Community Balance and Mobility Scale

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Objective

The Community Balance and Mobility Scale (CB&M) was developed to evaluate the balance and mobility of patients who may be ambulatory, yet still have balance deficits that affect their engagement in the community[1]. This test can be beneficial for patients that have reached a ceiling effect on other objective measures, such as the Berg Balance Test and Timed Up and Go, due to the challenging nature of the tasks[2]. The purpose of the CB&M is not to indicate a need for a gait aid, falls risk, or discharge placement, but to reflect the balance and mobility skills necessary for full participation in the community[2].

Intended Population

The CB&M is intended for assessing the balance and mobility of higher functioning ambulatory individuals with ABI, including children and adolescents. Other populations that have been validated for its use include patients with stroke or cerebral palsy, and older adults[3]. This test may be especially useful for individuals who are in the process of returning to living in the community.

Method of Use

Test Setting & Equipment Required

The CB&M is completed using a set 8-meter measured track and a full flight of stairs is required. This test requires approximately 20-30 minutes to administer. It is recommended that the assessor instructs the patient verbally as well as demonstrates all of the items to ensure proper understanding[2].
CB&M scale 8-meter track setup[2]

Other materials include:[2]

  • Stopwatch
  • Laundry basket or large rigid box of the same dimensions
  • 2 lb. and 7.5 lb. weights
  • A visual target (a paper circle 20 cm in diameter with a 5 cm black circle in the middle)
  • A bean bag

Scoring

The CB&M is comprised of 13 items, and 6 of the tasks are to be performed bilaterally. Scoring is based on a scale of 0 to 5, with a score of 0 reflecting complete inability to perform the task and a score of 5 reflecting the most successful completion of the task possible[2]. CB&M scores range from 0 to 96, and items are scored upon completion of the first trial of an item. The only exceptions are if it is clear that the individual did not understand the task, in which case re-instruction and a second trial are allowed[2]. Items are to be completed without use of a gait aid, with exception for #12, although orthoses are allowed to be worn[2]. If the patient is unable to complete the task or the therapist deems the task would not be safe for the patient to complete, a score of zero should be recorded[2].

List of Items

  1. Unilateral Stance
  2. Tandem Walking
  3. 180 Tandem Pivot
  4. Lateral Foot Scooting
  5. Hopping Forward
  6. Crouch and Walk
  7. Lateral Dodging
  8. Walking & Looking
  9. Running with Controlled Stop
  10. Forward to Backward Walking
  11. Walk, Look and Carry
  12. Descending Stairs
  13. Step-Ups x 1 Step

Evidence

Reliability

In adults, intraclass correlation coefficients (ICCs) of 0.977 (95% CI = 0.957 - 0.986) for intra-rater reliability, 0.977 (95% CI = 0.972 - 0.988) for inter-rater reliability, 0.898 (95% CI = 0.624 - 0.953) for 5 day apart reliability, and 0.975 (95%CI = 0.810 - 0.991) for immediate test-retest reliability were established[1].

In children and youth, ICCs of 0.93 (95% CI = 0.87 - 0.97) for inter-rater and 0.90 (95% CI = 0.81 - 0.95) for test-retest reliability (3 - 14 days apart, with a mean interval of 8.4 days) were established within a live-rating setting[4]. In the video-rating setting, ICCs of 0.95 (95% CI = 0.89 - 0.97) for inter-rater reliability and 0.90 (95% CI = 0.79 - 0.95) for test-retest reliability were demonstrated[4].

Validity

Construct validity was established by Howe et al. (2006) with a significant correlation with self-paced gait velocity at r = 0.53 (p = 0.001) and maximal gait velocity r = 0.64 (p = 0.001)[1]. In addition, mean CB&M scores were statistically significant (p < 0.03) between different care settings, demonstrating the measure's ability to differentiate amongst various settings and the continuum of rehabilitation[1].

CB&M can be used to determine if a patient will be able to return to community living and is considered a valid outcome measure in order to determine dynamic instability[2].

Miscellaneous

While further research is required, it is suggested that a CB&M change score of 8 points or more in the patient is reflective of true change beyond measurement error[2].

In children and youth, the minimal detectable change (MDC) was established as 12.7 points at the 90% CI level [4].

Considerations

  • Administration of the CB&M scale does not require specific training, but therapists should be familiar with the tool and have a good understanding of it prior to use. While therapists reported difficulty with observing all required criteria simultaneously when first using the scale, over time and with practice it became easier[1].
  • The CB&M items represent skills that are required for community living. As a result, the environmental context in which the items are performed should be considered to provide a complete assessment of the patient's mobility[1].
  • The test can be administered within 20-30 minutes depending on familiarity for therapist and patient. The test may require more time if the therapist is unfamiliar with the administration or when a patient is first introduced to the scale. In addition, the scale may  take longer to administer in children[2].

Links

Community Balance & Mobility Scale Manual

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Howe JA, Inness EL, Venturini A, Williams JI, Verrier MC. The Community Balance and Mobility Scale-a balance measure for individuals with traumatic brain injury. Clinical Rehabilitation. 2006 Oct;20(10):885-95.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 Howe J, Inness E, Wright V. The Community Balance and Mobility Scale [Internet]. Tbims.org. 2011 [cited 5 May 2018]. Available from: http://www.tbims.org/cbm/index.html
  3. Community Balance and Mobility Scale [Internet]. Shirley Ryan AbilityLab - Formerly RIC. 2013 [cited 5 May 2018]. Available from: https://www.sralab.org/rehabilitation-measures/community-balance-and-mobility-scale#stroke
  4. 4.0 4.1 4.2 Wright F, Ryan J, Brewer K. Reliability of the Community Balance and Mobility Scale (CB&M) in high-functioning school-aged children and adolescents who have an acquired brain injury. Brain Injury. 2010;24(13-14):1585-1594.