Alina loves going to school and spending time with her classmates. She is a first grader with hemiplegic cerebral palsy (GMFCS level 1). Alina’s typical school day involves getting up and down from circle time, getting in and out of chairs at various stations, and moving to get supplies. As a PT coming into the classroom for the first time, you are pleased with the number of activities she joins. However, her teacher shares concern that Alina struggles to keep up with the movement pace of the classroom. How can you compare Alina’s classroom mobility to that of her peers? Is there a test with norms that you can use?
TFTS-N Quick Facts:
- 5-14 years
- Stand-alone test for children in school environments
- Walking at a natural pace
- Timing begins at “go,” not when movement is initiated
- Tape 3m apart on floor
- Face validity: activity of transitioning to/from floor and walking short distance.
- Test-retest reliability: 0.871
- Intertester reliability: 0.988
The Timed Floor to Stand-Natural (TFTS-N) test measures time as a child transitions from floor sitting to standing, walks 3m at a natural pace, turns around, walks back to the starting point and then returns to floor sitting. The sitting position is tailor (criss-cross).
In the typical kindergarten and first grade classroom, children are said to be moving from circle time to stations for 25% of their day. Moving between stations, getting supplies and lining up continues to be important in the higher grades. The TFTS-N quantifies transition and short distance walking speed without necessarily looking at the method by which the child is getting it done. It is a measure of how the child can keep up with peers in a classroom.
In 2016 Norms were published for neurotypical children aged 5-14 years. Interestingly, there was no significant difference in TFTS-N times between boys or girls or by body mass index in each age group. The data did show that 8-year old students were the fastest to complete the test and 13-year old students were the slowest. I’ve had several 12-13 year olds that suddenly tested slower and it is reassuring to know that this is not necessarily due to regression of skills.
In addition to speed, it is helpful to identify portions that add time onto the score. Is the time increasing because of the transition from floor to standing? Walking speed? Momentum control while walking? Taking the 180 degree turn? Returning to the floor? Identifying this provides a targeted functional skill to work on or the opportunity to change something in the environment. In one child I tested, I had not realized that 10 seconds went by while she tried to motor plan a safe return to her assigned place in circle; she was afraid of crashing down. Moving her to an assigned place where she could hold onto the wall helped bring down the transition by 8 seconds. Secondarily, we worked on the skill of controlled lowering while in PT. There are other more subtle aspects of this test to ponder; the TFTS-N offers an opportunity to assess auditory processing, attention to keep focused on a multi-step task, and vision to support this kind of movement.
So the next time you are specifically thinking about the time challenges of classroom mobility, take a moment to consider the use of the TFTS-N.