RehabMeasures Instrument
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  2. Community Balance and Mobility Scale

Community Balance and Mobility Scale

Last Updated

Purpose

The CB&M identifies postural instability, evaluates change following intervention, and informs a rehabilitation team about the balance and mobility status of the ambulatory adult who is returning to the community environment. (Howe, 2006)

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Instrument Details

Acronym CB&M

Area of Assessment

Bodily Functions

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

The assessment manual is free to access online. However, access to the resources needed (laundry basket, bean bag, stopwatch, and paper) are considerations in cost.

Diagnosis/Conditions

  • Brain Injury Recovery
  • Cerebral Palsy
  • Stroke Recovery

Populations

Brain Injury
Cerebral Palsy
Mixed Conditions
Stroke
Cardiovascular Disease
Arthritis and Joint Conditions

Key Descriptions

  • A performance measure composed of 13 challenging tasks with six tasks performed on both sides.
  • Scaling is specific to the task being measured.
  • Scoring is done using the first trial for each item.
  • Item scores are summed, with the maximum possible score of 96.
  • Item scores range from 0 to 5 and reflect progressive task difficulty.
  • A score of "0" = complete inability to perform the task.
  • A score of "5" = the most successful completion of the item possible.
  • All tasks are performed without ambulation aides, with the exception of item 12 (descending stairs) for which a cane can be used.
  • Patients are permitted to wear an orthotic.

Number of Items

13

Equipment Required

  • An 8-m track is used in the evaluation of the various tasks performed
  • Stopwatch
  • Laundry basket
  • 2lb and 7lb weights
  • Visual target (a paper circle 20cm in diameter with a 5cm diameter black circle in the middle)
  • Bean bag

Time to Administer

20-30 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

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. Updated in May 2025 by UIC OT students Anna Buzzard, Gianna Buffano, Alexa Vetos, and HnuHnu Win under the direction of Sabrin Rizk, PhD, OTR/L, Department of Occupational Therapy, University of Illinois Chicago.

ICF Domain

Body Structure
Body Function

Measurement Domain

Motor

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: 

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

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

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

R

R

R

R

R

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

R

R

NR

NR

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

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

TBI EDGE

Yes

Yes

Yes

Not reported

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.
  • All tasks are performed without ambulation aides (with one exception, item 12: Descending Stairs). The safety of the patient should be considered when administering this.
  • “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”
  • No standardized interpretations of the scores, though the assessment can be used to give insight into a person’s balance and mobility
  • The items represent skills that are required for community living, so it is important to consider the environmental context in which the items are performed
  • The test may require more time to administer if the therapist is unfamiliar with administration or when the scale is first introduced to a patient
  • The purpose the assessment is to reflect the balance and mobility skills necessary for full participation in the community it is not to denote need for a walking aid, fall risk or discharge placement
  • The test can be beneficial for patients who have reached a ceiling effect on other assessments because of the challenging demands of the tasks
  • Assessor should verbally instruct and demonstrate all of the items to ensure proper understanding

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Brain Injury

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Standard Error of Measurement (SEM)

Traumatic Brain Injury (TBI): (Howe et al, 2006; phase 1: n=36; mean age(SD)= 31(9) years; mean time post-injury (SD)= 11(23) months; phase 2: n=32; mean age(SD)=34(12) years; mean time post-injury (SD)= 4(6) months) ? SEM = 4.1 (calculated using Cronbach’s α value 0.96) ? SEM = 3.2 (calculated using test-retest ICC 0.975)

Minimal Detectable Change (MDC)

Traumatic Brain Injury (TBI): (Howe et al, 2006)

  • MDC90 = 9.6 (calculated using SEM and Cronbach’s α value)
  • MDC90 = 7.5 (calculated using SEM and test-retest ICC values) 

 

Acquired Brain Injury in school-aged children and adolescents: (Wright et al, 2010)

  • MDC90 = 13.5% points (established)
  • MDC95=14.6% points (established)

Normative Data

Traumatic Brain Injury: (Howe, 2006; n = 32; participants were able to ambulate with or without aid, participants drawn from 3 locations including acute care, inpatient, day hospital and outpatient; 5 days between assessments)

Care Setting Norms*:

Population

Mean 

Standard Deviation

Acute care

30.39

11.7

Outpatients

41.69

18.0

Inpatient rehabilitation

53.59

21.2

Day hospital setting

62.49

17.1

*Statistically different across all settings (p < 0.03)

 

 

Test/Retest Reliability

Traumatic Brain Injury: (Howe, 2006)

Test-retest Reliability:

 

Item

Test-retest (5 days apart)

Test-retest (Immediate)

Unilateral stance left

0.81

0.76

Unilateral stance right

0.44

0.8

Tandem walking

0.59

0.85

1808 tandem pivot

0.53

0.9

Lateral foot scooting left

0.54

0.74

Lateral foot scooting right

0.58

0.92

Hopping forward left

0.68

0.85

Hopping forward right

0.6

0.87

Crouch and walk

0.45

0.92

Lateral dodging 

0.61

0.61

Walking & looking left

0.3

0.86

Walking & looking right

0.35

0.87

Running with controlled stop

0.58

0.85

Forward to backward walking

0.64

0.77

Walk, look & carry left

0.69

N/A

Walk, look & carry right

0.77

N/A

Descending stairs

0.77

0.96

Step-ups X 1 step left

0.6

0.98

Step-ups X 1 step right

0.51

0.94

 

Acquired Brain Injury in school-aged children and adolescents: (Wright et al, 2010)

  • Excellent test re-test reliability (3–10-day re-test interval) (ICC=0.90)

Interrater/Intrarater Reliability

Traumatic Brain Injury: (Howe, 2006; n = 13 Physical Therapist raters, mean practice experience = 5.89 (4.4) years)

  • Intra-rater = 0.977 (CI = 0.957-0.986)
  • Inter-rater = 0.977 (CI = 0.972-0.988)

 

Inter and Intra-rater Reliability:

 

Item

Intra-rater

Inter-rater

Unilateral stance left

0.89

0.87

Unilateral stance right

0.92

0.98

Tandem walking

0.71

0.85

1808 tandem pivot

0.64

0.59

Lateral foot scooting left

0.84

0.78

Lateral foot scooting right

0.62

0.88

Hopping forward left

0.81

0.81

Hopping forward right

0.76

0.86

Crouch and walk

0.64

0.7

Lateral dodging 

0.53

0.78

Walking & looking left

0.34

0.53

Walking & looking right

0.72

0.64

Running with controlled stop

0.78

0.67

Forward to backward walking

0.76

0.71

Walk, look & carry left

0.58

0.75

Walk, look & carry right

0.71

0.8

Descending stairs

0.85

0.78

Step-ups X 1 step left

0.71

0.84

Step-ups X 1 step right

0.82

0.85

 

Acquired Brain Injury in school-aged children and adolescents: (Wright et al, 2010)

  • Excellent interrater reliability (ICC=0.93)

Internal Consistency

Traumatic Brain Injury: (Howe, 2006; n = 32; participants were able to ambulate with or without aid, participants drawn from 3 locations including acute care, inpatient, day hospital, and outpatient; 5 days between assessments)

  • Excellent internal consistency (Cronbach's alpha > 0.95)

Acquired Brain Injury in school-aged children and adolescents: (Wright et al, 2010)

  • Excellent internal consistency (Cronbach’s alpha=0.89) for the primary assessors’ baseline CB&M scores.

Construct Validity

Convergent validity:

Traumatic Brain Injury: (Howe et al., 2006)

  • Adequate: self-paced gait velocity (r = 0.53; p = 0.001)
  • Excellent: maximal gait velocity (r = 0. 64; p = 0.001)

 

Traumatic Brain Injury: (Inness, 2011 n= 35 patients with TBI; 13 in-patients, 22 outpatients) 

  • Adequate : a moderate to good magnitude (r =0.54, p < 0.001) was demonstrated between the CB&M and the CIQ. This was obtained by combining current study data with a prior study for n=47
  • Excellent : a significant relationship between CB&M and ABC scores emerged (r = 0.60, p = 0.011)

Discriminant validity:

Traumatic Brain Injury (TBI): (Howe et al., 2006)

  • Significant ability of CB&M scores above (n = 11) or below 50 (n = 6) to discriminate between levels of community integration (p = 0.004)

 

Content Validity

TBI patients and clinicians experienced in neurorehabilitation were involved in item generation.  A group of PT's then rated items for relevance (Howe, 2006).

Face Validity

Traumatic Brain Injury: (Howe, 2006; n = 32; participants were able to ambulate with or without aid, participants drawn from 3 locations including acute care, inpatient, day hospital and outpatient; 5 days between assessments) 

  • Items for the CB&M scale were derived from a series of interviews and discussions with individuals with traumatic brain injury living in the community, students in physical therapy with experience in neurological rehabilitation and therapists. Items were added or eliminated based on expert opinion on relevance to key constructs of balance and mobility. 
 

Stroke

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Criterion Validity (Predictive/Concurrent)

Acute Stroke: (Knorr et al, 2010)

Chedoke McMaster Stroke Assessment (CMSA) and Lower-Limb Strength Results across measures~:

 

Variables

CB&M

(n = 44)

BBS

(n = 44)

TUG

(n = 42)

CMSA leg

0.63*

0.54*

-0.70*

CMSA foot

0.61*

0.50?

-0.69*

Paretic limb

0.67*

0.50*

-0.71*

Nonparetic limb

0.46?

0.28

-0.44?

~Spearman correlation coefficients
Adjusted level of significance = p < .01
* p < .001
? p < .01

 

 

Floor/Ceiling Effects

Acute Stroke: (Knorr et al, 2010; n = 44; time post stroke (baseline assessment) 98.6 (52.6) days; Mean FIM scores, Motor = 82.0 (range = 20 to 91) Cog = 33.0 (range = 23 to 35) points) 

  • Scores on the CB&M covered the scale’s range; the maximum score was not achieved by any of the participants.

 

Floor and Ceiling Effects:

 
 

Baseline (n = 44)

Follow-Up (n = 44)

Scale

Floor Effect

Ceiling Effect

Floor Effect

Ceiling Effect

CB&M

4 (9.1)

0 (0.0)

3 (6.8)

0 (0.0)

BBS

0 (0.0)

15 (34.1)*

0 (0.0)

21 (47.7)*

TUG

2 (4.5)

10 (22.7)*

0 (0.0)

16 (36.4)*

*Significant effect (> 20%)

 

Responsiveness

Acute Stroke: (Knorr et al, 2010) 

  • The Standardized Response Mean (SRM) suggests a large effect size for the CB&M and small effect sizes for the BBS and TUG.

 

Standardized Response Mean Across Measures:

 

Variable

Metric

Baseline*

Follow-Up*

p

SRM

CB&M

96 points

42.7 (22.6)

51.3 (24.6)

<.001

0.83

BBS

56 points

48.9 (12.4)

50.4 (11.0)

<.010

0.42

TUG

Seconds

16.7 (17.1)

13.7 (16.0)

<.010

0.34

*Mean (SD)
p = between the baseline and follow-up

 

Cerebral Palsy

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Responsiveness

Cerebral Palsy: (Bien et al, 2011; n = 4; mean age = 16 (2.25) years; The study span 5 days and used a 90 minute virtual reality balance intervention)

  • True change from the mean CB&M score were achieved in 3 of 4 participants
  • In a follow-up, these improvements were maintained and true change was observed in all participants

Mixed Conditions

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Cut-Off Scores

Older Adults and Geriatric Care: (Balasubramanian, 2015; n = 40; mean age = 73.4 (6.9) years; community-dwelling older adults)

  • ≤ 39 on the CB&M was the optimal cutoff score for balancing sensitivity (79%) and specificity (76%) in predicting fall risk
  • ≤ 45 on the CB&M maximized sensitivity (93%) for discriminating between individuals with two or more falls in the past year from those with fewer than 2 falls, although specificity was lower (60%)

 

Normative Data

Older Women With Low Bone Mass: (Liu-Ambrose et al, 2006; n = 98; mean age = 79.3 (2.7) years)

 

CB&M Norms: 

 

Measure

Scale

Mean (SD)

Range

CB & M 

max. 85 pts

42 (19)

0–81

MMSE

max. 30 pts

29 (2)

24–30

ABC

max. 100 pts

77 (20)

5–100

PASE

 

85.8 (40.6)

17.9–224.1

Fast-paced gait (m/s)

 

1.38 (0.30)

0.51–2.24

MMSE = Mini-Mental State Examination
ABC = Activities-Specific Balance Confidence
PASE = Physical Activity Scale for the Elderly

 

 

Healthy individuals aged 20-79 years (Clegg et al, 2009; n=54)

Age group 

N 

Mean* 

SD 

95% CI 

20-29 

24 

88.71 

3.53 

87.2-90.2 

30-39 

27 

86.33 

5.78 

84.1-88.6 

40-49 

23 

84.35 

4.03 

82.6-86.1 

50-59** 

26 

77.43 

6.55 

75.0-79.9 

60-69** 

17 

64.94 

8.22 

60.7-69.2 

70-79** 

4 

49.75 

6.95 

38.7-60.8

Interrater/Intrarater Reliability

Older Adults and Geriatric Care: (Balasubramanian, 2015)

  • Excellent Interrater reliability: (ICC = 0.953, 95% CI = 0.88-0.98)
  • Excellent intra-rater reliability: (ICC = 0.962, 95% CI = 0.928-0.98)

Young-older adults, no significant condition: (Weber et al., 2018; n = 51; mean age = 62.5 (7.4) years; age range = 60 – 70 years; community-dwelling adults w/no cognitive impairment (Montreal Cognitive Assessment score ≥ 26 points))

  • Excellent Interrater reliability: (ICC = 0.97, 95% CI = 0.94-0.98)
  • Excellent intra-rater reliability: (ICC = 1.00, 95% CI = 0.99-1.00)

 

Internal Consistency

Older Adults and Geriatric Care: (Balasubramanian, 2015)

  • Excellent: Cronbach’s alpha = 0.962*

Young-older adults, no significant condition: (Weber et al., 2018)

  • Excellent: Cronbach’s alpha = 0.88

*Scores higher than 0.9 may indicate redundancy in the scale questions

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Young-older adults, no significant condition: (Weber et al., 2018)

  • Excellent correlation between CB&M and Fullerton Advanced Balance (FAB) scale (ρ&苍产蝉辫;= 0.75; 95% CI = 0.59; 0.85, p < 0.001)
  • Excellent correlation between CB&M and Three Meter Tandem Walk (3MTW) test errors (ρ&苍产蝉辫;= -0.61; 95% CI = -0.83; -0.33, p < 0.001)
  • Adequate correlations between CB&M and:
    • Gait Speed (ρ&苍产蝉辫;= 0.46; 95% CI = 0.22; 0.66, p < 0.001)
    • Timed-Up-and-Go (TUG) (ρ&苍产蝉辫;= 0.42; 95% CI = -0.10; -0.67, p = 0.006)
    • 8-level Balance Scale (ρ&苍产蝉辫;= 0.35; 95% CI = 0.04; 0.61, p = 0.013)
    • 3 Meter Tandem Walk (3MTW) time (ρ&苍产蝉辫;= -0.35; 95% CI = -0.65; 0.00, p = 0.05)

 

Construct Validity

Convergent validity:

Community-dwelling persons after stroke: (Knorr et al, 2010)

  • Excellent (ρ=.70 to .83, P=.001) correlation were observed among the CB&M, BBS, and TUG

 

Discriminant validity:

Young-older adults, no significant condition: (Weber et al., 2018)

  • The CB&M was unable to discriminate between fallers (mean score = 58.3 (14.6)) and non-fallers (mean score = 66.3 (11.8)), p = 0.09 

 

Floor/Ceiling Effects

Young-older adults, no significant condition: (Weber et al., 2018)

  • Excellent: No ceiling effects

 

Cardiovascular Disease

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Normative Data

Individuals with a CVD diagnosis or categorized as high risk: (Martelli et al. 2018; n = 53; mean age = 67.2 (8.8) years, mean height = 1.69 (0.09 m); mean weight = 81.9 (15.7 kg); mean body mass index = 28.7 (4.7 kg/m2); patients ≥ 18 years of age recruited from local cardiac rehabilitation programs w/no history of stroke in the past 6 months and/or other medical conditions known to impact balance)

  • Mean score on CB&M for entire group (n = 53): 61.9 (16.2)
  • Score range: 21 to 88 (primarily distributed over the upper two-thirds of the scale continuum)

 

 

Interrater/Intrarater Reliability

Individuals with a CVD diagnosis or categorized as high risk: (Martelli et al., 2018; novice and expert testers simultaneously evaluated a subset (n = 8) of participants performing the CB&M)

  • Excellent interrater reliability between novice and expert testers (ICC = 0.96, p = 0.0002)
    • All differences between scores fell within the calculated 95% limits of agreement (-9.5 to 10.8 points). The largest difference in scores between testers was 7 points.
    • The CB&M can reliably be administered by individuals with minimal training and experience with assessment 

 

Construct Validity

Convergent validity:

Individuals with a CVD diagnosis or categorized as high risk: (Martelli et al., 2018)

  • Adequate convergent validity between the CB&M and LOS results for:
    • Direction control (r = 0.501, p < 0.05)
    • Maximum excursion (r = 0.527, p < 0.05)
    • End point excursion (r = 0.456, p < 0.05)
  • No significant correlation was found between the CB&M and reaction time

 

Floor/Ceiling Effects

Individuals with a CVD diagnosis or categorized as high risk: (Martelli et al., 2018)

  • Excellent: No floor or ceiling effects were observed for any participants
    • Highest score was 88/96; lowest score was 21/96

 

Arthritis and Joint Conditions

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Standard Error of Measurement (SEM)

Individuals aged 50+ with knee osteoarthritis: (Takacs et al, 2014; n = 25; mean age = 62.5 (7.4) years; injury present, no post injury; average knee pain on 0 – 10 scale = 3.3 (2.4))

  • SEM for entire group (n = 25): 3 (95% CI = 2.68 to 4.67)

Minimal Detectable Change (MDC)

Individuals aged 50+ with knee osteoarthritis: (Takacs et al, 2014)

  • MDC for entire group (n = 25): 9.4

 

Test/Retest Reliability

Individuals aged 50+ with knee osteoarthritis: (Takacs et al, 2014)

  • Excellent test-retest reliability: (ICC = 0.95; 95% CI = 0.70 to 0.99)

Floor/Ceiling Effects

Individuals aged 50+ with knee osteoarthritis: (Takacs et al, 2014)

  • Adequate ceiling effect of 12% for the CB&M
  • Excellent: No floor effects using CB&M

 

Bibliography

Balasubramanian, C. (April/June, 2015). The Community Balance and Mobility Scale alleviates the ceiling effects observed in the currently used gait and balance assessments for community-dwelling older adults. Journal of Geriatric Physical Therapy, 38(2), 78-89.

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. University of Toronto TSpace,

Community Balance and Mobility Scale. (2025, January 15). Physiopedia, Retrieved April 2, 2025 from

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. 

Martelli, L., Saraswat, D., Dechman, G., Giacomantonio, N., & Grandy, S. (2018). The Community Balance and Mobility Scale. Journal of Cardiopulmonary Rehabilitation and Prevention, 38(2), 100-103.

Takacs, J., Garland, S. J., Carpenter, M. G., & Hunt, M. A. (2014). Validity and reliability of the Community Balance and Mobility Scale in individuals with knee osteoarthritis. Physical Therapy, 94(6), 866–874.

Weber, M., Van Ancum, J., et al. (2018). Concurrent validity and reliability of the Community Balance and Mobility scale in young-older adults. BMC geriatrics, 18(1), 156. 

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. 

 

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