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Updated: Jun 28, 2026
Measurements of Motor Function and Other Clinical Outcome Parameters in Ambulant Children with Duchenne Muscular Dystrophy
Published on: January 12, 2019
The Use of the Four Square Step Test and the 10-m Walk/Run Test to Determine Fall Risk in Children With Duchenne
Numan Bulut1, Esra Aldırmaz1,2, İpek Alemdaroğlu-Gürbüz1
1Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
Insights
The four square step test (FSST) and 10-meter walk/run test (10MWRT) can identify fall risk in children with Duchenne muscular dystrophy (DMD). These tests help clinicians assess fall risk and plan rehabilitation programs for children with DMD.
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Background:
- Duchenne muscular dystrophy (DMD) is a progressive genetic disorder affecting muscle strength.
- Identifying fall risk in children with DMD is crucial for early intervention and preventing injuries.
- Standardized functional tests are needed to accurately assess fall risk in this population.
Purpose of the Study:
- To evaluate the effectiveness of the four square step test (FSST) and the 10-meter walk/run test (10MWRT) in distinguishing between children with DMD who fall and those who do not.
- To establish cut-off points for these tests to aid in fall risk assessment.
Main Methods:
- Ninety-five children with DMD were assessed, categorized as fallers (n=50) or non-fallers (n=45) based on recent fall history.
- The Vignos Scale was used to determine functional levels.
- Children performed the FSST and 10MWRT, with data analyzed using the Mann-Whitney U test and receiver operating characteristic (ROC) curves.
Main Results:
- Fallers exhibited significantly lower functional levels compared to non-fallers (p < 0.001).
- The FSST showed a significant difference between fallers and non-fallers, with a cut-off point of 13.10 seconds (p < 0.05).
- The 10MWRT also revealed significant differences, establishing a cut-off point of 5.60 seconds (p < 0.05).
Conclusions:
- Both the FSST and 10MWRT are sensitive and specific tools for assessing fall risk in children with DMD.
- The identified cut-off points can guide healthcare professionals in developing targeted rehabilitation strategies.
- Implementing these tests can lead to proactive management, reducing fall-related injuries in children with DMD.
Introduction/Aims:
The identification of the risk of falling in Duchenne muscular dystrophy (DMD) is essential for the implementation of timely preventive approaches. This study aimed to examine the ability of the four square step test (FSST) and the 10-m walk/run test (10MWRT) to discriminate between fallers and non-fallers in children with DMD.
Methods:
Ninety-five children with DMD were included in this study. Functional level was determined with the Vignos Scale. Children who had fallen at least once in the previous month were categorized as "fallers" (n = 50), while those who had not fallen were categorized as "non-fallers" (n = 45). The FSST and 10MWRT were performed. The Mann-Whitney U test was performed to examine group differences in the FSST and 10MWRT scores. The predictive values of the FSST and 10MWRT were determined with receiver operating characteristic curves.
Results:
The demographic characteristics of fallers (median age: 9.50 years; median body mass index [BMI]: 19.02 kg/m2) and non-fallers (median age: 9.00 years; median BMI: 17.95) were similar (p > 0.05). Fallers demonstrated lower functional levels compared with non-fallers (p < 0.001). The FSST for fallers was 20.04 ± 12.57 s while that for non-fallers was 11.44 ± 2.94 s with a cut-off point of 13.10 s (p < 0.05). The 10MWRT for fallers and non-fallers were 9.42 ± 4.77 and 5.36 ± 2.10 s, respectively, with a cut-off point of 5.60 s (p < 0.05).
Discussion:
The two outcome measures were shown to be sensitive and specific in determining the risk of falls in children with DMD. The cut-off points may guide professionals in planning a proactive rehabilitation program to reduce fall risk or minimize subsequent injuries.
