CB&M Syllabus

It is highly recommended that clinicians beginning to use the CB&M carefully review the administration guidelines and grading criteria included in the Rating Forms section. As the purpose of the scale is to evaluate persons functioning at the higher end of the continuum, the descriptors are often detailed in order to measure performance precisely. There are carefully laid out instructions to the rater and to the patient which will expedite administration and ease of scoring. Of note is that the standard to which the patient is compared is the performance of a young adult with a normal neuro-musculoskeletal system. It is strongly recommended that novice users of the scale observe the performance of healthy young adults ( in their 20's) to set the correct standard.

Item Administration

It is recommended that the rater instruct the patient verbally as well as demonstrate all of the items. In this manner, the rater acts as a model, demonstrating optimal performance and promoting understanding of the task.

All items are to be performed without walking aids (with one exception – Descending Stairs).

The item is scored on the first trial. In cases where it is clear that the individual did not understand the task, only then is re-instruction and a second trial allowed. This will ensure that the performance reflects the patient's balance ability in novel situations as would be encountered in real-life, not learned behavior.

As many of the items are challenging, if in the rater's clinical judgment, the patient would be unsafe in performing part or all of a task, the patient should not attempt it. The item should be scored according to the guidelines for any part of the task that was completed or 0 if it is not attempted.

An important set of instructions is found under the sub-title "Test is over" in 4 of the items (Unilateral Stance, 180° Tandem Pivot, Lateral Foot Scooting and Hopping Forward.) "Test is Over" implies that there has been a substantial loss of stability/balance as demonstrated by, for example, the raised foot touching down to the floor. The item should be scored up to that point when the loss of balance occurred.

CB&M Track and Equipment

The CB&M is designed to occur within a clinic setting on an 8 meter track (26.25 feet) with perpendicular start and finish lines. It may be applied to the floor with duct tape or paint. The track is very useful in identifying the accuracy of foot placement on the line (as in Tandem Walking) or as a reference to indicate whether the patient maintains a straight trajectory or veers off course (as in Walking & Looking.). In addition, several of the items are timed; the start and finish lines on the track are important for scoring by demarcating the start and end points.

The equipment requirement is minimal and includes readily available materials: digital stop watch, laundry basket or comparable-sized box, sandbag weights, a bean bag and a paper circle used as the visual target in the Walking & Looking item.

Scoring

The items are evaluated on a 6-point scale from 0 to 5. There is one exception (Descending Stairs) which has a possible high score of 6 if the person descends the stairs with vision partially obstructed, that is carrying a laundry basket. Thus, the highest possible total score for the CB&M is 96. A score of 0 denotes the inability to perform the task. The criteria for scores 1 to 5 are progressively demanding with regard to time, distance and quality of performance. The latter includes precision (eg. foot placement on the track), the accuracy of the path trajectory (straight or veering) and the presence of balance reactions such as a protective step (change-in-support strategy.) At a score of 5, the patient is able to perform the item within a specified distance and time frame and with normal quality of movement.