Keep it simple: comparing functional assessments in individuals with Down syndrome.
Use TUG or EPESE for adults with Down syndrome; harder balance tests inflate risk by loading cognition.
01Research in Context
What this study did
The team compared three ways to check mobility in adults with Down syndrome.
They ran the Timed Up and Go (TUG) and the EPESE balance test.
They also gave harder balance tasks that need more thinking.
All tests were done with the same the adults to see which pair matched best.
What they found
TUG and EPESE scores lined up almost perfectly with each other.
The hard balance tests did not agree with either simple test.
Authors say the tough tests add brain work, so they hide true leg strength.
Simple tests give a cleaner picture of how well the person can really move.
How this fits with other research
Coceski et al. (2021) saw the same trap in cerebral palsy: when teens used motor-free WISC-V subtests, their IQ scores jumped.
Both papers warn that extra motor or thinking steps can mask real skill.
Fox et al. (2001) and Gutierrez et al. (1998) showed the same hierarchy in behavior tools: quick QABF beats the heavy Motivation Assessment Scale.
Together these studies build one rule across domains: pick the tool with the fewest extra demands.
Why it matters
If you test mobility for health or program placement, start with TUG or EPESE. Skip long balance batteries that make clients count steps or remember rules. You will see what their legs can do, not what their memory cannot.
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02At a glance
03Original abstract
BACKGROUND: A number of assessments exist that evaluate function in ambulatory adults. However, these assessments take for granted the cognitive abilities required for the participant to understand what is being asked of them in order to demonstrate their functional abilities. It has been shown that individuals with Down syndrome (DS) demonstrate lower functional levels when asked to perform additional tasks while walking. Therefore, measurements of function may not be reflective of actual function if the assessment requires additional tasks in those with DS. It is for these reasons the current investigation sought to evaluate four common functional assessments, two with [modified Berg balance test (mBERG) and Functional Gait Assessment (FGA)] and two without [Timed Up and Go (TUG) and Established Populations for Epidemiologic Study in the Elderly (EPESE)] complex tasks. METHODS: Adults with DS (n = 19) completed four functional assessments, which were later compared using bivariate Pearson correlation coefficients. RESULTS: There were large associations between simple assessments (TUG-EPESE: r = -0.525, P = 0.021) and complex assessments (FGA-mBERG: r = 0.612, P = 0.005), respectively. The TUG also inversely correlated with the FGA (r = -0.476, P = 0.039), and the EPESE had a large association with mBERG (r = 0.508, P = 0.027). CONCLUSIONS: The mBERG may be the best test to replicate real-world scenarios through its tasks, although it may also be confounded by the cognitive load required to perform the movements as asked. The TUG and EPESE may be more appropriate as mobility assessments because they require very little cognitive attention when completing the tasks. True assessments of mobility ought to err on the side of simple so to not confuse the outcomes with executive functionality.
Journal of intellectual disability research : JIDR, 2022 · doi:10.1111/jir.12980