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BALANCE SELF TEST

To help determine if you may be headed for a fall, take the Balance Self Test below. If you answer yes to one or more of the questions, you could be at risk. The best way to determine if you have a problem, though, is to talk with your physician who might recommend that you get a balance screening test from a qualified clinician. A listing of clinicians specializing in balance disorders is posted on the BalanceandMobility.com web site under "Getting Help."

Balance Self Test

1.

Have you fallen more than once in the past year?

 Yes No

2.

Do you take medicine for two or more of the following diseases: heart disease hypertension, arthritis, anxiety, and depression?

Yes

 No

3.

Do you feel dizzy or unsteady if you make sudden changes in movement such as bending down or quickly turning?

 Yes

No
4.Do you have black-outs or seizures? Yes No
5.Have you experienced a stroke or other neurological problem that has affected your balance? Yes No
6.Do you experience numbness or loss of sensation in your legs and/or feet? Yes No
7.Do you use a walker or wheel chair, or do you need assistance to get around? Yes No
8.Are you inactive? (Answer yes if you do not participate in a regular form of exercise, such as walking or exercising 20-30 minutes at least three times a week.) Yes No
9.Do you feel unsteady when you are walking, climbing stairs? Yes No
10.Do you have difficulty sitting down or rising from a seated or lying position? Yes No

If you answered "yes" to one or more of the above questions, then you could have a balance problem and should consult with your physician. You may print this balance test.