TUG Dual Task

The TUG dual task adds a second job, counting backward or carrying a cup of water, to the Timed Up and Go. It shows how much divided attention slows someone down. The Academy of Neurologic Physical Therapy highly recommends it for Parkinson’s disease (stages 1 to 4) and multiple sclerosis. It takes under 5 minutes.

How to give the test

1. Use a standard chair with armrests and mark a line on the floor 3 meters (about 10 feet) in front of it. The person sits with their back against the chair and may use their usual walking aid, but no hands-on help.
2. TUG (regular): on “Go,” they stand, walk past the line as quickly and safely as they can, turn, walk back and sit down. Time from “Go” until they are seated. See our Timed Up and Go tool for the full single-task test.
3. TUG cognitive: repeat while they count backward by threes out loud from a number you choose at random between 20 and 100.
4. TUG manual: repeat while they carry a cup filled with water.
5. Keep the order and instructions the same at every retest. Consider language and education level when using the counting task.

This is a measurement, not a diagnosis. The TUG dual task shows how much a second task slows down standing up, walking and turning. It can’t tell you why, or what treatment is needed. Results should be reviewed with a physical therapist or another licensed health care provider who examines the person.

Reading the result

Reference values, not pass/fail rules. The numbers below come from specific published study groups. Use them as a guide alongside your own examination.

• TUG cognitive over 15 seconds: classified community-dwelling older adults as fallers with an overall correct prediction rate of 87% (Shumway-Cook et al., 2000).
• TUG manual more than 4.5 seconds slower than the regular TUG: linked to increased fall risk (Maranhao-Filho et al., 2011, as listed by the Shirley Ryan AbilityLab).
• Adding a task did not improve fall prediction over the regular TUG in Shumway-Cook et al. (2000), so the dual-task versions are most useful for showing how attention affects walking and for tracking change.
• Average times, healthy adults 60 to 87: TUG 8.39 s, TUG cognitive 9.82 s, TUG manual 11.56 s (Hofheinz & Schusterschitz, 2010). Older adults without falls averaged 8.4, 9.7 and 9.7 s (Shumway-Cook et al., 2000).
• Parkinson’s disease: in one small study, the regular TUG averaged 16.4 s and a high-cognitive-demand TUG 21.5 s, compared with 9.85 s and 11.58 s in healthy older adults (Campbell et al., 2003).