Sitting Balance Scale: A Practical Tool for Early Fall Risk Identification

The Sitting Balance Scale plays an important role in fall prevention by helping clinicians identify balance impairments that may not yet be apparent during standing or walking tasks.

Falls are a significant concern in neurological and rehabilitation populations, particularly among individuals with impaired postural control and trunk stability. Up to 73 percent of stroke survivors fall within their first year post-stroke, making falls a very common sequela during recovery.

While gait and standing balance often receive the most attention, instability frequently appears earlier—during seated tasks that are part of everyday function. For many patients, difficulty maintaining upright posture, reaching safely, or controlling trunk movements can quietly increase fall risk during transfers, dressing, or toileting. Identifying these deficits early allows clinicians to intervene before mobility demands increase.

The Sitting Balance Scale (SBS) provides a structured way to evaluate seated balance and postural control when standing or gait-based testing isn’t yet appropriate—helping clinicians translate early balance deficits into safer, more targeted care planning.

What is the Sitting Balance Scale?

The Sitting Balance Scale is an 11-item ordinal assessment used to evaluate seated balance and postural control, typically in patients who are non-ambulatory or recovering from a neurological injury or condition. Rather than focusing on ambulation or upright mobility, the SBS assesses how an individual maintains and controls posture while seated.²

Specifically, the assessment examines the ability to:

• Maintain upright sitting

• Control trunk movements

• Reach safely in multiple directions

• Respond to balance challenges while seated

Performance on these tasks provides insight into postural control and stability during functional activities, including reaching, transfers, and transitional movements. These seated balance demands are closely linked to fall risk, particularly in individuals who are not yet appropriate for standing or gait-based assessment.

Use a standardized score sheet to support consistency

Because the Sitting Balance Scale relies on precise task execution and scoring, having a standardized score sheet can make a meaningful difference—especially in busy clinical environments.

We’ve created a free, printable Sitting Balance Scale PDF that includes all 11 assessment items, scoring criteria, and space for documentation. Using a consistent format helps streamline administration, support clear clinical reasoning, and improve documentation at the point of care.

Sitting Balance Scale PDF

Fill out a few quick details to access your free Sitting Balance Scale PDF!

Who is the sitting balance scale best suited for?

The Sitting Balance Scale is commonly used with patients who require a safe, seated approach to balance assessment. It is particularly well suited for:

• Patients who are nonambulatory or minimally ambulatory

• Individuals early in rehabilitation following hospitalization, illness, or surgery

• Neurological populations, such as stroke or Parkinson’s disease

• Home health and skilled nursing facility patients, where standing balance assessments may not yet be safe

• Older adults with generalized weakness or frailty

In these populations, seated balance deficits are often the earliest functional red flag. Addressing these impairments early allows clinicians to reduce downstream fall risk as patients progress toward standing and walking activities.

How the Sitting Balance Scale is administered

Administering the Sitting Balance Scale is intentionally straightforward, but consistency matters. The goal is to observe how a patient controls posture and responds to balance challenges in a seated position—without introducing unnecessary variability or safety risk.

Each activity is performed with the patient seated unsupported on a firm, stable surface, without the trunk or back resting against a support, unless otherwise specified. Feet should be positioned in a supported, weight-bearing position when applicable.

To ensure reliable results, clinicians follow several key principles throughout the assessment:

• Clear instructions are provided before each task

• One attempt is allowed per activity

• Performance is observed and documented for each item

• Scoring follows defined criteria, with the next lower score assigned if full requirements are not met

• The patient is guarded throughout testing, and the assessment is discontinued if safety concerns arise

This structured approach allows clinicians to assess seated balance consistently while prioritizing patient safety.

Clinical example: Using the Sitting Balance Scale in practice

Clinical scenario

An 82-year-old patient is admitted to home health following a recent ischemic stroke. She primarily uses a wheelchair for mobility, is unable to ambulate independently, and requires moderate assistance for transfers. Due to impaired trunk control, limited endurance, and safety concerns, standing balance testing is not yet appropriate.

To assess balance safely while still gathering meaningful functional data, the clinician selects the Sitting Balance Scale.

What the assessment reveals

During administration of the Sitting Balance Scale, several key patterns emerge:

• The patient maintains upright sitting with eyes open but demonstrates reduced postural control when visual input is removed, suggesting increased reliance on vision for balance

• Forward and lateral reaching tasks reveal trunk instability and limited ability to control center-of-mass shifts

• Turning to look behind and retrieving objects from the floor challenge balance, particularly during trunk rotation and forward weight shift

• Performance declines further when tasks are completed on a foam surface, indicating difficulty adapting to reduced somatosensory input

Together, these findings point to impaired seated postural control related to neurologic involvement, rather than isolated lower-extremity weakness.

How this informs clinical decision-making

Based on the Sitting Balance Scale results, the clinician:

• Identifies seated postural control deficits as a primary contributor to transfer-related fall risk and wheelchair mobility safety

• Prioritizes interventions targeting trunk control, controlled reaching, and balance reactions in sitting

• Uses the SBS score as a functional baseline to monitor progress and determine readiness to progress toward supported standing and gait-related activities

By addressing seated balance early, the clinician can reduce fall risk and support safer progression of mobility—without exposing the patient to unnecessary standing challenges.

Sitting Balance Scale vs Function in Sitting Test

Both the Sitting Balance Scale and the Function in Sitting Test (FIST) assess seated balance, but they were designed for different clinical purposes and stages of mobility. Understanding how these tools differ can help clinicians select the most appropriate assessment based on patient presentation, safety, and functional goals.

The Sitting Balance Scale and the Function in Sitting Test are not interchangeable. Many clinicians use the SBS earlier in the plan of care to assess safety and foundational postural control, then transition to the FIST as patients demonstrate improved sitting balance and readiness for more complex tasks. Used together, these tools support balance assessment across the continuum of care.

Scoring and interpreting results

Each Sitting Balance Scale item is scored on a 5-point ordinal scale (0–4), with a total possible score of 44. Higher total scores reflect stronger seated balance and postural control, while lower scores may indicate impaired postural stability and increased fall risk during seated activities.

In practice:

• Higher scores suggest greater independence and control during sitting tasks such as reaching, trunk movement, and transitional activities

• Lower scores may point to deficits in postural control that can affect transfers, ADLs, and safety during movement

Importantly, Sitting Balance Scale results should always be interpreted in conjunction with clinical judgment and the individual’s overall functional presentation. The scale is not intended to diagnose balance disorders or predict falls in isolation, but rather to inform clinical decision-making and guide progression of care.

Using the Sitting Balance Scale in a fall prevention program

When integrated into a broader fall prevention strategy, the Sitting Balance Scale helps clinicians move beyond screening to actionable decision-making.

Clinicians commonly use the assessment to:

• Establish a safe functional baseline for patients who are not yet appropriate for standing balance testing

• Identify seated balance deficits that influence transfers, activities of daily living, and transitional movements

• Guide intervention selection and progression, particularly as patients prepare for upright mobility

• Support clear documentation and clinical reasoning when communicating fall risk and readiness for progression

By addressing seated balance early, clinicians can reduce risk and support safer transitions as patients progress toward standing and walking activities.

Supporting fall prevention beyond assessment with guided Pathways

Clinical assessments like the Sitting Balance Scale help identify seated balance impairments and early fall risk—but preventing falls often requires ongoing engagement and progression beyond the evaluation visit.

Medbridge Pathways supports this next step by providing clinically validated, digital fall prevention programs that help patients build balance, confidence, and functional mobility over time. Powered by AI and behavioral science, Pathways is designed to complement clinician-led care, not replace it.

How Pathways supports fall prevention programs

When used alongside tools like the Sitting Balance Scale, Medbridge Pathways can help organizations:

• Triage patients to the right level of care faster, identifying individuals appropriate for hybrid or digital-first support

• Keep patients engaged and progressing with guided education, exercises, and automated reminders between visits

• Monitor progress and adapt care in real time through motion assessments, outcomes tracking, and two-way communication

• Improve access to care, helping reduce wait times while maintaining clinical oversight

In senior care populations, Pathways is designed to address both the physical and psychological contributors to falls. Programs incorporate motion assessments, dual-task exercises, and education focused on confidence, home safety, and functional movement—supporting patients as they transition from early balance deficits to more advanced mobility goals.

By pairing early identification from the Sitting Balance Scale with guided digital support, clinicians can extend fall prevention efforts beyond the clinic and support safer, more confident movement over time.

From assessment to action

Falls continue to place older adults at risk for injury, loss of independence, and reduced quality of life—but effective prevention starts with choosing the right assessment at the right time.

By emphasizing seated balance and postural control, the Sitting Balance Scale allows clinicians to gather meaningful information even when standing or gait-based testing isn’t yet appropriate. This early insight supports clearer clinical reasoning, safer progression of mobility, and more intentional intervention planning.

Used as part of a comprehensive fall prevention approach, the Sitting Balance Scale helps clinicians move from observation to action—supporting confident decision-making as patients progress toward higher-level balance and functional goals.

References

1. O'Malley N, Clifford AM, Conneely M, Casey B, Coote S. Effectiveness of interventions to prevent falls for people with multiple sclerosis, Parkinson's disease and stroke: an umbrella review. BMC Neurol. 2021 Sep 29;21(1):378. https://pmc.ncbi.nlm.nih.gov/articles/PMC8480085/

2. Medley A, Thompson M. Development, reliability, and validity of the Sitting Balance Scale. Physiother Theory Pract. 2011 Oct;27(7):471-81. doi: 10.3109/09593985.2010.531077. Epub 2011 May 15. PMID: 21574772. https://pubmed.ncbi.nlm.nih.gov/21574772/