Balance Self Test

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1.

Have you fallen more than once in the past year?

2.

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

3.

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

4.

Do you find yourself tripping or stubbing your toes occasionally?

Have you experienced a stroke or other neurological problem that has affected your balance?

Do you use a cane, walker or wheel chair, or do you need assistance to get around?

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.)

Do you feel unsteady when you are walking, climbing stairs, or up or down a curb?

Without using your hands, do you have difficulty sitting down or rising from a seated position?