Balance problems are the most common reason for falls and decreased quality of life. However, balance control is based on many underlying complex systems that can be affected by disease and injury. It is important to evaluate the specific systems affected in each patient with a balance problem in order to develop effective treatments. However, current balance evaluation tests do not differentiate different types of balance problems.

The Balance Evaluation Systems Test

Dr. Horak has developed a Balance Evaluation Systems Test (BESTest) for clinicians to differentiate balance into 6 underlying systems that may constrain balance: Biomechanical, Stability Limits, Postural Responses, Anticipatory Postural Adjustments, Sensory Orientation, and Dynamic Balance during Gait and Cognitive Effects. This unique evaluation tool is appropriate for any age and severity of ambulatory patients with Parkinson’s Disease, Cerebellar Ataxia, Vestibular Disorders, Neuropathy, Head Injury, Multiple Sclerosis, Stroke, Cerebral Palsy, Cognitive Deficits, and other balance disorders. The BESTest is a sensitive, quantitative balance assessment that will improve third party reimbursement by identifying subtle deficits and changes with therapy.

About Fay B. Horak, Ph.D., P.T.


Dr. Horak is a professor of Neurology and Biomechanical Engineering at Oregon Health and Science University. She is director of the Balance Disorder's Laboratory with several NIH and Foundation grants focused on developing new balance assessment tools and balance rehabilitation for neurological patients. She has over 175 research publications and was awarded a prestigious Merit Award from NIH. Dr. Horak also was awarded the Mary McMillian Research Award from the APTA and Research Awards from the Neurology and Pediatric Sections of the APTA. She is past-president of the International Society of Posture and Gait Research, organizer of the Rehabilitation Social for the Society for Neuroscience, and editor/reviewer for many prestigious neuroscience and rehabilitation journals.


Test Copies

Full BESTest.pdf 

MiniBEST.pdf (revised 3/08/13)

Coming soon: the following translations of the BESTest and Mini-BESTest are currently being finalized. Download links will be posted below as they become available.


The BESTest and Mini-BESTest may be used for Clinical and Research purposes.  Contact us for any commercial use.


Search for BESTest papers on Pubmed

Original Papers

Horak, F. B., Wrisley, D. M., & Frank, J. (2009). The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits. Physical Therapy, 89(5), 484–98. doi:10.2522/ptj.20080071

Franchignoni, F., Horak, F., Godi, M., Nardone, A., & Giordano, A. (2010). Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest. Journal of Rehabilitation Medicine : Official Journal of the UEMS European Board of Physical and Rehabilitation Medicine, 42, 323–331. doi:10.2340/16501977-0537

Related Papers

King, L., & Horak, F. (2013). On the Mini-BESTest: Scoring and the Reporting of Total Scores. Physical Therapy, 93(4), 571–5. doi:10.2522/ptj.2013.93.4.571 (pub med link)  note: subscription to Physical Therapy Jounral required for login

Duncan, R. P., Leddy, A. L., Cavanaugh, J. T., Dibble, L. E., Ellis, T. D., Ford, M. P., … Earhart, G. M. (2013). Comparative utility of the BESTest, mini-BESTest, and brief-BESTest for predicting falls in individuals with Parkinson disease: a cohort study. Physical Therapy, 93(4), 542–50. doi:10.2522/ptj.20120302 (pub med link) (ptjounral ink(pdf download)

Mak, M. K. Y., & Auyeung, M. M. (2013). The mini-BESTest can predict Parkinsonian recurrent fallers: a 6-month prospective study.  Journal of Rehabilitation Medicine: Official Journal of the UEMS European Board of Physical and Rehabilitation Medicine, 45, 565–71. doi:10.2340/16501977-1144 (pub med link)

O’Hoski, S., Winship, B., Herridge, L., Agha, T., Brooks, D., Beauchamp, M. K., & Sibley, K. M. (2014). Increasing the Clinical Utility of the BESTest, Mini-BESTest, and BriefBESTest: Normative Values in Canadian Adults Who Are Healthy and Aged 50 Years and Over. Physical Therapy, 94(3), 334–42. doi:10.2522/ptj.20130104 (ptjounral link) (pdf download)

Padgett, P. K., Jacobs, J. V, & Kasser, S. L. (2012). Is the BESTest at Its Best? A Suggested Brief Version Based on Interrater Reliability, Validity, Internal Consistency, and Theoretical Construct. Physical Therapy, 92(9), 1197–207. doi:10.2522/ptj.20120056 (ptjournal link) (pdf download)


Other Endevors with Dr. Horak


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