| Sitting: Please stand up. Try not to use your hand for support | Able to stand without using hands & stabilize independently Able to stand independently using hands Able to stand using hands after several tries Needs minimal aid to stand or to stabilize Needs mod/max assist to stand |
| Standing to sitting: Please sit down | Sits safely with minimal use of hands Controls descent by using hands Uses back of legs against chair to control descent Sits independently but has uncontrolled descent Needs assistance to sit |
| Stand unsupported: Please stand for 2 min without holding | Able to stand safely 2 min Able to stand safely 2 min w/supervision Able to stand 30 sec unsupported Needs several tries to stand 30 sec unsupported Unable to stand 30 sec unassisted |
| Transfers: Please transfer from bed/chair to chair (one should have an armrest) | Transfers safely with minor use of hands Transfers safely with definite need for hands Transfers w/VC &/or supervision Needs 1 person to assist Needs 2 people to assist |
| Sitting with back unsupported but feet supported on floor: Please sit with arms folded for 2 min | Able to sit safely 2 min Able to sit 2 min w/supervision Able to sit 30 sec Able to sit 10 sec Unable to sit 10 sec without support |
| Standing unsupported with eyes closed: Please close your eyes & stand still for 10 seconds | Stands 10 sec safely Stands 10 sec safely w/supervision Stands 3 sec safely Unable to keep eyes closed 3 sec but stays steady Needs help to keep from falling |
| Standing unsupported with feet together: Place your feet together & stand without holding | Independent × 1 min safely Independent × 1 min w/supervision Independent but unable to hold for 30 sec Need help to attain position but can maintain × 15 sec Need help to attain position & cannot maintain × 15 sec |
| Turning to look behind over shoulder while standing: Turn to look directly behind you over left shoulder & then right shoulder | Looks behind from both sides & wt shifts well Looks behind from 1 side only, shows less wt shift Turns sideways only but maintains balance Needs supervision when turning Needs assist to keep from losing balance or falling |
| Reaching forward with outstretched arm while standing: Stand with arms at 90° & reach as far forward as possible (record distance of fingertips) | > 25 cm with confidence > 12 cm safely > 5 cm safely reaches but needs supervision loses balance while trying |
| Turn 360°: Turn completely around in a full circle, turn in other direction | Turns 360° safely in 4 sec Turns 360° safely to 1 side only in 4 sec Turns 360° safely but slowly Needs close supervision or VC Needs assistance while turning |
| Pick up object from floor from a standing position: Pick up shoe or slipper placed in front of your feet | Able to pick up safely & easily Able to pick up w/supervision Unable to pick up but reaches 2-5 cm from floor & keeps balance independently Unable to pick up & needs supervision while trying Unable to try/needs assistance to keep from losing balance |
| Placing alternate foot on step while standing unsupported: Place each foot alternately on a step 4 times | Independently & safely completes 8 steps in 20 sec Independently & safely completes 8 steps in > 20 sec Completes 4 steps w/o aid with supervision Completes > 2 steps with min assist Needs assist to keep from falling |
| Standing unsupported one foot in front: Place one foot directly in front of the other & stand for 30 seconds | Tandem independently & hold 30 sec Able to place foot ahead of other independently & hold 30 sec Takes small step independently & holds 30 sec Needs help to take step but can hold 15 sec Loses balance while stepping or standing |
| Stand on one leg: Stand on one leg as long as you can without holding. | Lifts leg independently & holds > 10 sec Lifts leg independently & holds 5-10sec Lifts leg independently & holds 3 sec Tries to lift leg, unable to hold 3 sec but remains standing independently Unable to try or needs assist to prevent fall |
Sensitivity = 64%
Specificity = 90%