The Community Balance and Mobility Scale (CBMS)

Background:

Each year up to five hundred thousand new cases of traumatic brain injury (TBI) are reported in the United States alone. Very often such injuries are accompanied by ambulatory disabilities which can only be overcome with specialized rehabilitation. Without good measurement tools it is impossible to draw accurate conclusions about the true effectiveness of such rehabilitation programs. Therefore, the Community Balance and Mobility Scale (CM&MS) was designed and verified to facilitate effective and systematic measurement of ambulatory skills in patients.

Psychometrics:

The psychometric properties of the Community Balance and Mobility Scale (CB&MS) are outlined in detail in Howe, Inness, Venturini, Williams, & Verrier, (2006).

Author of Tool:

Howe, J. A., Inness, E. L., Venturini, A., Williams, J. I. Verrier, M. C.

Key references:

Howe, J. A., Inness, E. L., Venturini, A., Williams, J. I. Verrier, M. C. (2006). The Community Balance and Mobility Scale–a balance measure for individuals with traumatic brain injury. Clinical rehabilitation, 20(10), 885-95.

Inness, E. L., Howe, J. A., Niechwiej-Szwedo, E., et al. (2009). Measuring Balance and Mobility after Traumatic Brain Injury: Validation of the Community Balance and Mobility Scale (CB&M). Physiotherapy Canada, 63(2), 199-208.

Primary use / Purpose:

The Community Balance and Mobility Scale (CB&MS) is designed to measure the ambulatory skills of individuals who are recovering from traumatic brain injuries (TBI) and attempting to once again integrate into the community.

Files:

The Community Balance and Mobility Scale (CBMS)

INTRODUCTION

The consequences of postural dyscontrol are pervasive and have a significant impact on activities of daily living, community mobility and social, work and leisure pursuits. The Community Balance and Mobility Scale (CB&M) was designed to evaluate balance and mobility in patients who, although ambulatory, have balance impairments which reduce their full engagement in community living.

The following is a brief summary of the key measurement properties of the CB&M established to date with individuals with traumatic brain injury (TBI). Content validity was obtained by the involvement of patients with TBI (n=7) and clinicians (n=17) during the item generation process. The CB&M demonstrates intraclass correlation coefficients (ICC’s) of 0.977 for both intra- and inter-rater reliability, 0.898 and 0.975 for test-retest reliability (5-day and immediate, respectively) and Cronbach’s alpha of 0.96 for internal consistency.1

Additional studies have shown that in ambulatory patients with TBI, the CB&M is less susceptible to a ceiling effect than the commonly used Berg Balance Scale and better able to capture change in this higher functioning group.2

The construct validity of the CB&M was supported by associations with laboratory measures of dynamic postural control and measures of community integration and balance confidence.2  Statistically significant correlations were demonstrated between the CB&M and spatiotemporal measures of gait including walking velocity, step length, step width and step time (r values ranging from 0.38 to 0.87). Importantly, variability in step length and step time, used as a marker of dynamic stability, also correlated significantly with CB&M scores (r values ranging from 0.46 to 0.70). Significant associations were also achieved with self-report measures of balance confidence and participation in the community using the Activities-specific Balance Confidence (ABC) scale (r=0.60) and the Community Integration Questionnaire (r=0.54), respectively.

The CB&M has been able to capture the decline in balance that occurs with aging in healthy individuals supporting the validity and sensitivity of the scale.3 Healthy age-referenced data across the decades is available from the authors to assist in interpretation of patient scores. Determining if patients are within the range of healthy values for their age group is helpful in identifying the presence and degree of balance impairment.

Clinical feedback and user reports have indicated that the scale is also appropriate for high-functioning clients with diagnoses other than traumatic brain injury but further studies are warranted.

The positive results support that the CB&M is a reliable and valid clinical outcome measure for detecting dynamic instability and evaluating change in ability in the higher functioning ambulatory patient with TBI.

For further information, please contact:

[email protected] or [email protected]

Howe J, Inness E, Venturini A, Williams JI, Verrier MC. (2006) The Community Balance and Mobility Scale: A balance measure for individuals with traumatic brain Clinical Rehabilitation, 20, 885-95.

Inness EL, Howe J, Niechwiej-Szwedo E, Jaglal S, McIlroy WE, Verrier MC. (2011) Measuring balance and mobility after traumatic brain injury: Validation of the Community Balance & Mobility Scale (CB&M). Physiotherapy Canada, 63 (2), 199-208.

Zbarsky, K, Parsley D, Clegg H, Welch T, Fernandes C, Jaglal S, Inness E, Williams J, McIlroy WE, Howe J. (2010) [Abstract] Community Balance & Mobility Scale (CB&M): Age-related reference values. Physiotherapy Canada, 62 (Suppl), 46.