Date of Award


Document Type

Scholarly Project

Degree Name

Doctor of Physical Education (PED)


Physical Therapy

First Advisor

Meridee Danks


Background: Everyday activities contain simultaneous performance of motor and cognitive tasks such as talking while walking. When two or more tasks are carried out concurrently, task performance declines in at least one of them. In the aging population, balance, mobility, and cognition may begin to decline and can impact routine daily activities. The Four Step Square Test (FSST) is used to assess dynamic stability and the ability of the subject to step over a low object forward, sideways, and backwards. This study aimed to collect normative data in healthy community dwelling individuals and find variations in the performance of the test after adding a cognitive task while performing the FSST, compared to the FSST alone.

Methods: Forty-five community-dwelling adults, 13 males and 32 females ages 21-94, consented to participate in the study. Each participant filled out a CDC Fall Risk Checklist, demographic survey, and completed the Mini-Cog prior to the FSST. Each participant then completed the FSST and Cognitive FSST and the best time was recorded from each. The study then added a cognitive dual task component of counting backwards and times/responses were recorded.

Results: The Cognitive FSST mean times of 12 sec for all subjects was 32.8% slower than FSST mean times of 8.07 sec for all subjects. There was a significant difference (p=.001) between the two age groups (21-48 years and ~50 years) in Cognitive FSST mean times and counting correctly. Cognitive FSST and FSST mean times were higher in the older group compared to younger group (FSST mean of 10.32 seconds versus 5.82 viii seconds and Cognitive FSST mean of 15.94 seconds versus 8.11 seconds, respectively). Overall, there was no significant difference in mean times or counting correctly between genders, though the males showed a tendency for faster times in the younger group and females had faster times in the older group. There was an overall significantly greater mean times in both tests for fallers compared to non-fallers (FSST mean of 9.84 seconds versus 7.08 seconds and Cognitive mean of 15.69 seconds versus 10.71 seconds, respectively). No significant difference was found falls and in the ability to count correctly. Limitations of this study included a small size within each age group, disparity between genders that may impact the statistics for score times, and the reliability of the Mini-Cog for testing cognitive impairments in younger age groups.

Conclusion/Discussion: It is crucial to develop valid, reliable, test and measures which assess a risk of falling such as the FSST. The FSST is a quick and inexpensive measure which can be used in the clinic to determine a patient's fall risk. The Cognitive FSST provides a therapist with further information to assess functional ability of dual tasks that occur in everyday functional activities. These findings can assist in identifying community dwelling individuals who are at increased risk of falling; however, additional Cognitive FSST research is needed in this area to gather normative data, accurately predict fall risk among gender, age groups, and reported fall history.