Fullerton Advanced Balance (FAB) Scale

Test Equipment:

Stop watch; 36” ruler; pen or pencil; 6” bench; metronome; 2 airex pads and one or more 12 inch lengths of non-slip material.

1) Standing with Feet Together and Eyes Closed.

Equipment: None

Verbal Instructions:
“Bring your feet together, and fold your arms across your chest. Close your eyes when you are ready and remain as steady as possible until I instruct you to open your eyes.”

Grading: Please mark the lowest category that applies.

0 - Unable to obtain the correct standing position independently.
1 - Able to obtain the correct standing position independently but unable to maintain the position or keep the eyes closed for more than 10 seconds.
2 - Able to maintain the correct standing position with eyes closed for more than 10 seconds but less than 30 seconds.
3 - Able to maintain the correct standing position with eyes closed for 30 seconds but requires close supervision.
4 - Able to maintain the correct standing position with eyes closed for 30 seconds safely.

2) Reaching Forward to Retrieve an Object (pencil) Held at Shoulder Height with Outstretched Arm.

Equipment: Pencil, 12 inch ruler

Verbal Instructions:
“Try and lean forward to take the pencil from my hand and return to your starting position without moving your feet from their present position.”

Grading: Please mark the lowest category that applies.

0 - Unable to reach the pencil without taking more than 2 steps.
1 - Able to reach the pencil but needs to take 2 steps.
2 - Able to reach the pencil but needs to take 1 step.
3 - Can reach the pencil without moving the feet but requires supervision.
4 - Can reach the pencil safely and independently without moving the feet.

3) Turn 360 Degrees in a Right and Left Direction.

Equipment: None.

Verbal Instructions:
“Turn around in a full circle, pause, then turn in a second full circle in the opposite direction.”

Grading: Please mark the lowest category that applies.

0 - Needs manual assistance while turning.
1 - Needs close supervision or verbal cueing while turning.
2 - Able to turn 360 degrees but takes more than 4 steps in both directions.
3 - Able to turn 360 degrees but unable to complete in 4 steps or less in one direction.
4 - Able to turn 360 degrees safely and takes 4 steps or less in both directions.

4) Step Up and Over a 6” Bench

Equipment: 6 inch high bench. (18 X 18 inch stepping surface)

Verbal Instructions:
“Step up onto the bench with your right leg; swing your left leg directly up and over the bench and step off the other side. Repeat in the opposite direction with your left leg as the leading leg.”

Grading: Please mark the lowest category that applies.

0 - Unable to step onto the bench without loss of balance or manual assistance.
1 - Able to step up onto the bench with lead leg but trailing leg contacts bench or swings around the bench during swing-through phase in both directions.
2 - Able to step up onto the bench with lead leg but trailing leg contacts bench or swings around bench during swing-through phase in one direction.
3 - Able to correctly complete the step up and over in both directions but requires close supervision in one or both directions.
4 - Able to correctly complete the step up and over in both directions safely and independently.

5) Tandem Walk

Equipment: Masking tape.

Verbal Instructions:
“Walk forward along the line, placing one foot directly in front of the other such that the heel and toe are in contact on each step forward. I will tell you when to stop”.

Grading: Please mark the lowest category that applies. An interruption refers to a lateral step, failure to achieve heel-toe position on certain steps, or loss of balance.

0 - Unable to complete 10 steps independently.
1 - Able to complete the 10 steps with more than 5 interruptions.
2 - Able to complete the 10 steps with 5 or less interruptions.
3 - Able to complete the 10 steps with 2 or less interruptions.
4 - Able to complete the 10 steps independently and with no interruptions.

6) Standing on One Leg

Equipment: Stopwatch.

Verbal Instructions:
“Fold your arms across the chest, lift your preferred leg off the floor (without touching your other leg), and stand with eyes open as long as you can.

Grading: Please mark the lowest category that applies.

0 - Unable to try or needs assistance to prevent falling.
1 - Able to lift leg independently but unable to maintain position for more than 5 seconds.
2 - Able to lift leg independently and maintain position for at least 5 but less than 12 seconds.
3 - Able to lift leg independently and maintain position for at least 12 but less than 20 seconds.
4 - Able to lift leg independently and maintain position for the full 20 seconds.

7) Standing on Foam with Eyes Closed

Equipment: Stopwatch; two AirexTM pads with one length of non-slip material placed between the two pads and one additional length of non-slip material between the floor and first pad if the test is being performed on a non-carpeted surface.

Verbal Instructions:
“Step up onto the foam and stand with feet shoulder width apart. Fold your arms over your chest, and close your eyes when you are ready. I will tell you when to open your eyes.”

Grading: Please mark the lowest category that applies.

0 - Unable to step onto foam and/or maintain standing position independently with eyes open.
1 - Able to step onto foam independently and maintain standing position but unable or unwilling to close eyes.
2 - Able to step onto foam independently and maintain standing position with eyes closed for 10 seconds or less.
3 - Able to step onto foam independently and maintain standing position with eyes closed for more than 10 seconds but less than 20 seconds.
4 - Able to step onto foam independently and maintain standing position with eyes closed for 20 seconds.

8) Two-footed Jump for Distance

Equipment: 36 inch ruler; piece of masking tape.

Verbal Instructions:
“Try and jump with two feet as far but as safely as you can”.

Grading: Please mark the lowest category that applies.

0 - Unable to attempt or attempts to initiate two-footed jump but one or both feet do not leave the floor.
1 - Able to initiate two-footed jump but one foot either leaves the floor or lands before the other.
2 - Able to perform two-footed jump but unable to jump further than the length of their own feet.
3 - Able to perform two-footed jump and achieve a distance greater than the length of their own feet.
4 - Able to perform two-footed jump and achieve a distance greater than twice the length of their own feet.

9) Walk with Head Turns

Equipment: Metranome set at 100 beats per minute.

Verbal Instructions: “Walk forward while turning your head from left to right with each beat of the metranome. I will tell you when to stop.”

Grading: Please mark the lowest category that applies.

0 - Unable to walk 10 steps independently while maintaining 30 degree head turns at an established pace.
1 - Able to walk 10 steps independently but unable to complete required number of 30 degree head turns at an established pace.
2 - Able to walk 10 steps but veers from a straight line while performing 30 degree head turns at an established pace.
3 - Able to walk 10 steps in a straight line while performing 30 degree head turns at an established pace but head turns less than 30 degrees in one or both directions.
4 - Able to walk 10 steps in a straight line while performing required number of 30 degree head turns at established pacing.

10) Reactive Postural Control

Equipment: None.

Verbal Instructions: “Slowly lean back into my hand until I ask you to stop.”

Grading: Please mark the lowest category that applies.

0 - Unable to maintain upright balance, no observable attempt to step- requires manual assistance to restore balance.
1 - Unable to maintain upright balance, takes two or more 2 steps and requires manual assistance to restore balance.
2 - Unable to maintain upright balance, takes two or more 2 steps but is able to restore balance independently.
3 - Unable to maintain upright balance, takes 1-2 steps but is able to restore balance independently.
4 - Unable to maintain upright balance, but is able to restore balance independently with one step only.

TOTAL SCORE = 40

1) Standing with feet together and eyes closed

Possible Impairments:

1. Weak hip ab/adductors
2. Poor COG control
3. Poor use of somatosensory cues

Recommended Exercises:

• Lateral weight shifts against resistance; side leg raises against gravity/resistance
• Seated/standing balance activities emphasizing weight shifts in multiple directions
• Standing balance activities with eyes closed (controlled sway in A-P and lateral directions)

2) Reach forward to object

Possible Impairments:

1. Reduced limits of stability
2. Reduced ankle ROM
3. Fear-of-Falling
4. Lower body muscle weakness

Recommended Exercises:

• Seated/standing COG control activities
• Ankle circles, heel lifts and drops from height
• Confidence-building activities – high success
• Wall sits; lower body exercises with resistance

3) Turn in a full circle

Possible Impairments:

1. Poor dynamic COG control
2. Possible vestibular impairment (dizziness)?
3. Lower body weakness

Recommended Exercises:

• Standing weight transfer activities; gait pattern enhancement (turns, directional changes)
• Head and eye movement coordination exercises
• Lower body exercises with resistance; emphasize hip and knee flexion; hip ab/dduction.

4) Step Up and Over

Possible Impairments:

1. Poor dynamic COG control
2. Lower body weakness
3. Reduced ROM at ankle, knee, hip

Recommended Exercises:

• Seated/standing balance activities emphasizing backward weight shifts.
• Lower body exercises with resistance (own body/ theraband: emphasize sustained unilateral stance positions.
• Flexibility exercises emphasizing hip/knee/ankle flexion. Seated and standing.

5) Tandem Walk

Possible Impairments:

1. Poor dynamic COG control
2. Poor use of vision
3. Weak hip ab/adductors

Recommended Exercises:

• Standing/moving COG control activities; emphasize A-P control during weight-shifts.
• Activities emphasizing gaze stabilization techniques.
• Side leg raise against gravity/resistance; lateral weight shift and lunge activities.

6) Stand on One Leg

Possible Impairments:

1. Poor COG control
2. Lower body muscle weakness
3. Poor use of vision

Recommended Exercises:

• Standing A-P weight shifts and transfers; reduced BOS activities
• Lower body exercises with resistance (body/theraband) emphasize hip ab/dductors
• Activities emphasizing gaze stabilization

7) Stand on foam with eyes closed

Possible Impairments:

1. Poor use of vestibular inputs for balance?
2. Lower body muscle weakness
3. Heightened fear-of-falling when vision absent

Recommended Exercises:

• Seated/standing activities performed with reduced/absent vision on altered surfaces
• Lower body exercises with resistance (body/theraband) (quadriceps; gastroc/soleus muscles).
• Confidence building activities with progressive reduction in availability of vision.

8) Two-footed jump

Possible Impairments:

1. Poor dynamic COG control
2. Poor upper and lower body coordination
3. Lower body muscle weakness

Recommended Exercises:

• Standing/moving COG activities emphasizing leaning away from and back to midline.
• Selected exercises to improve upper and lower body coordination; multiple task activities.
• Lower body exercises with resistance (body/theraband) performed at progressively faster speeds.

9) Walk with head turns

Possible Impairments:

1. Possible vestibular impairment
2. Poor use of vision
3. Poor dynamic COG control

Recommended Exercises:

• Head and eye movement coordination exercises Gait pattern enhancement (turns, directional changes).
• Activities emphasizing gaze stabilization.
• Standing/moving activities with head turns – progressively increase head turning speed and frequency.

10) Reactive Postural test

Possible Impairments:

1. Absent postural strategy (i.e. step)
2. Poor COG control
3. Lower body muscle weakness

Recommended Exercises:

• Activities emphasizing step strategy (i.e. theraband release activity).
• Standing COG control activities; volitional stepping activities in multiple directions.
• Lower body exercises with resistance; emphasize hip and knee flexion; hip ab/dduction.