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RehabMeasures Instrument

Walking and Remembering Test; Modified Walking and Remembering Test

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Purpose

The WART is a clinical test of single and dual-task performance of walking and a working memory task. The original test required walking on a narrow pathway, and the modified version does not require walking on a narrow path.

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instrument details

Acronym WART

Area of Assessment

Attention & Working Memory

Assessment Type

Performance Measure

Cost

Free

Diagnosis/Conditions

  • Brain Injury

Key Descriptions

  • The protocol for testing includes three components:
    1) Single task walking
    2) Single task forward digit span testing
    3) Dual-task walking while remembering a digit span
  • Percent dual-task costs (or benefits) for the cognitive and motor tasks are calculated.
  • Difference in dual vs. single task performance is divided by single task performance for each task.

Number of Items

Depends on condition

Equipment Required

  • Stopwatch
  • Marked distance of 20 feet on floor (with or without narrow path, depending on population)
  • Protocol for assessing forward digit span
  • Sufficiently quiet environment so digit span can be tested without noise interference in single and dual-task conditions

Time to Administer

15 minutes

Required Training

Reading an Article/Manual

Instrument Reviewers

Initially reviewed by Karen McCulloch, PT, PhD, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 8/2012.

ICF Domain

Activity

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

NR

NR

NR

LS

NR

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

LS

NR

NR

NR

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

TBI EDGE

No

No

Yes

Not reported

Considerations

The approach has varied with populations tested, keeping the narrow path derived from a study by Lindenberger et al for community dwelling older adults who were high functioning. The narrow path walking proved too difficult for a population of individuals with TBI, who required a wider base of support to walk quickly and were not able to walk with a narrow base of support. Individuals with TBI were able to successfully accomplish working memory task during walking. 

The time and quiet space needed to complete the forward digit span testing is a drawback, in some clinical environments it may not be feasible. 

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Older Adults and Geriatric Care

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Normative Data

Community Dwelling Older Adults and Young Adults: (McCulloch et al, 2009; n= 25 young adults, aged 22-35; n= 25 older adults, aged 65-85, samples of convenience)

 

Young adults (n=25)

 

Older adults (n=25)

 

 

Test 1

Test 2

Test 1

Test 2

Average walking times (s)

 

 

 

 

Single task

3.60‡ (3.33, 3.88)

3.23† (3.0, 3.46)

6.25‡ (4.91, 7.59)

5.24† (4.35, 6.13)

Dual-task

3.48‡ (3.22, 3.74)

3.27† (3.04, 3.51)

5.29‡ (4.55, 6.04)

5.04† (4.25, 5.82)

Digit span

 

 

 

 

Longest digit span length

7.68‡ (7.24, 8.12)

7.76 (7.34, 8.18)

6.68‡ (6.19, 7.17)

7.00 (6.52, 7.48)

Digit span length with delay

6.80‡ (6.44, 7.16)

7.12 (6.76, 7.48)

5.72‡ (5.32, 6.12)

6.08 (5.69, 6.47)

Dual-task digit span accuracy

.92‡ (.88, .96)

.92 (.87, .96)

.85‡ (.79, .91)

.85 (.78, .92)

Average steps off path

 

 

 

 

Single task

.03‡ (-.01, .07)

.03 (-.004, .06)

.27‡ (.08, .46)

.22 (.12, .32)

Dual task

.07‡ (.00, .14)

.06 (.01, .11)

.57‡ (.29, .85)

.59 (.30, .87)

Single task averages based on 4 trials – single task set 1 trial 2-3 and both set 2 trials. Dual task averages based on 4 dual-task trials. Significant group differences (p < .05). †significant time differences (p < .05)

 

 

 

 

Test/Retest Reliability

Community dwelling older adults and young adults:(McCulloch et al, 2009)

  • Excellent test-retest reliability for walking time ICC (2,1) values > .79.

Interrater/Intrarater Reliability

Community dwelling older adults and young adults: (McCulloch et al, 2009)

  • Excellent inter-rater reliability ICC (2,1) > .97 for walking time and digit span accuracy. Rater agreement of steps off the path was excellent (93%) for young adults and good (76%) for older adults.

Construct Validity

Community dwelling older adults and young adults: (McCulloch et al, 2009)

  • Significant differences in performance on multiple indicators between young and older adults including walking times, digit span measures and step accuracy measures.

Bibliography

McCulloch, K. L., Buxton, E., et al. (2010). "Balance, attention, and dual-task performance during walking after brain injury: associations with falls history." J Head Trauma Rehabil 25(3): 155-163. Find it on PubMed

McCulloch, K. L., Mercer, V., et al. (2009). "Development of a clinical measure of dual-task performance in walking: reliability and preliminary validity of the Walking and Remembering Test." J Geriatr Phys Ther 32(1): 2-9. Find it on PubMed

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