Left foot, right foot, left foot, right. My brain ticks off the steps like an easy reader version of Dr. Seuss’s 1960’s tome.
Every time we turn a corner or pass over a threshold, or have a conversation about the grandkids, Robert’s steps falter and die. He doesn’t trip. He doesn’t freeze. He doesn’t wobble his centre of mass outside his base of support.
And yet, it is immediately obvious that he is not a candidate for discharge directly to home from the hospital. A pit stop in inpatient rehab is needed.
How do I know?
He walks too darn slow.
Walking Speed – the Sixth Vital Sign
Measuring walking speed seems like a simple test but boy, it is a robust one.
The walking speed test consists of exactly what its name specifies – patients are measured on the speed with which they can walk a specific distance. Its simplicity and ease of use have made it a popular test for assessing everything from functional status to the need for rehabilitation.
Therapists have coined the phrase ‘the sixth vital sign’ as a useful way to describe the powerfully predictive nature of walking speed.
Authors have gone so far as to compare it to the blood pressure test in its versatility, predictive capabilities, and ease of administration (Fritz & Lusardi 2009). It’s hard to imagine another test that can be completed in under 2 minutes in almost all settings which can give as much information as the measurement of walking speed.
When evaluating the standards of a test, it is useful to look at the safety, cost-effectiveness, ease of use, and ease of interpretation. A walking speed test marks-off all of these boxes.
Why Test Walking Speed?
Walking speed is a great predictor of future health. Elderly people with slow walking speed were at a higher risk for future disabilities than their counterparts (Shimada et al. 2015).
Improving your patient’s performance on the walking speed test can also improve overall results in rehabilitation. A recent study on the effects of increasing walking speed times in post-stroke rehabilitation showed that the capacity for distance walking (such as that needed for community ambulation) was enhanced when walking speed increased (Awad 2014). This goes to show that measuring walking speed over short distances is an easy way for physiotherapists and nurses to gauge progress in bigger tasks like long-distance walking.
Not only does walking speed provide valuable information about mobility and disease progression, the speed at which you walk is associated with cognition. When researchers looked into the relationship between cognitive function and walking speed, they found that walking speed and cognition ran parallel to each other (Gale et al. 2014). Whenever they found less decrease in walking speed over time, they also found less decrease in cognitive function.
How to Perform the Walking Speed Test
Fritz and Lusardi (2009) charted out an inexpensive way to perform the walk test in most locations.
All that is needed is a 20 metre stretch of straight path. Although the test itself is timed for 10 metres, there should be a 5 metre ‘ramp up zone’ and 5 metre ‘deceleration zone’ before and after the testing area.
The patient is cued to walk at a comfortable speed and continue walking until reaching the end of the 20 metres. Timing begins the moment the first limb crosses the testing line and ends the moment the first limb leaves it.
The deceleration zone prevents the patient from slowing down to ‘stop on a dime’ at the end of the test strip and thus skewing the test.
The Future? Walking Speed Applications
This test is so simple, so old-school that it was absolutely predictable that someone would figure out a way to tech-it-up.
This fascinating wireless device (the WiGait) was designed to improve accuracy in walking speed tests. Using wireless signals that reflect off the patient’s body, the WiGait is able to accurately record speed, stride length, and gait patterns. Gone are the days of recording speed with a stopwatch or doing mental math to find the patient’s speed with a GPS (unless of course your WiFi goes out or your battery dies or….).
The information harvested using WiGait can be used to predict disease progression. By analysing patterns in stride, you can also predict fall risk in your patients.
The other advantage this technology offers is a completely hands-off approach. There’s no need to hook patients into a complex machine to analyse their gait patterns; the device is simply mounted on a wall.
Walking speed tests can also be used outside of the rehabilitation setting. As this article points out, when city planners know the average walking speed of their community ambulators, they can adjust stoplights to accommodate the average speed (Duke Forward 2015). It’s possible that walking speed tests can eventually even reduce traffic accidents!
The simple nature of walking speed tests make them a tool every physiotherapist and nurse should have in their back pocket.
Convinced? Pull out a tape measure, mark off a stretch of hall, buy a stopwatch and go!
- Awad, LN, Reisman, DS, Wright, TR, Roos, MA & Binder-Macleod, SA 2014, ‘Maximum Walking Speed Is a Key Determinant of Long Distance Walking Function After Stroke’, Topics in Stroke Rehabilitation, vol. 21, no. 6, pp. 502-9, viewed 2 June 2017, https://www.ncbi.nlm.nih.gov/pubmed/25467398.
- Duke Forward 2015, ‘The sixth vital sign: 5 surprising ways your walking speed reflects your health’, Duke Forward, 4 November, viewed 2 June 2017, https://dukeforward.duke.edu/news/the-sixth-vital-sign-5-surprising-ways-your-walking-speed-reflects-your-hea
- Dorfman, J 2017, ‘Wireless device can see through walls to detect walking speed’, Science Daily, 1 May, viewed 3 June 2017, https://www.sciencedaily.com/releases/2017/05/170501112531.htm.
- Fritz, S & Lusardi, M 2009, ‘White Paper: ‘Walking Speed: the Sixth Vital Sign”, Journal of Geriatric Physical Therapy, vol. 32, no. 2, pp. 2-5, viewed 2 June 2017, http://journals.lww.com/jgpt/Citation/2009/32020/White_Paper_Walking_Speed_the_Sixth_Vital_Sign_.2.aspx.
- Gale, CR, Allerhand, M, Sayer, AA, Cooper, C & Deary, IJ 2014, ‘The dynamic relationship between cognitive function and walking speed: the English Longitudinal Study of Ageing’, Age, vol. 36, no. 4, viewd 2 June 2017, https://www.ncbi.nlm.nih.gov/pubmed/24997019.
- Shimada, H, Makizako, H, Doi, T, Tsutsumimoto, K & Suzuki, T 2015, ‘Incidence of Disability in Frail Older Persons With or Without Slow Walking Speed’, Journal of the American Medical Directors Association, vol. 16, no. 8, pp. 690-6, viewed 2 June 2017, https://www.ncbi.nlm.nih.gov/pubmed/25922120.