Tinetti Balance and Gait Test (POMA)

What is the Tinetti Balance and Gait Assessment?

The Tinetti Performance Oriented Mobility Assessment (POMA) is a clinician-administered 28-point scale developed by Dr. Mary Tinetti (1986) to assess balance and gait in older adults and predict fall risk. It is divided into two subscales: a Balance Scale (9 items, max 16 points) assessing sitting stability, transfers, and standing balance; and a Gait Scale (8 items, max 12 points) assessing walking initiation, step length, symmetry, continuity, path deviation, and trunk stability. The total score (0–28) stratifies fall risk into three categories, with scores of 18 or below indicating high fall risk and scores of 24 or above indicating low risk.

The 9 Tinetti Balance Items Explained

• Sitting Balance: Assesses whether the patient leans or slides in the chair — reflects trunk stability and postural tone.
• Arises from Chair: Assesses the ability to rise from a firm, armless chair — tests hip extensor and quadriceps strength.
• Attempts to Arise: Records the number of attempts needed to stand — multiple attempts indicate significant lower extremity weakness.
• Immediate Standing Balance (first 5 seconds): Captures the critical transition period when falls most commonly occur.
• Standing Balance: Timed standing with feet close together — assesses quiet stance balance and base of support.
• Nudged (Sternal Push): Light push on the sternum 3 times — tests reactive postural control (the ability to recover from external perturbations).
• Eyes Closed (Standing): Removes visual input to isolate proprioceptive and vestibular contributions to balance.
• Turning 360°: Assesses step continuity and stability during turning — a high-risk movement for falls.
• Sitting Down: Assesses controlled lowering into the chair — eccentric quadriceps control and distance judgment.

The 8 Tinetti Gait Items Explained

• Initiation of Gait: Any hesitancy or freezing at gait initiation indicates basal ganglia dysfunction (Parkinson's) or fear of falling.
• Step Length and Clearance (Right & Left): Assesses whether the swing foot passes the stance foot and clears the floor — identifies steppage gait and foot drop.
• Step Symmetry: Compares step length between right and left — asymmetry indicates pain, weakness, or neurological asymmetry.
• Step Continuity: Stopping between steps indicates freezing or significant fear of falling.
• Path Deviation: Walking in a straight line — veering indicates vestibular dysfunction or cerebellar ataxia.
• Trunk Stability: Trunk sway during walking — excessive sway indicates core weakness or neurological impairment.
• Walking Stance (Step Width): Wide base of support indicates balance deficit — the body widens the base to compensate for impaired dynamic balance.

Tinetti vs Other Fall Risk Measures

• vs Timed Up and Go (TUG): TUG takes 5 minutes and provides a single time score; Tinetti takes 15 minutes and provides subscale detail. Use TUG for quick screening; Tinetti for comprehensive balance and gait profiling when fall risk is confirmed.
• vs Berg Balance Scale (BBS): BBS is longer (20 minutes) with 14 tasks scored 0–4 each (max 56); Tinetti is faster (15 min) and includes gait assessment that BBS lacks. BBS is more sensitive for mild impairment; Tinetti is preferred when gait analysis is needed alongside balance.
• vs BESS: BESS uses error counting on foam and firm surfaces in 6 stances; Tinetti assesses functional tasks. BESS is preferred for sport concussion; Tinetti for geriatric fall risk.