Balance grades for occupational therapy

Sitting and Standing Balance Grades for Occupational Therapy

As occupational therapists, we are well aware that balance impairments can impact our patients’ level of independence, but we can sometimes feel uncertain about what the formal balance grades actually are in occupational therapy assessments and treatment notes.

To help clear things up, we’ll be highlighting the balance grades for static and dynamic sitting and standing balance as well as balance outcome measures you can use. You will note that some occupational therapists and physical therapists may document balance grades slightly differently depending on what measure they are using.

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At times, I still find myself trying to explain my patient’s current sitting or standing balance ability, but it is so much more efficient to use a formal balance grade to define it.

For example, documenting that…

“Patient has fair dynamic standing balance, which impacts his ability to complete lower body dressing independently,” sounds so much more professional and concise than…

“Patient was able to stand without physical assistance from OT, but could only reach on the one side of his body and was unable to cross over in lower body dressing, resulting in him losing his balance.”

They’re both describing the same thing, but the use of balance grades results in faster note documentation.

You too will be able to write more concise notes using the sitting and standing balance grades detailed below.

Center of Mass vs Base of Support

You first need to understand what the following two terms mean, before you can fully understand static and dynamic balance:

  • Base of support: This is the area that is supporting you. Ex: your feet when you are standing, or your buttocks, thighs and feet when you are sitting unsupported.
  • Center of mass: If you think of the name, it actually defines it. It is the center of your mass, in other words your ‘middle.’

Static Balance vs Dynamic Balance

  • Static balance: The body remains stationary. This is when your center of mass stays above your base of support. Ex: You are sitting on a chair and using your phone.
  • Dynamic balance: This is when you move. Your center of mass moves outside of your base of support. Ex: reaching for your cellphone far away from you on the table in front of you. It can also be when your center of mass is moving while walking or riding a swing.

Note that it is easier to achieve static balance than dynamic balance, in both sitting and standing.

addressing balance in occupational therapy

Grading Balance

Some occupational therapists document balance grading a bit more simply in the following format:

  • Normal
  • Good
  • Fair
  • Poor

Some occupational therapists, however, document balance in more detail in the following format:

Grading/Interpretation

Normal

  • Static sitting: Able to maintain steady balance without a backrest or arm support against maximal resistance
  • Dynamic sitting: Able to sit unsupported and easily shift weight in all directions with maximum challenge and cross midline maximally.
  • Static standing: Able to maintain standing balance against maximal resistance
  • Dynamic standing: Able to stand independently unsupported, shift weight in standing in all directions and cross midline maximally.

Good

  • Static sitting: Able to maintain steady balance without a backrest or arm support against moderate resistance
  • Dynamic sitting: Able to sit unsupported and weight shift in different directions, and cross midline moderately.
  • Static standing: Able to maintain standing balance against moderate resistance
  • Dynamic standing: Able to stand independently unsupported and cross midline moderately.

Good -/Fair +

  • Static sitting: Able to maintain steady balance without a backrest or arm support against minimal resistance
  • Dynamic sitting: Able to sit unsupported and weight shift in different directions, and cross midline minimally.
  • Static standing: Able to maintain standing balance against minimal resistance
  • Dynamic standing: Able to stand independently unsupported and shift weight in standing in all directions and cross midline minimally.

Fair

  • Static sitting: Able to sit without support without use of upper extremities and balance loss
  • Dynamic sitting: Able to sit unsupported and can minimally weight-shift to the same side and the front. Pt has difficulty crossing their midline.
  • Static standing: Able to stand unsupported without use of upper extremities and without losing balance for 1-2 minutes.
  • Dynamic standing: Able to stand unsupported , weight shift and reach to the same side only. Difficulty in crossing midline without losing their balance.

Fair –

  • Static sitting: Able to maintain static sitting balance without use of upper extremities
  • Dynamic sitting: Able to sit unsupported with minimal assistance and reach to the same side only. They are unable to weight-shift.
  • Static standing: Standing without balance loss with use of upper extremities or minimal support from a person.
  • Dynamic standing: Able to stand with cues and reach to the same side, but no weight shifting.

Poor +

  • Static sitting: Able to sit with minimum assistance from a chair or a person
  • Dynamic sitting: Able to sit unsupported with moderate assistance and reach to the same side only. They are unable to weight-shift.
  • Static standing: Standing without balance loss with use of upper extremities and moderate support from a person.
  • Dynamic standing: Able to stand with minimal assistance and reach to the same side, but no weight shifting.

Poor

  • Static sitting: Unable to maintain static sitting balance; they require moderate or maximum assistance from a chair or a person
  • Dynamic sitting: Able to sit unsupported with moderate assistance and reach to the same side and front. Unable to cross their midline.
  • Static standing: Standing without balance loss with use of upper extremities and maximum support from a person.
  • Dynamic standing: Able to stand with moderate assistance and reach minimally to the side. Unable to cross midline.

5 Free Balance Outcome Measures You Can Use

At My OT Spot, we like to include what outcome measures you can use, as we know the importance of using these to formally assess your patient and track their progress.

Here are five balance outcome measures and tests you can use with your patient:

  1. The Berg Balance Scale
  2. 10-meter Walk Test
  3. Timed Up and Go (TUG)
  4. Functional Reach Test
  5. Mini-BESTest

Treating Balance in Occupational Therapy

One of our most popular (and recently updated) OT interventions articles highlights our favorite occupation-based balance interventions for OTs. It provides you with several functional ideas for addressing sitting and standing balance in various occupations.

Check it out here: Occupation-Based Balance Interventions For Your OT Practice

Additionally, these 25 balance exercises from Step2Health, while not necessarily occupation-based by themselves, can also be incorporated during functional activities to further address and challenge impaired balance during self-care tasks. 

balance grades

 

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OTs and PTs may document balance slightly differently, but it is important to have an understanding of the balance grades so that you can grade your patient accordingly.

Occupational therapists target static and dynamic sitting and standing balance, as it has a direct impact on independence and safety within so many different occupations. As mentioned above, there are a variety of tests that you can use to assess and track your patient’s safety.

We hope you now feel more confident about sitting and standing balance grades and find these balance assessments useful as well. Happy balancing!

This article was co-written by Alexia Stavrou, BScOT and Sarah Stromsdorfer, OTR/L.

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