Timed Up and Down Stairs (TUDS) Article Summary

Posted on: February 24, 2019 | By: kblackburn6 | Filed under: Timed Up and Down Stairs (TUDS)

Fisher-Pipher S, Kenyon LK, Westman M. Improving balance, mobility, and dual-task performance in an adolescent with cerebral palsy: A case report. Physiotherapy Theory and Practice. 2017;33(7):586-595. doi:10.1080/09593985.2017.1323359.

Purpose: The purpose of this case study was to determine the effects of a specific task-oriented physical therapy treatment program on a patient with cerebral palsy. The program was designed specifically to address aspects of health that influence functional limitations including anaerobic endurance, cardiovascular performance, agility, strength and dynamic balance. Additionally, another purpose of this study was to examine the effects of dual-task on dynamic balance.

Study Population: This study was a case report involving a 15-year-old female with spastic triplegic cerebral palsy (CP).

Methods: An 11-week physical therapy program was implemented. Interventions were completed for 60-70 minute, twice a week. Additionally, a home exercise program was to be completed 2-3 times per week.

Outcome Measures: The outcome measures used in this study were the following: Canadian Occupational Performance Measure, 6 Minute Walk Test, Muscle Power Sprint Test, 10 x 5-meter sprint test, Timed Up and Down Starts Test, Gross Motor Function Measure, Gillette Functional Assessment Questionnaire, and functional lower extremity strength tests.

Intervention: Each intervention consisted of a 5-10 minutes warm-up, followed by an individualized interval training and ended with a 5-10 minute cool-down. The interval training included tasks that were focused on improving dynamic balance, agility, gait on uneven surfaces, lower extremity strength, core strength, and agility. All treatment interventions were progressed throughout the 11 week period, either the speed of the task was increased, dual-task was added, the number of repetitions was increased or the overall difficulty of the activity was increased. All balance and motor interventions had dual-task demands incorporated into them. The home exercise program included treadmill walking and modified yoga poses. A home exercise program log was kept to monitor compliance.

Results: Improvements were seen in the following: functional mobility, gross motor skills, cardiorespiratory fitness, agility, ascending/descending stairs and anaerobic power. Additionally, the time taken to complete dual-task activities decreased. There was a significant improvement in the 10 x 5-meter sprint test, the Gross Motor Function Measure, and the Canadian Occupational Performance Measure. The individual and her parent also reported overall improvements in mobility in the community and with the ability to converse while ambulating without decreased walking speed. The only significant improvement in lower extremity strength testing was in the participants right half-kneel to stand score.

Strengths: The use of the task-oriented approach to the interventions was a strength of this study. This helped keep the interventions focused on outcomes that were meaningful to the individual. The use of test and measures that would reflect these outcomes was also a strength of this study because it allowed them to determine significant improvements in these areas that the individual herself found meaningful. Additionally, the authors used tests and measures that have are valid and reliable in children with CP, further strengthening this study.

Limitations: The limitations of this study are similar to the limitations seen in many case studies. Without a control, there are many other factors that may have contributed to the improvements seen with this individual. Improvements may have been due to a learning curve, increased excitement/engagement with the program and/or increased confidence in her abilities. There also could have been improvements without an intervention in general.

Conclusion: For this 15-year-old female with spastic triplegic cerebral palsy, functional improvements were seen following an 11-week individualized physical therapy intervention program which focused on improving functional mobility, dual-task performance, and dynamic balance. More research is needed to determine the effects of the task-oriented approach and its relationship with dynamic balance and functional mobility in children with CP.

 

2 responses to “Timed Up and Down Stairs (TUDS) Article Summary”

  1. cpoole7 says:

    I found this study to be interesting and wonder how much more of an improvement there could have been if the HEP given to the child was more aggressive and aligned better with the intervention other than treadmill walking and yoga poses. I agree with you that task oriented interventions are proven to be effective in progressing the patient towards achieving meaningful goals. Do you know of any research studies with similar patient population but larger sample size? I think the small sample size may impact generalizability of these results to the larger population.

    • kblackburn6 says:

      Cara,
      Thank you for your response! I definitely agree with you in the fact that the small sample size is a very big limitation of this study. With n=1, it would be very difficult to generalize this to the larger population. There are many research studies done on children with cerebral palsy and various treatment approaches. However, I am not familiar with one done using this same intervention. I did come across one randomized control study done by Mary Law that compared the effects of context-focused therapy to child-focused therapy that had a larger sample size. However, this was looking at differences between treatment approaches and did not include the use of the TUDS as an outcome measure.

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