This paper aims to compare and contrast two physical assessment tools used to evaluate balance; postural control has been defined as the ability to maintain the body’s center of gravity within the base of support during a stable position or involuntary movements and responds to postural disturbance, posture, and motor coordination in older adults. The physical assessment tools that have been chosen for comparative analysis include Berg Balance Scale (BBS) physical assessment tool and the Timed Up and Go Test (TUG). Berg balance scale can be deemed reliable and valid because it has greater reliability due to the ceiling effect of 56 points. On the other hand, the Timed Up and Go Test (TUG) is also reliable and valid because when used with frail, it has good inter-rater reliability and concurrent validity.
The first test is the BBS which provides scores that allow us to approximate the state of balance of the patient, detect the risk of falls and focus treatment on the areas that are most compromised. The test consists of 14 items performed in a standardized order in which the support base decreases, leading the patient to increasingly unstable positions. Each item has a 5-point scale (0 to 4 points) according to the quality or time necessary to carry out each task, with a maximum score of 56 points (Donnelly, 2018). If the score obtained is from 0 to 20, it implies that the patient requires a wheelchair; from 21 to 40, assistance is required to walk, and from 41 to 56, the patient is functionally independent. The BBS is made up of the following items: From seated to bipedal, unsupported bipedal, unsupported seated, from bipedal to seated, transfers, bipedal with eyes closed, bipedal with feet together, forward reach (arm at 90º), pick up an object on the floor, trunk twist, turn 360º, alternating feet on the stool, tandem position and one-legged support.
In contrast TUG test includes basic skills such as getting up from a chair, walking, turning, and sitting back in the same chair45. The TUG, according to Bischoff, is an effective method to assess mobility and quantify the performance of the musculoskeletal system, as well as being an objective, quick, and easy to perform the test. The TUG is a modification of the GetUp and Go test created by Mathias100 in 1986, which measured the risk of falling using a scale. The original concept is attractive because it describes a realistic assessment of mobility, including situations of possible falls, as well as transfer in and out of a chair, walking, and turning. It is a test in which the time it takes the subject to get up from a chair, walk 240 cm, turn around, walk the 240 cm back, and sit down again101 is taken. The subject can use his usual aids but without receiving assistance from another person101.
This test aims to evaluate the body mobility of the MA, and it implies power, speed, agility, and dynamic balance. The chair must remain leaning against the wall (Berwanger, 2017). Further, the floor should be marked with tape or a cone located 240 cm from the chair. The assessor should be located at a medium distance between the chair and the marking in case the patient loses his balance; turning on the timer at the moment of giving the order “now” to stop it when the participant is sitting in the chair.
According to Carreon (2019), one critique of the Berg Balance scale is that this tool cannot be used as a strong predictor of fall risk in, for instance, stroke population, as the scoring explanations show. On the other hand, Greenberg (2019) asserts that one critique of the TUG test is that it has limited ability to foretell falls in elderly living communities and therefore should not be used in isolation to categorize persons at high risk of falls in this setup. Therefore TUG test predictive ability remains unlimited for future falls. It is pertinent to say that the physical assessment tools discussed above can support older adults in maintaining or improving their quality of life.
References
Donnelly, A. E. (2018). A systematic literature review of reviews on techniques for physical activity measurement in adults: a DEDIPAC study. International Journal of Behavioral Nutrition and Physical Activity, 15(1), 1-33.
Carreon, L. Y. (2019). The Berg balance scale for assessing dynamic stability and balance in the adult spinal deformity (ASD) population. Journal of Spine Surgery, 5(4), 451.
Greenberg, M. R. (2019). Effectiveness of the “Timed Up and Go”(TUG) and the Chair test as screening tools for geriatric fall risk assessment in the ED. The American journal of emergency medicine, 37(3), 457-460.
Berwanger, D. D. (2017). Identifying frailty syndrome with TUG test in home-dwelling elderly. Geriatrics, gerontology and aging, 11(2), 80-87.
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