Timed ‘Up and Go’ in Children (TUG-IC)
Descriptive Information
Title, Edition, Dates of Publication and Revision: Timed ‘Up and Go’ Test in Children (TUG-IC), 2005, adapted from Podsiadlo and Richardson’s Timed ‘Up and Go’ Test, 1991. 4 Also referred to as a Modified Timed Up and Go Test.
Authors: Williams EN, Carrol SG, Reddihough DS et al. 4
Source: Mary P Galea, PhD BAppSc(Physio) BA, School of Physiotherapy, University of Melbourne, Austin Health, Parkville, Victoria, Australia. Correspondence at School of Physiotherapy, University of Melbourne, Parkville, Victoria 3010, Australia. E-mail: m.galea@unimelb.edu.au4
Costs: free, however a diagram and data collection worksheet for the TUG-IC can be found in the reference book for pediatric normative values by Parrot.3
Purpose: To test functional ambulatory mobility including balance and difficulty turning during gait of children with or without physical disabilities and to monitor change over time.4
Type of Test: evaluative screening test or outcome measure
Target Population and Ages: 3-12 y/o 2
Time Requirements: unspecified
Test Administration
Administration: The structure of the TUG-IC differs from the standard TUG to increase validity in the pediatric population. The test consists of a pre-test and a timed test to familiarize the patient with the procedure. The chair used is a height that supports hip and knee flexion of 90 degrees. The child is instructed to touch the star on the wall that is at his/her shoulder height and is 3 meters from the chair. The child is not instructed on how fast to walk and the test may be restarted if the child skips or hops instead of walks during the test. The timer is started when the child’s bottom leaves the chair and is stopped when the child’s bottom touches the chair again.4
Scoring: timed in seconds and compared to normal ranges4
Type of information, resulting from testing: mean score for preschoolers is 6.7 seconds and the mean score for primary school children is 5.1.4 No MCID is established in the pediatric population. TUG(s) = 6.387-(age(y) x 0.166) + (weight (Kg) X 0.014) is an equation to find an age and weight comparable score. 1
Environment for Testing: indoor, unobstructed hallway with a wall4
Equipment and Materials Needed: stopwatch, tape, tape measure, goniometer, paper star, and a pediatric sized chair with no armrests4
Examiner Qualifications: none
Psychometric Characteristics: Inter- and intraexaminer ICC of .81-.99, Same-day retest ICC of .76-.99, Within-session ICC of .80-.992
Predictive: of age and weight1
Summary Comments
Strengths: The TUG-IC is free and easy to administer with no special equipment. The instructions are simple and understandable for the pediatric population. Multiple research studies have proven high reliability and validity for this test in the pediatric population.
Weaknesses: The methodology of the TUG may be mistakenly administered in the pediatric population rather than the TUG-IC. The TUG-IC must be used in conjunction with other tests and measures to monitor physical mobility and balance. No absolute normative value or MCID is currently determined for the TUG-IC.
Clinical Applications: The TUG-IC is best utilized in conjunction with other tests and measures to evaluate and monitor progress of physical mobility and balance in children who are typically developing. Although no MCID is given, the score may be compared to the average normative value for the patient population. The TUG-IC has been researched in populations including typical development, cerebral palsy I-III, acute lymphoblastic leukemia, LE amputation, anorexia nervosa, developmental deficiency, cystic fibrosis, spina bifida, disabled children and adolescents, LE sarcoma, and traumatic brain injury.1
References
- Nicolini-Panisson RD and Donadio MVF. Normative values for the Timed ‘Up and Go’ test in children and adolescents and validation for individuals with Down syndrome. Developmental Medicine & Child Neurology. 2014;56(5): 490–497.
- Nicolini-Panisson RD and Donadio MVF. Timed “Up & Go” test in children and adolescents. Rev Paul Pediatr. 2013;31(3):377-83.
- Parrot A. Chapter 5: Functional ambulatory mobility test—timed ‘up and go’ test in children. In: Parrot A, ed. Normative reference values for musculoskeletal conditions and functional motor abilities in the pediatric population literature review and clinical guidelines; part 1: gait. Canada, Quebec: Wilfrid-Hamel; 2009:23-28.
- Williams EN, Carroll SR, Reddihough DS. Investigation of the timed ‘Up & Go’ test in children. Dev Med Child Neurol. 2005;47(8):518-24.
Summary of an article utilizing the timed up-and-go:
Collange Grecco LA, Zanon N, Malosa Sampaio LM, et al. A comparison of treadmill training and overground walking in ambulant children with cerebral palsy: randomized controlled clinical trial. Clin Rehabil. 2013;27(8):686-96.
The purpose of this study was to compare treadmill training and overground walking in regard to functional mobility for patients with cerebral palsy. The population consisted of patients between the ages of 3 and 12, with no cognitive or visual impairments, GMFCS Levels I-III, functional ambulation for >12 months, no orthopedic surgical procedures or neuromuscular block within 12 months, and no orthopedic deformity indicating a need for surgery. The methods were prospective and randomized with a blinded rater. The methods included an initial evaluation, intervention, post-intervention evaluation, and follow-up evaluation. The outcome measures included the 6-minute walk test, timed up-and-go test, Pediatric Evaluation Disability Inventory, Gross Motor Function Measure, Berg Balance Scale, and the study specific treadmill walking measures. The experimental group performed treadmill training with their habitual braces for two 30 minute sessions per week for 7 weeks with therapist corrected gait components as needed. Speed was increased to patient tolerance during the first 2 sessions and 80% of this recorded tolerance level for the remainder of the sessions, with 60% of this recorded tolerance for each 5 minute warm-up and cool-down. The alternate group performed overground walking with their habitual braces for two 30 minute sessions per week for 7 weeks with therapist corrected gait components as needed. The patients were instructed to walk at a comfortable, self-selected pace for the 5 minute warm up and cool down and were encouraged to increase the speed for the rest of the treatment time. The results consisted of a significant improvement for 6 minute walk test at postintervention and follow-up for both groups, with the experimental group with significantly better results for both postintervention and follow-up. The results also consisted of a significant improvement for the experimental and overground walking groups at postintervention for the timed-up-and-go test, mobility section of the Pediatric Evaluation Disability Inventory, C and E subscales of the Gross Motor FunctionMeasure-88, Berg Balance Scale and time and velocity tolerated on the effort test. The experimental group maintained these significant improvements at follow-up: timed up-and-go test, mobility section and overall Pediatric Evaluation Disability Inventory score, subscales C, D and E and overall Gross Motor Function Measure-88 score, Berg Balance Scale, anteroposterior oscillation with eyes closed, mediolateral oscillation with eyes open and time and velocity tolerated on the effort test Overall, this study provided evidence that children with cerebral palsy retain lasting functional benefits after undergoing treadmill training for 7 weeks.
6 responses to “Timed ‘Up and Go’ in Children (TUG-IC)”
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I think this would be a very easy test to administer to children and it’s great that it is free. One random thought I did have while reading over the testing information, is that all clinics may not have a chair that is an adequate height to position the child in 90º hip and knee flexion, especially if the clinic is not specialized for pediatrics. I also think it’s very interesting that this test has an equation that can allow you to find a comparable value – this can be very helpful!
In pediatrics, I feel that creatvity is very important in order to keep the focus and/or interest of the child. This test however could easily be suggested as a “game” or fun challenge for the patient. This would be a credible tool for gauging effect of physical therapy on functional gait since the test retest reliability is in an acceptable range. I’m curious if the lack of an MCID or other normative data isn’t available due to the variable activity performance that can be expected for this age group.
I think this is a great tool to use for older kids. Its quick and easy to administer and a great outcome measure. This would work well for my group’s 9 yo patient.
I recently evaluated the Timed Up and Down Stairs (TUDS) outcome measure, which evaluated and was predictive of function and mobility specifically tested in children ages 8-14 with CP with a norm of 8.1 sec. The shorter the time taken to complete the test was reflective of increased function and mobility and could be used evaluate progress and efficacy of intervention. I believe that this version of the TUG, specifically designed for the pediatric population, can be a beneficial adjunct to the TUDS as there are many similar qualities. The age range is children 3-12 y/o, research has been performed in children with CP, the test is easy to administer, and it can be used as an objective predictive measurement tool for intervention success and patient progress. Additionally, based on the research, this test appears to have positive long term predictive results.
I think this is a great test to utilize in the clinic. It doesn’t require many resources to employ and I think the simple nature of the test would make it easy for a child to understand and follow. I agree as therapists we need to make sure that we are employing the TUG-IC vs. the TUG as those two based on the similarity of the name could be mistaken. Another test is much this test has been in administered in specific pediatric populations and I wonder if there are norms available for those populations.
The best way to look up normative values for specific pediatric populations is to go to my first reference in my cited references. If the value is not stated in that article, look into their references. There may not be a normative value even though this test has been researched in these populations.