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.
Depends on condition
15 minutes
Initially reviewed by Karen McCulloch, PT, PhD, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 8/2012.
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:
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Abbreviations: |
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HR |
Highly Recommend |
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R |
Recommend |
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LS / UR |
Reasonable to use, but limited study in target group / Unable to Recommend |
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NR |
Not Recommended |
Recommendations based on level of care in which the assessment is taken:
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Acute Care |
Inpatient Rehabilitation |
Skilled Nursing Facility |
Outpatient Rehabilitation |
Home Health |
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TBI EDGE |
NR |
NR |
NR |
LS |
NR |
Recommendations for use based on ambulatory status after brain injury:
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Completely Independent |
Mildly dependant |
Moderately Dependant |
Severely Dependant |
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TBI EDGE |
LS |
NR |
NR |
NR |
Recommendations for entry-level physical therapy education and use in research:
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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) |
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TBI EDGE |
No |
No |
Yes |
Not reported |
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.
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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)
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Young adults (n=25) |
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Older adults (n=25) |
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Test 1 |
Test 2 |
Test 1 |
Test 2 |
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Average walking times (s) |
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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) |
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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) |
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Digit span |
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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) |
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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) |
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Dual-task digit span accuracy |
.92? (.88, .96) |
.92 (.87, .96) |
.85? (.79, .91) |
.85 (.78, .92) |
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Average steps off path |
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Single task |
.03? (-.01, .07) |
.03 (-.004, .06) |
.27? (.08, .46) |
.22 (.12, .32) |
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Dual task |
.07? (.00, .14) |
.06 (.01, .11) |
.57? (.29, .85) |
.59 (.30, .87) |
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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) |
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Community dwelling older adults and young adults:(McCulloch et al, 2009)
Community dwelling older adults and young adults: (McCulloch et al, 2009)
Community dwelling older adults and young adults: (McCulloch et al, 2009)
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.
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.
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.