Toe tap test (TTT) for assessing people with chronic stroke

Abstract

BACKGROUND AND RATIONALE: Impaired ankle control is common in stroke survivors (Ng & Hui-Chan 2012, 2013). Ankle control, including ankle dorsiflexion and plantarflexion, is important in regaining normal gait pattern after stroke. Indeed, ankle dorsiflexor strength was independently associated with the walking endurance (Ng & Hui-Chan 2013) and functional mobility (Ng & Hui-Chan2013) of stroke survivors. In order to reflect changes in ankle control during the rehabilitation process, a reliable, valid and comprehensive measurement tools for assessing ankle control are definitely needed. Toe tap test (TTT) was initially introduced as a simple toetapping test to determine speed of ankle control in healthy adults (Kent-Braun & Ng 1999). Each subject was required to sit with knee and hip at 90 degrees of flexion, and maintain their heel on floor. Then, subjects were instructed to tap the floor as rapid as possible for 10 seconds. The objectives of this study were to investigate: (1) the interrater and test-retest reliability, (2) the correlation of TTT counts with other measures of stroke-specific impairments (3) minimal detectable change (MDC) of TTT counts. METHODS: It was a cross-sectional study with 37 subjects with chronic stroke. The main outcome measured included: TTT counts, Fugl-Meyer Lower Extremity assessment (FMA-LE); ankle muscle strength; Five Times Sit-to-Stand Test (FTSTS) times; Berg Balance Scale (BBS) and Timed ‘Up and Go’ test (TUG) scores. RESULTS: Excellent intra-rater and test-retest reliability (ICC = 0.725–0.995)) of TTT counts were found. The TTT counts of paretic legs were significantly associated with FMA-LE, ankle dorsiflexor and plantarflexor strength, BBS score, FTSTS completion time and TUG score. The 95% MDC of TTT counts was 8.7 counts and 12.6 counts of the paretic and non-paretic legs, respectively. CONCLUSION: The TTT counts is a reliable and valid measurement tool for assessing the ankle control of subjects with chronic stroke.