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Self Assess your Level of Balance and Confidence in Movement.

How confident are you that you will not lose your balance and/ or become unsteady when...
0 = No confidence
100 = Complete confidence.

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* 1. Can you, walk around the house?

0 50 100

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* 2. Can you walk up and down stairs?

0 50 100

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* 3. Can you bend over and pick up a shoe from the floor?

0 50 100

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* 4. Can you reach for a small can off a shelf at eye level?

0 50 100

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* 5. Can you stand on your tiptoes and reach for something above your head?

0 50 100

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* 6. Can you stand on a chair and reach for something?

0 50 100

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* 7. Can you sweep or vacuum the floor?

0 50 100

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* 8. Can you walk to a taxi that is waiting by the sidewalk?

0 50 100

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* 9. Can you get into or out of a car?

0 50 100

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* 10. Can you cross a street?

0 50 100

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* 11. Can you step onto or off a curb?

0 50 100

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* 12. Can you walk on a street where people are rapidly passing?

0 50 100

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* 13. Can you walk on a street where other people bump into you as you walk?

0 50 100

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* 14. Can you travel by bus without a bag of groceries

0 50 100

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* 15. Can you travel by bus with a bag of groceries

0 50 100

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* 16. Can you walk on icy or slippery sidewalks?

0 50 100
0 of 16 answered