Individuals using the Community Balance & Mobility Scale (CB&M) should review and refer to the administration and scoring guidelines during patient testing (see Rating Forms section). The following training vignettes do not encompass all of the task items but provide some key points of clarification related to scoring some select items. For further clarification or information, please contact the developers identified in contacts.
Item 1. Unilateral stance
Jane stood in unilateral stance on her affected left lower limb for 5 seconds, placed her foot down on the ground and then lifted it again to hold it for a further 20 seconds. Jane was able to stand on her unaffected right lower limb for 45 seconds. The therapist observed increased amount of sway at the hips and ankles during the last 5 seconds of the test in attempt to maintain balance.
Correct Score: Left 2
The Unilateral Stance test is over when the stance foot moves or the opposite foot touches the ground, therefore, the first 5 seconds constituted her test performance. For all CB&M items, the rater should score on the patient's first trial (unless the patient clearly did not understand the task).
Correct Score: Right 4
Despite achieving the time criteria of 45 seconds with her unaffected lower limb, the patient was not able to sustain this position in a 'steady and coordinated manner'; therefore, she was rated the lower score of 4. The rating therapist should always judge the patient's quality of performance in comparison to a young adult with a healthy neuro-musculoskeletal system.
Item 2. Tandem walking
Bill was able to walk for 7 steps on the line. For the first 2 steps, he walked in a straight line, with a heel-toe distance of approximately 2 inches. On the 3rd step his heel and toe were approximately 6 inches apart. For the last 4 steps, he was able to walk again in a straight line but with the heel-toe distance approximately 2 inches apart.
Correct Score: 3
The patient is allowed to take a maximum of 7 steps. For scoring count only those consecutive steps for which the heel is on the line and the heel-toe distance is < 8 cm (3 inches). The first 2 steps would be considered 'consecutive' steps, as per the scoring criteria. However the 3rd step does not meet the heel-toe distance criterion and therefore is not counted. The subsequent 4 steps again met the heel-toe distance criteria and are counted as consecutive steps. Therefore, his best performance of the 7 steps was the last 4 consecutive steps. He would not score 4 as the scoring criteria of a 4 or 5 require good alignment (heel-toe contact, feet straight on the line, no toeing out).
Item 3. 180 Tandem Pivot
Jack turned 90°, placed his heels down, then completed the 180° turn and maintained this final position.
Correct Score: 2
The test is over when the patient puts his heels down i.e. when he had only turned 90°. He therefore was unable to complete the 180° turn.
Item 5. Hopping Forward
The physical therapist was concerned that Karen's left ankle was too unstable to hop safely without a potential injury.
Correct Score: Left 0
If in the therapist's clinical judgment the patient would be unsafe in performing part or all of a task, the patient should not attempt it. Score according to the guidelines if part of the task is attempted or score "0" if it is not attempted.
Item 6. Crouch and Walk
Suzanna was able to complete the crouch and walk task in 6.0 seconds but she paused briefly during the crouch to pick up the bean bag.
Correct Score: 2
The patient must be able to crouch and walk in a continuous motion i.e. maintain forward momentum during the task. Sometimes the inability to maintain forward momentum is obvious as the patient will plant both feet side by side prior to bending down to pick up the bean bag. However, even if the patient maintains a stride stance, a hesitation may still occur. In deciding whether or not the patient hesitated, the main point is that the patient should not have to pause to re-establish postural control during the transition from the onset of the crouch and back up to walking. Picture how a baseball player may swoop down to retrieve a baseball or a busy mom may be in continuous motion to clear the child's toys off the family room floor.
Item 8. Walking & Looking Scenario One
Maria was able to walk forwards while keeping her eyes fixated on the target circle to her left. On close observation, the physical therapist noticed that after Maria passed the 4 metre mark, she kept her head oriented towards the target but furtively glanced ahead to the finish line on a few occasions.
Correct Score: 2
Maria is not able to maintain forward walking with her vision directed at the target and away from her path. Maria would score a "2" as she did not maintain visual fixation i.e. constant gaze at the target. It is critical for the physical therapist to stand beside the target to ensure that visual fixation can be monitored and appropriately rated. A second person may therefore be needed to walk alongside the patient to ensure safety.
Item 8. Walking & Looking Scenario Two
Ed was able to walk and maintain visual fixation on the target between the 2 to 6 metre marks. The physical therapist then instructed him to "look straight ahead and continue walking…" As he turned his head forward, he took a small, rapid lateral step before resuming his straight path to the finish line.
Correct Score: 3
A protective step (or compensatory step) is a reactive balance response. It can often be characterized by the rapid nature of the step, not in rhythm with the patient's usual stepping pattern. Ed took a rapid step in order to establish a new base of support, thus keeping his centre of mass within it and maintaining stability.