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Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team; Updated with references from the TBI population by Tammie Keller Johnson, PT, DPT, MS and the TBI EDGE task force of the Neurology Section of the APTA in 2012; Updated by Minu M. Nair, PT in 10/2012.

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association¡¯s Multiple Sclerosis Taskforce (MSEDGE), Parkinson¡¯s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  

Recommendations based on level of care in which the assessment is taken:

Recommendations for use based on ambulatory status after brain injury:

Recommendations for entry-level physical therapy education and use in research:

Considerations

• In patients with mild to moderate neurologic deficits secondary to stroke, the CB&M was superior to either the TUG or BBS five months after stroke onset 

• Designed for ambulatory individuals living in the community. 

• The CB&M is a valid outcome measure for detecting dynamic instability and for evaluating the ability of patients of TBI to successfully return to community living (Inness, 2011) 

• ¡°Clinical feedback and preliminary evidence indicates that the scale is also appropriate for clients with diagnoses other than traumatic brain injury. The items of the CB&M encompass challenging balance and mobility tasks and, therefore, the CB&M may be more appropriate for patients in the rehabilitation and community setting rather than acute care.¡± (Toronto rehab CB&M pdf document) 

• Since the tool has not been specifically studied in community dwelling elderly population, the psychometric properties of the other studies can be considered which have included the age group of more than 60 years of age. 

• The studies which have taken the community dwelling elderly group into consideration are as follows:

  • Knorr et al, 2010: For community dwelling elderly group with stroke, the available psychometric properties include convergent validity, sensitivity to change, and floor and ceiling effects as detailed above.

  • Clegg et al, 2009 (healthy individuals aged 20-79 years: normative data): The age related reference values for community dwelling elderly show that the CB&MS score decline after the age of 50 indicating that balance is affected significantly in healthy elderly population. 

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Bibliography

Brien, M. and Sveistrup, H. (2011). "An intensive virtual reality program improves functional balance and mobility of adolescents with cerebral palsy." Pediatr Phys Ther 23(3): 258-266. 

Clegg, H., Fernande, S., et al. (2009). "Community balance and mobility scale: age-related reference values." 

Howe, J. A., Inness, E. L., et al. (2006). "The Community Balance and Mobility Scale--a balance measure for individuals with traumatic brain injury." Clin Rehabil 20(10): 885-895.   

Inness, E. L., Howe, J. A., et al. (2011). "Measuring Balance and Mobility after Traumatic Brain Injury: Validation of the Community Balance and Mobility Scale (CB&M)." Physiotherapy Canada 63(2): 199-208. 

Knorr, S., Brouwer, B., et al. (2010). "Validity of the Community Balance and Mobility Scale in community-dwelling persons after stroke." Arch Phys Med Rehabil 91(6): 890-896.   

Liu-Ambrose, T., Khan, K. M., et al. (2006). "Falls-related self-efficacy is independently associated with balance and mobility in older women with low bone mass." J Gerontol A Biol Sci Med Sci 61(8): 832-838. 

Wright, F. V., Ryan, J., et al. (2010). "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 Inj 24(13-14): 1585-1594.