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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

1. 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.
2. Nicolini-Panisson RD and Donadio MVF. Timed “Up & Go” test in children and adolescents. Rev Paul Pediatr. 2013;31(3):377-83.
3. 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.
4. 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.