One-Legged (Single Limb) Stance Test

The One-Legged Stance Test (OLST)^1,2 is a simple, easy and effective method to screen for balance impairments in the older adult population.

You may be asking yourself, “how can standing on one leg provide you with any information about balance, after all, we do not go around for extended periods of time standing on one leg?”

True, as a rule we are a dynamic people, always moving, our world always in motion, but there are instances were we do need to maintain single limb support. The most obvious times are when we are performing our everyday functional activities.

Stepping into a bath tub or up onto a curb would be difficult, if not impossible to do without the ability to maintain single limb support for a given amount of time. The ability to switch from two- to one-leg standing is required to perform turns, climb stairs and dress.

As we know, the gait cycle requires a certain amount of single limb support in order to be able to progress ourselves along in a normal pattern. When the dynamics of the cycle are disrupted, loss of balance leading to falls may occur.

This is especially true in older individuals whose gait cycle is altered due to normal and potentially abnormal changes that occur as a result of aging.

Reliability

The One-Legged Stance Test measures postural stability (i.e., balance) and is more difficult to perform due to the narrow base of support required to do the test. Along with five other tests of balance and mobility, reliability of the One-Legged Stance Test was examined for 45 healthy females 55 to 71 years old and found to have “good” intraclass correlations coefficients (ICC range = .95 to .099). Within raters ICC ranged from 0.73 to 0.93.³

To perform the test, the patient is instructed to stand on one leg without support of the upper extremities or bracing of the unweighted leg against the stance leg. The patient begins the test with the eyes open, practicing once or twice on each side with his gaze fixed straight ahead.

The patient is then instructed to close his eyes and maintain balance for up to 30 seconds.¹

The number of seconds that the patient/client is able to maintain this position is recorded. Termination or a fail test is recorded if 1) the foot touches the support leg; 2) hopping occurs; 3) the foot touches the floor, or 4) the arms touch something for support.

Normal ranges with eyes open are: 60-69 yrs/22.5 ± 8.6s, 70-79 yrs/14.2 ± 9.3s. Normal ranges for eyes closed are: 60-69 yrs/10.2 ± 8.6s, 70-79 yrs/4.3 ± 3.0s.⁴ Briggs and colleagues reported balance times on the One-Legged Stance Test in females age 60 to 86 years for dominant and nondominant legs.

Given the results of this data, there appears to be some difference in whether individuals use their dominant versus their nondominant leg in the youngest and oldest age groups.

When using this test, having patients choose what leg they would like to stand on would be appropriate as you want to record their “best” performance.

It has been reported in the literature that individuals increase their chances of sustaining an injury due to a fall by two times if they are unable to perform a One-Legged Stance Test for five seconds.⁵ Other studies utilizing the One-Legged Stance Test have been conducted in older adults to assess static balance after strength training,⁶ performance of activities of daily living and platform sway tests.⁷

Interestingly, subscales of other balance measures such as the Tinetti Performance Oriented Mobility Assessment⁸ and Berg Balance Scale⁹ utilize unsupported single limb stance times of 10 seconds and 5 seconds respectively, for older individuals to be considered to have “normal” balance.

Thirty percent to 60 percent of community-dwelling elderly individuals fall each year, with many experiencing multiple falls.¹⁰ Because falls are the leading cause of injury-related deaths in older adults and a significant cause of disability in this population, prevention of falls and subsequent injuries is a worthwhile endeavor.¹¹

The One-Legged Stance Test can be used as a quick, reliable and easy way for clinicians to screen their patients/clients for fall risks and is easily incorporated into a comprehensive functional evaluation for older adults.

References

1. Briggs, R., Gossman, M., Birch, R., Drews, J., & Shaddeau, S. (1989). Balance performance among noninstitutionalized elderly women. Physical Therapy, 69(9), 748-756.
2. Anemaet, W., & Moffa-Trotter, M. (1999). Functional tools for assessing balance and gait impairments. Topics in Geriatric Rehab, 15(1), 66-83.
3. Franchignoni, F., Tesio, L., Martino, M., & Ricupero, C. (1998). Reliability of four simple, quantitative tests of balance and mobility in healthy elderly females. Aging (Milan), 10(1), 26-31.
4. Bohannon, R., Larkin, P., Cook, A., & Singer, J. (1984). Decrease in timed balance test scores with aging. Physical Therapy, 64, 1067-1070.
5. Vellas, B., Wayne, S., Romero, L., Baumgartner, R., et al. (1997). One-leg balance is an important predictor of injurious falls in older persons. Journal of the American Geriatric Society, 45, 735-738.
6. Schlicht, J., Camaione, D., & Owen, S. (2001). Effect of intense strength training on standing balance, walking speed, and sit-to-stand performance in older adults. Journal of Gerontological Medicine and Science, 56A(5), M281-M286.
7. Frandin, K., Sonn, U., Svantesson, U., & Grimby, G. (1996). Functional balance tests in 76-year-olds in relation to performance, activities of daily living and platform tests. Scandinavian Journal of Rehabilitative Medicine, 27(4), 231-241.
8. Tinetti, M., Williams, T., & Mayewski, R. (1986). Fall risk index for elderly patients based on number of chronic disabilities. American Journal of Medicine, 80, 429-434.
9. Berg, K., et al. (1989). Measuring balance in the elderly: Preliminary development of an instrument. Physio Therapy Canada, 41(6), 304-311.
10. Rubenstein, L., & Josephson, K. (2002). The epidemiology of falls and syncope. Clinical Geriatric Medicine, 18, 141-158.
11. National Safety Council. (2004). Injury Facts. Itasca, IL: Author.