The SLS is used to assess static postural and balance control.
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1 minutes
Updated with references for the PD population by Jeffrey Hoder, PT, DPT, NCS and the PD EDGE task force of the Neurology Section of the APTA in 2013.
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: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations
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Abbreviations: |
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HR |
Highly Recommend |
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R |
Recommend |
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LS / UR |
Reasonable to use, but limited study in target group / Unable to Recommend |
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NR |
Not Recommended |
Recommendations for use based on acuity level of the patient:
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Acute (CVA < 2 months post) (SCI < 1 month post) (Vestibular < 6 week post) |
Subacute (CVA 2 to 6 months) (SCI 3 to 6 months) |
Chronic (> 6 months) (Vestibular > 6 weeks post) |
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VEDGE |
LS |
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LS |
Recommendations Based on Parkinson Disease Hoehn and Yahr stage:
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I |
II |
III |
IV |
V |
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PD EDGE |
LS/UR |
LS/UR |
LS/UR |
NR |
NR |
Recommendations for entry-level physical therapy education and use in research:
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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) |
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PD EDGE |
No |
No |
Yes |
Not reported |
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VEDGE |
Yes |
Yes |
No |
Yes |
With regards to use for people with PD: Average time of SLS for age 80 in healthy older adults is < 10 seconds (Springer, 2007). This may not be a valid predictor of falls in individuals over age 80. Follow up studies after Jacobs (Mak, 2009, 2010) failed to identify 10 seconds as an accurate cut-off to discriminate fallers from non-fallers.
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(Springer et al, 2007)
Unipedal Stance Test Time by Age Group and Gender for Eyes Open and Closed
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Age & Gender Groups |
Eyes Open Best of 3 |
Eyes Open Mean |
Eyes Closed Best |
Eyes Closed Mean |
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18-39 Female (n= 44) Male (n = 54) Total (n = 98) |
45.1 (0.1) 44.4 (4.1) 44.7 (3.1) |
43.5 (3.8) 43.2 (6.0) 43.3 (5.1) |
13.1 (12.3) 16.9 (13.9) 15.2 (13.3) |
8.5 (9.1) 10.2 (9.6) 9.4 (9.4) |
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40-49 Female (n = 47) Male (n = 51) Total (n = 98) |
42.1 (9.5) 41.6 (10.2) 41.9 (9.9) |
40.4 (10.1) 40.1 (11.5) 40.3 (10.8) |
13.5 (12.4) 12.0 (13.5) 12.7 (12.9) |
7.4 (6.7) 7.3 (7.4) 7.3 (7.0) |
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50-59 Female (n = 50) Male (n = 48) Total (n = 98) |
40.9 (10.0) 41.5 (10.5) 41.2 (10.2) |
36.0 (12.8) 38.1 (12.4) 37.0 (12.6) |
7.9 (8.0) 8.6 (8.8) 8.3 (8.4) |
5.0 (5.6) 4.5 (3.8) 4.8 (4.8) |
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60-69 Female (n = 50) Male (n = 51) Total ( n = 101) |
30.4 (16.4) 33.8 (16.0) 32.1 (16.2) |
25.1 (16.5) 28.7 (16.7) 26.9 (16.6) |
3.6 (2.3) 5.1 (6.8) 4.4 (5.1) |
2.5 (1.5) 3.1 (2.7) 2.8 (2.2) |
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70-79 Female (n = 45) Male (n = 50) Total (n = 95) |
16.7 (15.0) 25.9 (18.1) 21.5 (17.3) |
11.3 (11.2) 18.3 (15.3) 15.0 (13.9) |
3.7 (6.2) 2.6 (1.7) 3.1 (4.5) |
2.2 (2.1) 1.9 (0.9) 2.0 (1.6) |
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80-99 Female (n = 22) Male (n = 37) Total (n = 59) |
10.6 (13.2) 8.7 (12.6) 9.4 (12.8) |
7.4 (10.7) 5.6 (8.4) 6.2 (9.3) |
2.1 (1.1) 1.8 (0.9) 1.9 (1.0) |
1.4 (0.6) 1.3 (0.6) 1.3 (0.6) |
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Total (all ages) Female (n = 258) Male (n = 291) Total (n = 549) |
33.0 (16.8) 33.8 (17.1) 33.4 (16.9) |
29.2 (17.4) 30.2 (17.7) 29.8 (17.5) |
7.7 (9.6) 8.2 (10.8) 8.0 (10.3) |
4.7 (6.0) 4.9 (6.4) 4.9 (6.2) |
Parkinson’s Disease
(Jacobs, 2006)
Cut-off time of 10 seconds provided the highest sensitivity and specificity for history of one or more falls (75% of those that had a h/o falls exhibited OLS time of 10 seconds or less (high sensitivity); 74% of non-fallers exhibited OLS time of > 10 seconds (high specificity). 67 subjects with PD with 65 age-matched controls (mean age of 67+ 12 years; PD 10+6 yrs)
For the one-leg stance test, a cut-off time of 10 seconds provided the best combination of sensitivity and specificity for fall history in the PD subjects, consistent with a previous report by Smithson et al who reported that PD subjects with a history of falling, on average, exhibited one-leg stance times of under 10 seconds, and PD subjects without a history of falling, on average, exhibited one-leg stance times of about 15 seconds.
Jacobs, J., Horak, F., et al. (2006). "Multiple balance tests improve the assessment of postural stability in subjects with Parkinson’s disease." Journal of Neurology, Neurosurgery & Psychiatry 77(3): 322-326.
Mak, M. K. and Pang, M. Y. (2009). "Balance confidence and functional mobility are independently associated with falls in people with Parkinson’s disease." Journal of neurology 256(5): 742-749.
Mak, M. K. and Pang, M. Y. (2010). "Parkinsonian single fallers versus recurrent fallers: different fall characteristics and clinical features." Journal of neurology 257(9): 1543-1551.
Smithson, F., Morris, M. E., et al. (1998). "Performance on clinical tests of balance in Parkinson's disease." Physical therapy 78(6): 577-592.
Springer, B. A., Marin, R., et al. (2007). "Normative values for the unipedal stance test with eyes open and closed." Journal of geriatric physical therapy 30(1): 8-15.
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.