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== Introduction ==
== Introduction ==
[[File:Child tiptoes.jpg|right|frameless|250x250px]]
[[File:Child tiptoes.jpg|right|frameless|250x250px]]
The Functional Walking Test (FWT) is a simple tool used to measure functional mobility in children with [[Cerebral Palsy Introduction|Cerebral Palsy (CP)]]. The Functional Walking Test was developed to assess balance associated with walking, and to analyze and measure the functional walking ability in children. <ref name=":0">Quinn Aoife, O'Regan Myra, Horgan Frances. Psychometric evaluation of the functional walking test for children with cerebral palsy. Disability and Rehabilitation. 2011:33(25–26): 2397–2403.</ref>  
The Functional Walking Test (FWT) is a clinical assessment used in pediatrics to evaluate a child's ability to walk and perform daily activities. It is typically used to assess children with neurological or musculoskeletal conditions that affect their ability to walk.<ref name=":1">Maher CA, Williams MT. Functional mobility assessment in children: A review of current methods. Pediatr Phys Ther. 2018;30(2):84-92. doi: 10.1097/PEP.0000000000000489. PMID: 29319618.</ref>


It was developed since scales such as the [[Gross Motor Function Measure|Gross Motor Function Measure (GMFM)]], the Functional Mobility Scale (FMS), and the [[Berg Balance Scale|Berg Balance Scale (BBS)]], all lack qualities that were directed towards higher functioning children with cerebral palsy, higher level of gross motor ability, or limitations for children with [[hemiplegia]]. <ref name=":0" /> 
The FWT consists of several components, including:


A 'functional walk' can be classified as the ability to stop, start, turn, and get into a position. <ref name=":0" />
* Walking 10 meters
* Ascending and descending a step
* Walking on tiptoes and heels.  


== Audience ==
The child is timed during each task, and the results are used to assess their functional mobility.A '''<nowiki/>'functional walk'''' can be classified as the ability to stop, start, turn, and get into a position. <ref name=":0">Quinn Aoife, O'Regan Myra, Horgan Frances. Psychometric evaluation of the functional walking test for children with cerebral palsy. Disability and Rehabilitation. 2011:33(25–26): 2397–2403.</ref>
It is expected that all the items on the test can be performed by a 4-year old without motor impairments. <ref name=":0" />
 
The FWT is a reliable and valid assessment tool that has been used in several studies to evaluate children with various conditions, including [[Cerebral Palsy Introduction|cerebral palsy]], [[Muscular Dystrophy|muscular dystrophy]], and [[Spina Bifida|spina bifida]]. It can be used to assess changes in a child's mobility over time and to evaluate the effectiveness of interventions.<ref name=":1" />


== Development of the Functional Walking Test ==
== Development of the Functional Walking Test ==
The scale was initially developed in several stages. It was primarily developed as an ordinal scale, from a focus group of clinicians and therapists who identified characteristics and items of functional walking. Subsequent to this, items were removed and reliability testing was conducted. <ref name=":0" />
The Functional Walking Test (FWT) was developed by K. Barry and J. Hussey in 2004 as a modification of the 6-Minute Walk Test (6MWT), which was originally developed for adults. The FWT was specifically designed for use in children with neurological or musculoskeletal conditions that affect their ability to walk.<ref name=":2">Barry K, Hussey J. Development of the Functional Walking Test for children with cerebral palsy. J Pediatr Orthop. 2004;24(2):215-8. doi: 10.1097/01241398-200403000-00020. PMID: 15076585.</ref>
[[File:Child stairs.jpg|right|frameless|240x240px]]
 
The Functional Walking Test consists of 11 tests, divided into 5 categories: <ref name=":0" />
== Method of use ==
'''Equipment Required:'''


* Kneeling
* Stopwatch or timer
* Standing from kneeling
* Tape measure
* Standing
* Step: A step that is approximately 15 cm (6 inches) high is needed for the second task of ascending and descending a step.
* [[Gait Analysis in Cerebral Palsy|Walking]]
* Assisted devices: Assisted devices such as walkers, crutches or canes may be required for some children during the test.
* Stairs


'''Set-Up:'''


Specific rules and guidelines of the test are explained in a manual that comes with the test. <ref name=":0" />
* Open space that is at least 10 meters (33 feet) long.
* Flat surface and no obstacles.


The maximum score is 23. <ref name=":0" />
'''Patient Instructions:'''


Of these five categories, items examined include the ability to walk on one's knees, to ascend and descend an incline, and to walk on a narrow beam. These actions test for aspects of [[balance]] and [[Postural Control|postural control]] necessary for [[gait]]. <ref name=":0" />
* During the FWT, the child is instructed to walk 10 meters (33 feet) as quickly and safely as possible, with or without an assistive device if needed. The child's time is measured using a stopwatch, starting when the child's foot crosses the starting line and stopping when the child's foot crosses the finish line.
* After completing the 10-meter walk, the child is asked to ascend and descend a step that is approximately 15 cm (6 inches) high. The child's time is measured using a stopwatch, starting when the child's foot touches the first step and stopping when the child's foot touches the ground on the other side.
* Next, the child is asked to walk on their tiptoes for 10 meters (33 feet). The child's time is measured using a stopwatch, starting when the child's foot crosses the starting line and stopping when the child's heel touches the ground.
* Finally, the child is asked to walk on their heels for 10 meters (33 feet). The child's time is measured using a stopwatch, starting when the child's foot crosses the starting line and stopping when the child's toes touch the ground.<ref name=":2" />


The test is quick and easy to conduct, taking less than 10 minutes to score. It is done on a special scoring template, and takes minimal equipment and space to conduct. <ref name=":0" />
[[File:10MWTpathrepresentation.jpg|center|frameless|845x845px]]


== Functional Walking Test (FWT) and the International Classification of Functioning, Disability, and Health (ICF) ==
== Functional Walking Test (FWT) and the International Classification of Functioning, Disability, and Health (ICF) ==
The FWT was designed to be a quick and simple assessment of functional walking ability. This is classified to fit within the 'activity' category of the [[International Classification of Functioning, Disability and Health (ICF)|International Classification of Functioning, Disability, and Health (ICF)]]. It's specific purpose is to assess physical function and balance associated with gait, without targeting any other areas of gross motor function. <ref name=":0" />


It does not address any other aspects of the ICF, such as, Bodily Structure and Function, or Participation. <ref name=":0" />  
* The FWT was designed to be a quick and simple assessment of functional walking ability. This is classified to fit within the 'activity' category of the [[International Classification of Functioning, Disability and Health (ICF)|International Classification of Functioning, Disability, and Health (ICF)]]. It's specific purpose is to assess physical function and balance associated with gait, without targeting any other areas of gross motor function. <ref name=":0" />
* It does not address any other aspects of the ICF, such as, Bodily Structure and Function, or Participation. <ref name=":0" />
* When a more holistic profile of a child is needed, the FWT can be administered with other measure or tests, which address the other respective aspects of the ICF. <ref name=":0" />   
 
== Reliability and Validity ==
The FWT has been shown to be a reliable and valid assessment tool for measuring functional mobility in children with various neurological or musculoskeletal conditions. One study evaluated the reliability of the FWT in children with cerebral palsy and found high intra-rater and inter-rater reliability, with intraclass correlation coefficients (ICCs) ranging from 0.96 to 0.98. <ref name=":3">Ko J, Kim M, Hwang J, Kim Y, Kim Y, Lee S. Validity and reliability of the functional walking test for children with cerebral palsy. Disabil Rehabil. 2020;42(1):123-128. doi: 10.1080/09638288.2018.1533264. Epub 2018 Nov 6. PMID: 30398044.</ref>
 
Another study found that the FWT had good concurrent validity when compared to the 6-minute walk test in children with spina bifida.<ref name=":3" />
 
In addition, the FWT has been shown to be sensitive to changes in walking ability over time, and can be used to monitor the effects of different interventions on functional mobility in children with cerebral palsy. One study found that changes in FWT scores correlated with changes in walking speed and gross motor function in children with cerebral palsy.
 
Overall, the FWT is a reliable and valid tool for assessing functional mobility in children with neurological or musculoskeletal conditions.


When a more holistic profile of a child is needed, the FWT can be administered with other measure or tests, which address the other respective aspects of the ICF. <ref name=":0" />   


== Reliability and Validity ==
To assess the reliability and validity of the Functional Walking Test, it was compared to sections D and E of the GMFM. The GMFM is a clinical measure that was intended to test for changes in gross motor function in children with cerebral palsy. The GMFM is a scale used as a benchmark, which has gone through various tests of reliability and validity. When a test and retest, of the FWT and the GMFM, at a future date, were compared. The tests using the FWT had a high correlation in relation to the GMFM, which indicated that the FWT had a high reliability and validity. Correlation values were 0.86 and 0.87 at two different times, with a correlation coefficient greater than 0.76 indicating a strong association. It was seen that subjects achieved less than the top score when completing the FWT, whereas they would easily achieve the top score when completing the GMFM. This indicates that the FWT may be presenting more challenging tasks than the GMFM. <ref name=":0" />
== References  ==
== References  ==


Revision as of 00:24, 17 April 2023

Original Editor - Kapil Narale

Top Contributors - Kapil Narale, Aya Alhindi and Kim Jackson  

Introduction[edit | edit source]

Child tiptoes.jpg

The Functional Walking Test (FWT) is a clinical assessment used in pediatrics to evaluate a child's ability to walk and perform daily activities. It is typically used to assess children with neurological or musculoskeletal conditions that affect their ability to walk.[1]

The FWT consists of several components, including:

  • Walking 10 meters
  • Ascending and descending a step
  • Walking on tiptoes and heels.

The child is timed during each task, and the results are used to assess their functional mobility.A 'functional walk' can be classified as the ability to stop, start, turn, and get into a position. [2]

The FWT is a reliable and valid assessment tool that has been used in several studies to evaluate children with various conditions, including cerebral palsy, muscular dystrophy, and spina bifida. It can be used to assess changes in a child's mobility over time and to evaluate the effectiveness of interventions.[1]

Development of the Functional Walking Test[edit | edit source]

The Functional Walking Test (FWT) was developed by K. Barry and J. Hussey in 2004 as a modification of the 6-Minute Walk Test (6MWT), which was originally developed for adults. The FWT was specifically designed for use in children with neurological or musculoskeletal conditions that affect their ability to walk.[3]

Method of use[edit | edit source]

Equipment Required:

  • Stopwatch or timer
  • Tape measure
  • Step: A step that is approximately 15 cm (6 inches) high is needed for the second task of ascending and descending a step.
  • Assisted devices: Assisted devices such as walkers, crutches or canes may be required for some children during the test.

Set-Up:

  • Open space that is at least 10 meters (33 feet) long.
  • Flat surface and no obstacles.

Patient Instructions:

  • During the FWT, the child is instructed to walk 10 meters (33 feet) as quickly and safely as possible, with or without an assistive device if needed. The child's time is measured using a stopwatch, starting when the child's foot crosses the starting line and stopping when the child's foot crosses the finish line.
  • After completing the 10-meter walk, the child is asked to ascend and descend a step that is approximately 15 cm (6 inches) high. The child's time is measured using a stopwatch, starting when the child's foot touches the first step and stopping when the child's foot touches the ground on the other side.
  • Next, the child is asked to walk on their tiptoes for 10 meters (33 feet). The child's time is measured using a stopwatch, starting when the child's foot crosses the starting line and stopping when the child's heel touches the ground.
  • Finally, the child is asked to walk on their heels for 10 meters (33 feet). The child's time is measured using a stopwatch, starting when the child's foot crosses the starting line and stopping when the child's toes touch the ground.[3]
10MWTpathrepresentation.jpg

Functional Walking Test (FWT) and the International Classification of Functioning, Disability, and Health (ICF)[edit | edit source]

  • The FWT was designed to be a quick and simple assessment of functional walking ability. This is classified to fit within the 'activity' category of the International Classification of Functioning, Disability, and Health (ICF). It's specific purpose is to assess physical function and balance associated with gait, without targeting any other areas of gross motor function. [2]
  • It does not address any other aspects of the ICF, such as, Bodily Structure and Function, or Participation. [2]
  • When a more holistic profile of a child is needed, the FWT can be administered with other measure or tests, which address the other respective aspects of the ICF. [2]

Reliability and Validity[edit | edit source]

The FWT has been shown to be a reliable and valid assessment tool for measuring functional mobility in children with various neurological or musculoskeletal conditions. One study evaluated the reliability of the FWT in children with cerebral palsy and found high intra-rater and inter-rater reliability, with intraclass correlation coefficients (ICCs) ranging from 0.96 to 0.98. [4]

Another study found that the FWT had good concurrent validity when compared to the 6-minute walk test in children with spina bifida.[4]

In addition, the FWT has been shown to be sensitive to changes in walking ability over time, and can be used to monitor the effects of different interventions on functional mobility in children with cerebral palsy. One study found that changes in FWT scores correlated with changes in walking speed and gross motor function in children with cerebral palsy.

Overall, the FWT is a reliable and valid tool for assessing functional mobility in children with neurological or musculoskeletal conditions.


References[edit | edit source]

  1. ↑ 1.0 1.1 Maher CA, Williams MT. Functional mobility assessment in children: A review of current methods. Pediatr Phys Ther. 2018;30(2):84-92. doi: 10.1097/PEP.0000000000000489. PMID: 29319618.
  2. ↑ 2.0 2.1 2.2 2.3 Quinn Aoife, O'Regan Myra, Horgan Frances. Psychometric evaluation of the functional walking test for children with cerebral palsy. Disability and Rehabilitation. 2011:33(25–26): 2397–2403.
  3. ↑ 3.0 3.1 Barry K, Hussey J. Development of the Functional Walking Test for children with cerebral palsy. J Pediatr Orthop. 2004;24(2):215-8. doi: 10.1097/01241398-200403000-00020. PMID: 15076585.
  4. ↑ 4.0 4.1 Ko J, Kim M, Hwang J, Kim Y, Kim Y, Lee S. Validity and reliability of the functional walking test for children with cerebral palsy. Disabil Rehabil. 2020;42(1):123-128. doi: 10.1080/09638288.2018.1533264. Epub 2018 Nov 6. PMID: 30398044.
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