconds feet together

( ) 0needs help to attain position and unable to hold for 5 seconds

7. PICK UP OBJECT FROM THE FLOOR FROM A STANDING POSITION

INSTRUCTIONS: Pick up the shoe/slipper from in front of patient’s feet

( ) 4able to pick up slipper easily

( ) 3able to pick up slipper but needs supervision

( ) 2unable to pick up but reaches 2cm(1 inch) from slipper and keeps balance

( ) 1unable to pick up independently but is possible supervision

( ) 0cannot pick up the shoe/slipper

8. TURN 360 DEGREES

INSTRUCTIONS: Turn completely around in a full circle. Pause. Then turn a full circle in the other direction.

( ) 4able to turn 360 degrees safely in 5 seconds or less

( ) 3able to turn 360 degrees safely one side only 5 seconds or less

( ) 2able to turn 180 degrees one way

( ) 1cannot turn without supervision

( ) 0cannot turn

9. STANDING UNSUPPORTED ONE FOOT IN FRONT

INSTRUCTIONS: (DEMONSTRATE TO SUBJECT) Place one foot directly in front of the other. Step far enough ahead that the heel of your forward foot is ahead of the toes of the other foot if one cannot put both feet as close together as possible.

( ) 4able to place foot directly in front of the other (touching) and hold 30 seconds

( ) 3able to place foot ahead with minimal space in between and hold 30 seconds

( ) 2able to place foot about 2 centimeters (1 inch) ahead of the other and hold 30 seconds

( ) 1able to place foot about 2 centimeters (1 inch) ahead of the other and hold 15 seconds

( ) 0loses balance while standing

10. STANDING ON ONE LEG

INSTRUCTIONS: Stand on one leg as long as you can without holding on.

( ) 4able to lift leg and hold > 10 seconds

( ) 3able to lift leg and hold for 5seconds

( ) 2able to lift leg with assistance and hold ≥ 3 seconds

( ) 1tries to lift leg unable to hold 3 seconds but remains standing

( ) 0cannot lift leg/balance

( ) TOTAL SCORE (Maximum = 40)

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