PESO, TALLA, PLIEGUE CUTANEO (PLICMETRO)

Timed Up and Down Stairs (TUDS)

Descriptive Information
1.

Title, Edition, Dates of Publication and Revision*

1.

2.

Zaino CA, Marchese VG, Westcott SL. Timed up and down stairs test:
preliminary reliability and validity of a new measure of functional mobility. Pediatr Phys
Ther. 2004;16(2):90-8.
Author (s) Zaino CA, Marchese VG, Westcott SL

3.

Source (publisher or distributor, address) Author contact information: Sarah

L. Westcott, 5019 218thNE, Redmond, WA 98053. Email: [email protected].

4.

Costs (booklets, forms, kit)* Free; cost of the test is the time required to
administer the test.

5.

Purpose* TUDS is a simple measure of functional mobility that can be easily done
in a variety of settings and should be considered for testing and potentially documenting
improvement of children with suspected limitations in functional mobility and balance. Use
of this measure could be an easy method of monitoring change across time or with therapy.
Responsiveness of the TUDS is yet to be determined.

6.

Type of Test (eg. screening, evaluative; interview, observation, checklist or

inventory)* The TUDS test is a screening test to identify children with suspected
limitations in functional mobility and balance.

7.
8.

Target Population and Ages* 8-14 y/o; with and without CP

Time Requirements Administration and Scoring* The length of time needed
for participant to ascend/descend full flight of stairs.
Test Administration

1.

Administration The participant stands 1 foot from the bottom of a 14-step flight
of stairs. The participant is instructed to Quickly, but safely go up the stairs, turn around
on the top step (landing) and come all the way down until both feet land on the bottom
step (landing. The participants are allowed to choose any method of traversing the stairs.
This includes using a step-to or foot over foot pattern, running up the stairs, skipping
steps, or any other variation. Handrails can be available. The participants wear shoes but
no orthotics. The subjects are given the cues ready and go.

2.

Scoring The TUDS score was the time in seconds from the go cue until the
second foot returned to the bottom landing. Shorter times indicated better functional
ability.

3.

Type of information, resulting from testing (e.g. standard scores, percentile

ranks) Score range (seconds) based on normative data of typically developing (TD) 8-14
y/o children.

4.
5.
6.
7.

Environment for Testing Stairs (14 steps), with handrails on one or both sides.
Equipment and Materials Needed Stopwatch, stairs (14 steps), participant
wearing shoes but no orthotics.
Examiner Qualifications Ability to administer and time the test.
Psychometric Characteristics* The TUDS demonstrated excellent intrarater,
interrater, and test-retest reliability [ICC (2,1) > or =0.94] and moderate to high
concurrent validity (Spearman r(s) = 0.78, -0.57, and -0.77, with the TUG, FRT, and TOLS,
respectively). Age accounted for 37% and 56% of the variance in the TUDS for the TD

group and for the Gross Motor Function Classification Scale level I CP group, respectively.
Significant differences in TUDS scores were found between all three functional level groups.
The TUDS has adequate reliability and validity in children with and without CP and appears
to complement current clinical measures of functional mobility and balance.
8.

Standardization/normative data 8.1 sec (range 6.3-12.6 sec), age 8-14 y/o
(N=27) or 0.58 sec/step for ascending/descending.

9.

Evidence of Reliability The TUDS demonstrated excellent intrarater, interrater,

and test-retest reliability [ICC (2,1) > or =0.94].

10.

Evidence of Validity The TUDS demonstrated moderate to high concurrent

validity (Spearman r(s) =0.78, -0.57, and -0.77; p < 0.001, with the TUG, FRT, and TOLS,
respectively.)

11.

Discriminative The TUDS scores for the typically developing (TD) group averaged
to 0.58 sec/step for ascending/descending. This average is almost half of the 1.11 sec/step
for children with CP, GMFCS level I and one third of the 1.75 sec/step for children with CP,
GMFCS level II/III. As a result, it appears use of this measure could be an easy method of
monitoring change across time or with therapy. Age accounted for 37% and 56% of the
variance in the TUDS for the TD group and for the Gross Motor Function Classification Scale
level I CP group, respectively. Significant differences in TUDS scores were found between
all three functional level groups.

12.

Predictive The TUDS was hypothesized to reflect changes in childrens functional

mobility and balance and when functional abilities were measured more directly using the
GMFCS to assign subjects to groups. The analysis revealed differences in the TUDS scores
across all three functional groups of children.

Summary Comments*
1.

2.
3.

Strengths The TUDS has adequate reliability and validity in children with and
without CP and appears to complement current clinical measures of functional mobility and
balance.
Weaknesses Further investigation needed across larger age ranges and samples.
Clinical Applications It appears use of this measure could be an easy method of
monitoring change across time or with therapy.

Adapted from:
1.
2.

Stangler S, Huber C, Routh D: Screening Growth and Development of Preschool

Children: A Guide to Test Selection. New York, McGraw-Hill, 1980, pp 55-59.
Anastasi A: Psychological Testing, 4th New York, MacMillan, 1976, pp 705-70

Article Summary:
Bonnyaud C, Zory R, Pradon D, Vuillerme N, Roche N. Clinical and biomechanical factors
which predict timed up and down stairs test performance in hemiparetic patients. Gait
Posture. 2013;38(3):466-70.
The purpose of this study was to determine the clinical (maximal gait speed, strength and
spasticity) and biomechanical (spatio-temporal, kinematic and kinetic gait parameters) gait
parameters, which could best predict the time taken by ambulatory hemiparetic patients to
ascend and to descend a flight of stairs as quickly but as safely as possible. The study
population included sixty hemiparetic patients (mean age: 50.3 years +/- 13.1, 30 with right
hemiparesis, 30 with left hemiparesis, 45 men and 15 women, time post-stroke: 5.7 years
+/- 6.7). The methods parameters were such that each patient participated in three types of
assessment: the Timed Up and Down Stairs test (TUDS); the clinical assessment (LE

strength using the MRC scale, LE spasticity using the Modified Ashworth Scale, and the
nFAC/Barthel Index/10mWT); and a 3D-gait analysis. The primary outcome measures
included the results from the Timed Up and Down Stairs test (TUDS); the clinical assessment
(LE strength using the MRC scale, LE spasticity using the Modified Ashworth Scale, and the
nFAC/Barthel Index/10mWT); and a 3D-gait analysis. There was no intervention. The results
indicated that maximal walking speed on the 10mWT and strength of the ankle dorsiflexors
were the clinical variables most related to TUDS test performance.
Strengths included consistency with prior data indicating that the 10mWT and ankle/knee
extensor strength was the main factor predictive of stair performance. Limitations included
patients who had moderate to good recovery, thus results should be interpreted relative to
similar populations.
Overall, this study demonstrated that maximal walking speed during the 10-m walk test,
ankle dorsiflexor strength, and the percentage of time spent in single support phase on the
paretic lower limb are the main factors that predict the capacity of ambulatory hemiplegic
patients to ascend and descend a flight of stairs as fast, but safely, as possible. This
information can help therapists identify patients with impaired stair climbing performance
and adapt the rehabilitation program to result in improved independence with functional
activities.

I. Timed Up and Down Stairs (TUDS)

Equipment: Stopwatch, stairs (14 steps)
Starting position: Student wears shoes but no orthotics. Student stands 1 foot from the bottom
of one flight of stairs (14 steps).
Directions: Instruct child to Quickly, but safely go up the stairs, turn around on the top step
(landing) & come all the way down until both feet land on the bottom step
(landing).
Mean: 8.1 sec (range 6.3-12.6 sec), age 8-14 yrs. or 0.58 sec per step
Correlates to: gait speed, stride length, fall risk, flexibility (ankle), fitness

II. Timed Up and Go (TUG)

Equipment: Stopwatch, chair
Starting Position: Student is barefoot, sits with knees and hips bent 90o
On go student stands up and walks 3 meters (9 ft 10 in) to a designated mark, turns around,
walks back and sits on the chair.
Mean: 5.2 sec (range 4.4-6.7 sec), 8-14 yrs.
Correlates to: gait speed, postural sway, functional mobility, balance

III. Timed Floor to Stand

Equipment: Stopwatch
Starting Position: Student seated on floor in a cross-legged position.
Student is asked to get up from floor, walk as quickly as possible for 3 meters (9 ft 10 in), turn
around, walk back to starting line, and sit back down on the floor in cross-legged position.
Mean: 6.6 sec (range 4.4-12.1 sec), age 5-22 yrs.

IV. Thirty-Second Walk Test

Equipment: Tape measure
Starting Position: Demarcated walking course
Instruct student to walk as if they are line leaders (walk not run), beginning when told and
stopping when instructed (30 sec.).

Measure the distance walked to the nearest inch. The students forward-most foot placement is
determined by the most advanced part of the foot in contact with the floor (e.g. heel at heel
strike, toes at mid stance)

V. 6-Minute Walk Test

Equipment: Tape measure
Starting Point: Mark a walking course in a large open space (gym, large corridor) with the tape,
and place a cone or other marker at the starting point of each lap.
At go student walks as fast as possible (without running) for 6 minutes. The therapist can
provide verbal encouragement every 30 seconds. At the end of 6 minutes, measure laps
completed and convert it to distance walked.

VI. Pediatric Reach Test (PRT)

Equipment: Tape measure
Starting point: Student stands barefoot on tape line on the floor. One end of tape measure is
secured to students fingers while evaluator holds the other end. Record initial reading from
tape.
Student reaches one arm forward. Student is allowed to use whatever strategy he/she wishes
as long as he/she does not touch the wall or take a step. Record final reading. Calculate final
reading minus initial reading.

VII. Shuttle Run

Equipment: Stopwatch, tape measure, 2 cones, 2 blocks
Starting Point: Mark off 30 ft with 2 pieces of tape & cones; place 2 blocks at the line opposite to
the starting line.
At go student runs from starting line to the opposite line, picks up a block, runs back to the
starting line, placing the block behind the line. The student repeats this for the 2nd block.
Measure time to complete task

Six Minute Walk Test / 6 Minute Walk Test

[1]

Method of Use
Equipment Required:

Stopwatch

Measuring/trundle wheel to measure distance covered

30-metre stretch of unimpeded walkway

Pulse oximeter for measuring heart rate and SpO2

Borg Breathlessness Scale

Set-Up:

Place cones at either end of the 30 metre stretch as turning points

Have chairs set up either side and halfway along the walking stretch

Patient Instructions:

"The object of this test is to walk as far as possible for 6 minutes. You will walk back
and forth in this hallway. Six minutes is a long time to walk, so you will be exerting
yourself. You will probably get out of
breath or become exhausted. You are permitted to slow down, to stop, and to rest as
necessary. You
may lean against the wall while resting, but resume walking as soon as you are able.
You will be walking
back and forth around the cones. You should pivot briskly around the cones and
continue back the other
way without hesitation. Now Im going to show you. Please watch the way I turn

[2]

without hesitation.
Read this standardised encouragement during the test:
After the 1st minute: You are doing well. You have 5 minutes to go.
When the timer shows 4 minutes remaining: Keep up the good work. You have 4
minutes to go.
When the timer shows 3 minutes remaining: You are doing well. You are halfway
done.
When the timer shows 2 minutes remaining: Keep up the good work. You have only
2 minutes left.
When the timer shows 1 minute remaining: You are doing well. You only have 1
minute to go.
With 15 seconds to go: In a moment Im going to tell you to stop. When I do, just
stop right where you
are and I will come to you.
At 6 minutes: Stop
If the participant stops at any time prior, you can say: You can lean against the wall
if you would like; then continue walking whenever you feel able.
Do not use other words of encouragement (or body language) to influence the
patients walking speed. Accompany the participant along the walking course, but
keep just behind them. Do not lead
them.
If available record the distance at which the oxygen saturation drops < 88%

Beighton Score
Posted By Donna Wicks, October 1, 2012

The Beighton modification of the Carter & Wilkinson scoring system has been used for
many years as an indicator of widespread hypermobility. However, it is more of a research
tool and an indicator of generalized hypermobility. As a clinical tool it can be a quick and
straightforward thing to do BUT there are two important things to realize:
i. A high Beighton score by itself does not mean that an individual has a hypermobility
syndrome. Othersymptoms and signs need to also be present.

ii. A low score should be considered with caution when assessing someone for widespread
pain as hypermobility can be present at a number of sites that are not counted in the
Beighton score. For example, this can be at the jaw joint (the TMJ), neck (cervical spine),
shoulders, mid (thoracic) spine, hips, ankles and feet.

The Beighton score is calculated as follows:

1. One point if while standing forward bending you can place palms on the ground
with legs straight
2. One point for each elbow that bends backwards
3. One point for each knee that bends backwards
4. One point for each thumb that touches the forearm when bent backwards
5. One point for each little finger that bends backwards beyond 90 degrees.

Another quick tool to use is the hypermobility questionnaire. An answer of Yes to 2 or more
of the questions gives a very high prediction of the presence of hypermobility. Again, like
the Beighton score, this does not mean that the person has a Hypermobility Syndrome.

Can you now (or could you ever) place your hands flat on the floor without
bending your knees?

Can you now (or could you ever) bend your thumb to touch your forearm?

As a child did you amuse your friends by contorting your body into strange
shapes OR could you do the splits?

As a child or teenager did your shoulder or kneecap dislocate on more than one
occasion?

Do you consider yourself double-jointed?

Dr Alan J Hakim MA FRCP
Consultant Physician and Rheumatologist
Hon. Senior Lecturer
Barts Health NHS Trust and Queen Mary University London
Updated: June 2013. Planned date of review 2016
Academic References
Beighton PH, Solomon L, Soskolne CL. Articular mobility in an African population. Ann
Rheum Dis. 1973; 32: 413-17
Hakim AJ, Grahame R. A simple questionnaire to detect hypermobility: an adjunct to the
assessment of patients with diffuse musculoskeletal pain. Int J Clin Pract 2003; 57: 163-6