Timed Up and Down Stairs (TUDS) for an Adolescent with Cerebral Palsy
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Reubens R, Silkwood-Sherer D. Intervention for an Adolescent With Cerebral Palsy During Period of Accelerated Growth. Pediatric Physical Therapy. 2016;28(1):117-125.
The Timed Up And Down Stairs test is an evaluative test that is used to assess an individual’s gait speed, step/stride length, flexibility, and fall risk. The purpose of the studied case report was to demonstrate and describe changes in activities, body structure and function, and participation after a 10-week physical therapy program. The program included home physical therapy and hippotherapy 2 times per week with the use of a weighted compressor belt. The participant was a 13-year-old boy with spastic diplegic cerebral palsy, assessed at a Gross Motor Function Classification System (GMFCS) level II. He was recommended for the therapy due to accelerated growth and function impairments that limited daily activities. Outcomes were assessed through multiple tests including, but not limited to, Modified Ashworth Scale (MAS), passive range of motion, the 1-Minute Walk Test (1-MWT), the Pediatric Balance Scale (PBS), and the Timed Up and Down Stairs test (TUDS). For the purpose of this summary, TUDS outcomes will be the concentration. During home physical therapy, the intervention focused on improvement of functional activities, mobility, strength, balance, and walking in common life situations; the hippotherapy focused on stretching, therapeutic posture responses, and core balance/strengthening exercises. The compression waist belt was used both during home and in hippotherapy therapy sessions. Intervention at home incorporated functional skills such as floor-to-stand transfers, gait training on both even and uneven surfaces, ascending and descending a 6-inch step, and 2 flights of stairs with tactile cues. Hippotherapy emphasized affect on intrinsic feedback by the participant while the trainer adjusted the horse’s movements. The Timed Up and Down Stairs, measured at week 1, 5, and 10, was used to assess the patient’s activity in real-life situations focusing on functional mobility, strength and balance. TUDS has been found to be a reliable test for children with CP and an independent predictor of community ambulation in these children who walk without support. The test included the patient ascending and descending a 14-step flight of stairs with 1 handrail being timed in seconds. The steps were 7 inches in height and mid-way through the stairs an 180deg turn was required to continue. From week 1 to week 5, the TUDS time increased by 1 second, but subsequently decreased by 9.6 seconds at week 10. The patient’s TUDS time at week 10 was 21.4 seconds compared to the week 1 time of 31 seconds. Although this was not below the cutoff for community ambulation, it was consistent with a GMFCS level II/III scoring (24.5 seconds) – ambulatory without an assistive device. Ultimately, it was an indicator of increase functional strength. Though the TUDS test puts the participant scoring GMFCS level II ambulatory without an assistive device, his 1-MWT scores at week 10 assess him to be a GMFCS level III. This shows that even with some correlation between these tests, a physical therapist should perform and compare all outcome measures prior to classifying GMFCS levels of a patient. This article has great strengths of the in-depth assessment and treatment of an adolescent with CP going through an accelerated growth spurt. Overall, the TUDS test is an excellent assessment for children with CP to measure their functional strength and mobility. This test places participants in life situations that assist physical therapists in creating and implementing appropriate interventions.
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I believe the timed up and down stairs test is a great outcome measure! Not only does it assess mobility, balance, and strength all in one test, but is also extremely functional, objective, and free. I actually used this test several times throughout my clinical rotation in the school system. Being able to safely and efficiently navigate stairs, or steps of any kind, is an important skill in order to navigate the school environment. I found this test of great help in goal writing for IEPs because again, it is extremely functional and can provide a lot of insight into any contributing balance and strength deficits.