4 Stage Balance Test

Learn about the 4 Stage Balance Test and use our template when assessing the fall risk of older adults and patients with neurological conditions!

By Matt Olivares on Jun 20, 2024.


Fact Checked by Ericka Pingol.

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4 Stage Balance Test PDF Example
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What is the Four Stage Balance Test?

As we get older, our bodies slowly deteriorate. Once we hit our senior years, we shouldn’t be surprised if we’re no longer as spry as we used to be. We might not be able to do the things we love the way we used to, and many of us can become so weak that we risk falling.

Falling is dangerous because it can be debilitating. The damage the injuries we sustain from falling can change our lives forever, and sometimes, they’re permanent, especially if we’re old. If we fall the “wrong way,” we might even die.

Once we become elders, it’s normal for us to get checked and have geriatricians, physical therapists, and occupational therapists examine and treat us. They can assess our likelihood of falling and develop ways to lessen our chances. If we’ve fallen before, then they will create treatment plans to account for the severity of our injuries and rehabilitate us to regain our strength and hopefully become independent (at least, to an extent).

These healthcare providers use specific clinical tools to assess fall risk and conduct balance tests. There are several kinds, one of which is the Four-Stage Balance Test.

This balance test specifically assesses a person’s static balance, and they will do so through four simple positions. However, given the target population of the test, these positions become more difficult as they progress through the test.

This test is not limited to older adults. It can also be used on patients who have neurological conditions that have negatively impacted their balance or young people who are dealing with balance issues as a result of injuries.

Printable 4 Stage Balance Test

Download this 4 Stage Balance Test to assess a patient’s balance because it doesn’t require anything special to conduct.

When is the 4-Stage Balance Test normally conducted?

During clinical consultations/check-ups

The 4-Stage Balance Test is best conducted when a patient presents for a consultation to discuss balance issues due to aging, injuries, or a neurological condition. Since this balancing test can screen individuals for increased risk of falls, healthcare providers can discuss what this balancing test is all about. Providers can begin conducting it to assess balance if the patient consents to taking it.

During house calls

Some older adults you’ll handle might have limited physical activity because of prior injuries or a neurological condition, so they might be unable to attend clinical check-ups. For such patients, your arrangements might be to visit them in their homes for house calls and have them take the 4-Stage Balance Test in their abodes so they don’t have to expend energy to make the trip to your clinic or hospital.

In rehabilitation settings

Healthcare professionals can conduct this assessment in rehabilitation settings. Suppose a patient's increased fall risk is due to injuries they've sustained because of multiple falls, some other kind of accident, or because of a neurological condition that has weakened their limbs. In that case, this test can be conducted occasionally to check if the patient is regaining strength and if their results are faring better than the last. In short, this test can be used to monitor patients to assess recovery progress and determine if the treatment and rehabilitation plans implemented are working.

How does the 4-Stage Balance Test work?

Here are some steps to follow when conducting the test:

For healthcare providers conducting the test

As mentioned earlier, the 4-Stage Balance Test is specifically designed to assess a patient’s static balance, and they will do so by assuming four positions.

The healthcare provider must do the following:

  • They must have a stopwatch ready because each position will be timed.
  • Once the patient is ready, the provider must describe each position to the patient.
  • For each stage, the provider must stand next to the patient, hold one of their arms, and help them assume the correct position.
  • Once the patient says they’re ready to assume each position on their own, the provider must let go of the patient, but they must be prepared to immediately assist them should they lose their balance.
  • After letting go of the patient, they must start their stopwatch and wait for 10 seconds to pass (this goes for each position).

For the patient

The patient must assume four different standing positions (stages) for 10 seconds. They can move their arms or body to maintain balance but must not move their feet.

Here are the four positions they must assume:

  • Stand with their feet together: their feet must be stuck side-by-side.
  • Semi-tandem stance: they must place the instep of one foot forward. The other foot’s big toe must be touching the instep.
  • Tandem stance: they must place one foot in front of the other so that the heel of the foot in front touches the big toe of the other.
  • Single-leg stance: they must stand on one foot

The moment the provider says “Begin,” a stage will start. It ends when the provider says, “Stop.”

To complete this test, they must complete all four stages.

Interpreting the results of the 4-Stage Balance Test:

Balance test rules

When assessing the patient, the provider conducting this test must take note of the following rules:

  • Participants are not allowed to use an assistive device like a cane or walker
  • Participants must keep their eyes open, so tell them that before beginning the test
  • The patient must hold each position for 10 seconds. If they can hold a position for 10 seconds without moving their feet or requiring support, move on to the next position
  • If they move their feet or require support, you must stop the whole test

Balance test results

If the patient can maintain all four positions for 10 seconds without moving their feet or requiring support, they have little to no fall risk and can balance themselves fine.

If the patient cannot complete the test, especially if they cannot hold the tandem stance for 10 seconds, you must designate them as having an increased risk of falling.

What are the next steps after accomplishing the 4-Stage Balance Test?

If the patient can accomplish all four stages, that’s great! But to be on the safe side, it would be prudent to conduct other balance assessments for consistency. Some examples of balanced assessments that you can conduct include the following:

If the patient cannot complete the test, it would be best to refer them to undergo physical therapy or occupational therapy so they can take gait and balance exercises to help improve their balancing capabilities and lower the risk of falling.

4-Stage Balance Test example

Now that you’re acquainted with the 4-Stage Balance Test, it’s time to show you our template.

Our template contains everything we’ve discussed, precisely the instructions of the healthcare provider conducting it and what the patient must do. We have editable fields to indicate how many seconds a patient can maintain their balance per stance. Remember that the minimum is 10 for each stage!

It also has a Notes box where the provider can write down their observations and plans for the patient moving forward, like having them re-take the test every two weeks or referring them to physical therapy or occupational therapy programs. You can even mention recommending a Tai Chi program!

Download this free 4-Stage Balance Test template here:


What are the benefits of conducting the 4-Stage Balance Test?

It’s a cost-efficient way to assess a patient’s balance

The 4-Stage Balance Test is a cost-efficient way to assess a patient’s balance because it doesn’t require anything special to conduct. Other fall risk assessments require other equipment like yardsticks, Velcro, and other things because they will cover different aspects of balance.

It's a quick way to assess someone's fall risk

The 4-Stage Balance Test is one of the quickest balance assessments you can conduct. Several balance assessments come in the form of batteries, meaning they’re composed of several exercises of different kinds that need to be accomplished. Such assessments take long to accomplish.

This test can be accomplished in no time because the patient only needs to stand in four different stances without moving their feet or requiring support. They only need to assume each stance for 10 seconds

It's more effective when conducted as part of a comprehensive fall risk assessment

While the 4-Stage Balance Test is effective for assessing balance, it only assesses static balance. It would be best to evaluate dynamic balance as well. By adding other balance tests to a comprehensive fall risk assessment, healthcare providers can cover more ground and assess the different aspects of a patient’s balance, especially when performing other actions besides standing in place.

By covering more ground with a comprehensive assessment, the overall results can be used to create an effective treatment plan for the patient, especially if rehabilitation and balance exercises are involved.

Why use Carepatron as your physical therapy software?

Thanks for reading this guide! We hope this was an excellent introduction or refresher to the 4-Stage Balance Test. If you decide to use our template, we hope it helps you easily record patient results.

While we still have you, we’d like to ask for your time to check more of the Carepatron platform if you haven’t. We have a lot of nifty features, and we’re confident they’re cool and helpful enough for you to consider us your number-one clinical documentation and physical therapy practice management software! We won’t detail those features here, but we’d like to highlight one related to this guide and template: our resource library.

Our resource library houses a massive collection of clinical resources. It covers numerous healthcare fields, topics, and practices, especially physical therapy! We have several guides and templates for balance assessments, some of which we’ve mentioned earlier, like the Tinetti Balance Test, Berg Balance Scale, and the Y-Balance Test, to mention a few.

If you work with physical or occupational therapists and your job is to gather test orders for your group, we have a Balance Test form template you can use to record test orders.

What’s great about our guides and templates is that they’re all free, so you can read as many guides as you want and download as many templates as you need for your work!

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How long does it take to accomplish the 4-Stage Balance Test?
How long does it take to accomplish the 4-Stage Balance Test?

Commonly asked questions

How long does it take to accomplish the 4-Stage Balance Test?

It can be accomplished within five minutes.

Is the 4-Stage Balance Test safe?

Yes. It’s a balance test, so there’s a chance that the patient will fall, especially if they’re known to have fallen before, but the healthcare provider conducting this test will provide assistance as soon as it looks like the patient is about to fall.

Can patients perform the stances of the 4-Stage Balance Test on their own time?

Of course. They can perform the stances as a way to exercise, but it would still be best to have a physical therapist or similar professional conduct the test so they can determine what else the patient needs.

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