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Article

Use of Instrumented Timed Up and Go in Adults with Traumatic Brain Injury

by
Shanti M. Pinto
1,
Nahir A. Habet
2,*,
Tamar C. Roomian
2,
Kathryn M. Williams
3,
Marc Duemmler
2,
Kelly A. Werts
3,
Stephen H. Sims
2 and
Mark A. Newman
4
1
Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, 1100 Blythe Blvd, Charlotte, NC 28203, USA
2
Atrium Health Musculoskeletal Institute, 3030 Randolph Road, Charlotte, NC 28211, USA
3
Inpatient Therapy Department, Carolinas Rehabilitation, 1100 Blythe Blvd, Charlotte, NC 28203, USA
4
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
*
Author to whom correspondence should be addressed.
BioMed 2025, 5(3), 16; https://doi.org/10.3390/biomed5030016
Submission received: 19 May 2025 / Revised: 23 June 2025 / Accepted: 2 July 2025 / Published: 23 July 2025
Browse Figure
Review Reports Versions Notes

Abstract

Objective: The primary objective was to identify whether there were differences in performance for the individual subcomponents of the instrumented timed “Up and Go” (iTUG) between adults with traumatic brain injury (TBI) and healthy controls. Methods: Fifteen adults with moderate-to-severe TBI and fifteen age- and sex-matched controls completed two separate trials of the iTUG. Paired t-tests or Wilcoxon signed rank tests were used to determine the differences between groups. Results: Adults with moderate-to-severe TBI took more time to complete the iTUG (14.50 ± 2.36 s vs. 9.85 ± 1.71 s; p-value = 0.0002), had slower chest flexion angular velocities (63.52 ± 23.25 s vs. 88.19 ± 29.20 s; p-value = 0.0486) and vertical acceleration (2.22 [1.23–2.74] s vs. 3.89 [3.36–5.02] s; p-value = 0.0005) during the sit-to-stand movements, and had slower angular velocities during the turns (p-value < 0.05 for both mean and peak turn angular velocities) compared with the controls. Conclusions: Adults with moderate-to-severe TBI completed the iTUG more slowly than healthy controls. Significant differences were noted in the sit-to-stand and turn subcomponents for adults with moderate-to-severe TBI compared with healthy controls, which would not be apparent from evaluating the total time taken alone.

1. Introduction

Traumatic brain injury (TBI) is a leading cause of acquired disability due to physical and cognitive impairments. Individuals with TBI ambulate with a slower gait speed due to a decreased cadence and shorter stride length [1,2,3,4]. One important measure of functional gait-related mobility is the instrumented timed “Up and Go” (iTUG) test, which can assess an individual’s ability to stand from a seated position, ambulate, and turn. The test was initially developed in older adults, but reliability has been established in children with TBI [5,6,7] and adults with chronic stroke [7,8]. Traditionally, the total time taken to complete the test is used to evaluate the iTUG performance [9,10]. However, the total time taken does not adequately capture the complex nature of the mobility assessment. It is of particular importance to have robust measures of functional mobility after TBI in order to help guide rehabilitative interventions and decision-making regarding a return to prior life roles. Presently, a standardized graded return to sports protocol exists for returning to sports [11,12]; however, a similar protocol does not exist for returning to work, school, or other activities and clinicians must rely on subjective symptom reporting, rather than objective measures, to guide their decisions regarding returning to activities.
Expanding the data analysis of the iTUG beyond the traditional analysis of a single metric (the total time taken to complete the test) may provide additional relevant clinical information about the subject’s functional mobility [13,14,15,16,17]. Wearable sensors have allowed researchers to instrument the iTUG to quantify patients’ performance on different complex components of the iTUG test (sit-to-stand and stand-to-sit transitions, walking, and turning subcomponents) to gain greater insights into the movement characteristics of patients with mobility impairment [6,18,19,20,21,22]. It was recently demonstrated that a single inertial measurement unit (IMU) can reliably and accurately measure and differentiate between normal and pathologic gait patterns when compared to the gold standard Vicon motion capture system [23]. To evaluate the reliability of the iTUG in children with TBI, Newman and colleagues used an IMU to instrument the iTUG in a sample of 12 children with moderate-to-severe TBI and 10 age- and sex-matched typically developed (TD) children. These researchers found excellent within-session reliability for the subcomponents of the iTUG test among children with TBI and fair-to-excellent reliability for the subcomponents of the iTUG test among their age- and sex-matched TD peers [6]. Additionally, between-group differences were observed in the total time taken to complete the iTUG test and the performance on the subcomponents. The maximum torso flexion to extension angle and peak flexion angular velocity during the sit-to-stand segment were lower among subjects with TBI, suggesting less forward progression during the movement. The peak turn angular velocity was lower in subjects with TBI during both turning segments, suggesting a lower axial rotation speed during turns [6,24]. These results highlight the potential benefits of outfitting patients with an IMU while they are completing the iTUG as additional between-group differences beyond those in the total time taken to complete the test provided insights into patients’ performance in complex gait-related mobility tasks. Prior research in persons with Parkinson’s disease demonstrated that the use of levodopa led to improvements in certain subcomponents of the iTUG with a minimal impact on the other subcomponents [13], highlighting the feasibility of using the iTUG to better investigate potential pathophysiologic changes due to acquired brain injuries, such as a TBI.
To date, the iTUG has not been used as a tool to evaluate gait-related mobility in adults with moderate-to-severe TBI. The main objective of this study was to identify differences in the subcomponents of the iTUG among adults with moderate-to-severe TBI and healthy controls without a history of prior TBI. We hypothesized that adults with moderate-to-severe TBI would have slower angular velocities during the sit-to-stand and turning subcomponents as compared with healthy controls.

2. Materials and Methods

2.1. Participants

A convenience sample of 15 adults, aged 18 years old or older, who were admitted to inpatient rehabilitation at the study institution between June and October 2020 following a moderate-to-severe TBI (a Glasgow Coma Scale [GCS] score of 3–12 within the first 24 h after the injury) were tested. Additional inclusion criteria were the clearance of post-traumatic amnesia (PTA) based on a Galveston Orientation and Amnesia Test (GOAT) score > 75, the ability to provide informed consent or the ability to give informed assent with a surrogate decision-maker who could provide assent, the ability to ambulate at least 10 m without physical assistance from another person or an assistive device (foot/ankle orthotics were permitted), and the ability to speak English. Participants were excluded if they had a prior brain injury, lower-extremity weight-bearing restrictions that interfered with their ability to safely ambulate even with foot/ankle orthotics, and language and/or cognitive deficits that interfered with their ability to follow the research protocol. We additionally recruited 15 healthy controls without a prior history of TBI. The control participants were matched based on their sex and age (±5 years). Institutional review board (IRB) approval was obtained from Atrium Health (Charlotte, NC, USA).

2.2. IMU Sensor

Prior to the iTUG testing protocol, study personnel placed a single IMU sensor (VN-100 AHRS, VectorNav, Dallas, TX, USA) on the participant’s sternum over their clothes and inferior to the interclavicular notch using elastic straps (Figure 1) [6,20,23], and motion data was transmitted at a rate of 200 Hz via a Bluetooth connection to a laptop using an application custom-built using MATLAB Ver.2020a (MathWorks Inc., Natick, MA, USA). Specifically, the IMU recorded the angular velocity of the torso about a body-centered axis system comprising a cephalad/caudad (x) axis, a medial/lateral (y) axis, and an anterior/posterior (z) axis, in addition to linear accelerations along these same three axes. Data collected from the iTUG assessments included the total time taken to complete the test and the following subcomponent variables: the maximum angular displacement during the sit-to-stand TUG segment; the maximum chest flexion and extension velocities for the sit-to-stand and stand-to-sit subcomponents; the maximum vertical acceleration for the sit-to-stand subcomponent; the mean angular velocity while turning around; and the time taken to complete the sit-to-stand, stand-to-sit, and turn segments. The AO Foundation Strategy Fund provided the resources for the development of the algorithms used to analyze the data collected, and these algorithms are its intellectual property.

2.3. Instrumented iTUG Protocol

The iTUG assessment was completed as per previously published protocols [6,20,25]. Individuals were tested in a closed room free of other distractions. The participants sat in an armless chair placed in front of a 3 m walkway clearly marked with 2.5 cm wide tape on the floor. The participants were instructed to sit straight on the chair with their hands on their thighs and their backs touching the back of the chair. After they were given the “1, 2, 3, and go” signal by the tester, the subjects arose from the chair, walked at their normal speed, turned around right after passing the tape at the end of the pathway, returned to the chair, turned around, and sat down. A licensed physical therapist was present to observe the testing to ensure participants’ safety. The therapist did not provide any physical assistance to the participants during testing. Two trials were completed by each individual participant as per previously published protocols to test the within-session test–retest reliability of the iTUG [7,8,25,26,27]. The participants were allowed up to a two-minute break between the trials.

2.4. Data Analyses

The data collected from the IMU sensor was analyzed using a proprietary MATLAB Ver.2020a (MathWorks Inc, Natick, MA, USA) algorithm, which automatically reported results for the previously listed variables. The algorithm took the raw angular velocity and acceleration data from the IMU and ran the waveforms through a low-pass Butterworth filter with a cut-off frequency of 2 Hz before converting the data to a local body coordinate system using matrix calculations [28,29]. The local coordinate system of the IMU was transformed into a global coordinate system—the coordinate system was fixed in place regardless of the sensor’s orientation or location. This transformation was performed in MATLAB Ver.2020a through quaternion math and matrix calculations. Specific features, such as peaks in the waveforms, were identified and used to identify the start and end of key temporal events, such as the beginning and end of the flexion and extension phases of the sit-to-stand and stand-to-sit segments as well as the beginning and end of each turning phase. Once the starts and ends of the events had been correctly identified, the desired variables, such as the segment times and peaks and mean accelerations and velocities could then be calculated. As an overlap in the different subcomponents of the test is common, the visual inspection of the waveforms, with the temporal events indicated, was conducted by the researchers as a means of confirming the accuracy of the results. For example, a correction to the start of the motion would be made if the patient struggled to get out of the chair and leaned forward repeatedly to gain momentum. The algorithm could select the point at which the patient finally stood up as opposed to the full period of motion starting from when the patient first tried to lean forward. Outliers were determined by assessing the raw data from trials with odd or irregular results. If certain features were absent from the waveforms and/or the results for the variables were deemed impossible or highly irregular (such as a negative value when the value should have been positive), then the test was considered an outlier. The missing features and irregularities can be attributed to dropped Bluetooth signals during testing or an action by the participant that caused sensor confusion and an inability to correctly identify a value.

2.5. Statistical Analyses

The data from the two iTUG trials were averaged for each participant [7,8,25,26], and the differences between the continuous variables were calculated for the matched pairs as (the HC value)–(the TBI value). The normality of each continuous variable for the TBI and HC groups, as well as the differences between the variables, were evaluated using histograms. Demographic and iTUG variables were compared between the TBI and control groups using a paired t-test [30] if they were normally distributed or a Wilcoxon signed rank test if they were not normally distributed. McNemar’s test was used for categorical variables.
To determine the within-session test–retest reliability, intraclass correlation coefficients (ICCs) were calculated using a two-way random-effects model to compare the values obtained for two separate single-task iTUG trials of the response variables of the total time taken as well as the time taken for the individual iTUG subcomponents. The ICC values were interpreted using previously published criteria [31]. A value of ≥0.75 indicated excellent reliability, 0.40–0.74 indicated fair-to-good reliability, and a value of ≤0.39 indicated poor reliability. A two-tailed p-value of < 0.05 was considered statistically significant.

3. Results

3.1. Participants

There was no difference between the TBI and HC participants based on their age (median: 28 years old) or sex (4/15 were female), Table 1. When looking at the injury-related variables in participants with TBI, the average GCS was 7.27 ± 3.03, and the median time for PTA to clear was 23 (interquartile range [IQR] of 15–30) days. Participants with TBI were tested at a median of 27 (IQR of 17–39) days post-injury. None of the participants utilized a foot/ankle orthosis for ambulation.
The first four TBI patients recruited were tested in an area where the environmental conditions affected the signal from the IMU, resulting in dropped signals; therefore, data was only recorded for part of the full iTUG test, resulting in us not being able to report the full time taken to complete it. Data was missing for one of the two full tests for one of the subjects with moderate-to-severe TBI (TBI 3). Additionally, one TBI patient started the iTUG test before data recording began, preventing us from reporting the full time taken to complete it. Further assessments were completed in a different room that was free of interference that would affect the Bluetooth device. Of the remaining trials, 7.4% had at least one value that was considered an outlier, and 3.9% of all the measured values were eventually excluded from the statistical analysis. The algorithm prompted a request for a second assessment in 17% of the trials as a result of a temporal event potentially having been mislabeled. All these trials were manually reviewed to confirm or adjust the timepoints for the temporal events prior to their inclusion in the statistical analysis. During the visual assessment of each individual waveform, the data from the turn subcomponent was determined to be unreliable for two of the participants with TBI (TBIs 2 and 5) and one HC participant (HC 2). Based on the waveform assessment, dropped packets of data during transmission were deemed to have been the cause of the unreliability. These values were considered outliers and were not utilized in the assessment of the within-session reliability or comparisons of the performance for subcomponents between the TBI and HC subjects.

3.2. Comparison of Performance for iTUG Subcomponents Between Adults with TBI and HCs

The overall iTUG completion time was longer for individuals with moderate-to-severe TBI than HCs (14.50 ± 2.36 s vs. 9.85 ± 1.71 s, p-value of 0.0002). When comparing the performance for individual subcomponents, the participants with moderate-to-severe TBI had a slower maximum chest flexion velocity and maximum vertical acceleration during the sit-to-stand subcomponent, took a longer time to stand and turn around, and had slower mean and peak turn angular velocities for the turning around subcomponents than HCs (Table 2).

3.3. Within-Session Reliability

ICCs were calculated to determine the within-session test–retest reliability of the iTUG for adults with moderate-to-severe TBI and healthy controls (Table 3). There was excellent within-session test–retest reliability for the total iTUG completion time in both the sample with TBI (ICC of 0.906 [95% CI of 0.700–0.973]) and the healthy controls (ICC of 0.940 [95% CI of 0.841–0.978]). The overall test–retest reliability was fair to excellent for all the subcomponents of the iTUG except the total time taken to stand and the total time taken to turn in adults with moderate-to-severe TBI (Table 2). There was fair-to-excellent within-session test–retest reliability for all the iTUG subcomponents in HC participants.

4. Discussion

In this study, important differences were found in the performance during the iTUG between the adults with moderate-to-severe TBI and the HCs. Overall, the total time taken to complete the iTUG was longer for the participants with moderate-to-severe TBI, and individual differences were noted when comparing the specific subcomponents of the iTUG. The adults with moderate-to-severe TBI had a slower maximum chest flexion velocity when standing and lower mean and peak angular velocities while turning around than the healthy controls. This is in keeping with prior studies of children with moderate-to-severe TBI that demonstrated a longer total iTUG completion time, slower maximum angular velocity during the sit-to-stand transition, and slower peak angular velocity while turning around compared with typically developed children [6]. These findings highlight the utility of the iTUG in identifying subtle differences in performance for the subcomponents of the iTUG assessment that would not be apparent from the total time taken alone. Prior research by Mirelman and colleagues found impairments in the sit-to-stand and turning subcomponents of the iTUG for individuals with mild cognitive impairments when compared with healthy older adults with normal cognitive functioning, even though the total iTUG completion time was the same between the groups [18,32]. Similarly, Dibilio and colleagues used an iTUG assessment to evaluate changes in gait-related mobility for individuals with Parkinson’s disease while on and off carbidopa–levodopa treatment. They found that the total time taken to complete the TUG was significantly shorter while on carbidopa–levodopa treatment, and this was associated with significantly greater acceleration during the sit-to-stand subcomponent and faster angular velocities during the turn [33]. Further research is needed to better understand how different aspects of functional mobility are affected by TBI.
In this study, significant differences were found in performance between the groups during the turn subcomponent of the iTUG, which warrants further investigation. Moderate-to-severe TBI can cause deficits in multiple areas of cognition, including working memory, attention, and executive function, which can impact the performance during complex mobility tasks, such as the turn during the iTUG. Prior research in other populations has demonstrated that physical performance during a 180° turn is impacted by changes in cognitive and physical performance. For example, one study of 414 older adults compared the performance while walking down a straight 4 m walkway compared with walking in a figure-of-eight pattern around two cones placed 1.525 m apart. They found that the reaction time and cognitive processing speed were correlated with the performance during the figure-of-eight walking but not the straight walking assessment [34]. Similarly, one study demonstrated that the time taken to complete a 180° turn during ambulation increased with Parkinson’s disease progression in a sample of 12 adults with early-stage Parkinson’s disease [35]. Those findings suggest that the turn would be the most impacted by impairments in cognitive and motor function, which would explain our finding that the individuals with TBI ambulated more slowly during the turn than the healthy controls.
It is important to evaluate the reliability of a functional measure before using it in clinical practice. To our knowledge, this is the first study to report the within-session test–retest reliability of the iTUG in adults with moderate-to-severe TBI. The within-session test–retest reliability was excellent for the overall iTUG completion time in both the adults with moderate-to-severe TBI and healthy adults without a prior history of TBI. The test–retest reliability for the iTUG has been established in individuals with neurologic conditions, such as stroke [7] and Parkinson’s disease [36,37,38], children with moderate-to-severe TBI [6,39,40], and community-dwelling older adults [26], among other populations, but not in TBI. These findings support the use of the iTUG as a reliable measure of functional mobility in adults with moderate-to-severe TBI. Similarly, the within-session test–retest reliability was fair to excellent for all the iTUG subcomponents in the adults with moderate-to-severe TBI. These findings are consistent with a previously published study in children with moderate-to-severe TBI. In that study, there was excellent within-session test–retest reliability for the total iTUG time and fair-to-good or excellent reliability for the subcomponents for both children with moderate-to-severe TBI and typically developed controls [6]. In the present study, the total time taken and mean angular velocity for the turn had low test–retest reliability in adults with moderate-to-severe TBI; however, the within-session test–retest reliability for the peak angular velocity was excellent (Table 2). It was noted that the algorithm used for determining the start of the turn required individuals to follow a smooth path to correctly identify when the turn started. During testing, it was observed that some adults with moderate-to-severe TBI did not take the turn smoothly, impacting the total time taken to complete the turn, as well as the mean angular velocity, but not the peak angular velocity. We recommend utilizing the peak angular velocity, and not the total time taken to complete the turn, as the primary measure to assess the performance of adults with moderate-to-severe TBI during the turn in the iTUG. Additionally, the test–retest reliability was fair to excellent for the maximum chest flexion and extension velocities, vertical acceleration, and angular displacement during the sit-to-stand subcomponent despite poor reliability for the total time taken to stand in the adults with moderate-to-severe TBI. This suggests that the maximum chest velocities and acceleration should primarily be used in future studies.

Limitations and Future Directions

This pilot study is not without limitations. First, this was a pilot study with a small sample size to test the feasibility of using the iTUG protocol in adults with moderate-to-severe TBI. We noted differences in the demographic variables between the adults with moderate-to-severe TBI and HCs in this small sample. One of the goals of this study was to test the feasibility of the protocol, and we identified technical challenges with the IMU connectivity in the initial room used for testing. This led to the loss of data in some of the early iTUG trials, which improved with the move to a secondary testing location. Though we were able to find statistically significant differences in performance for the iTUG subcomponents between the groups, this study was not designed to determine whether these differences were clinically significant. Future studies will be needed to assess how the performance during the iTUG correlates with clinically relevant outcomes, such as functional recovery, falls, or rehospitalization. Prior research in older adults demonstrated that the total iTUG completion time was not predictive of falls in community-dwelling older adults; however, the addition of a wearable sensor identified important differences in the sit-to-stand and stand-to-sit transitions that were associated with an increased risk for falls [24].

5. Conclusions

The results from this study demonstrate that the adults with moderate-to-severe TBI completed the total iTUG more slowly than the healthy controls, and differences were noted in the sit-to-stand and turn subcomponents for the adults with moderate-to-severe TBI compared with the healthy controls, highlighting the utility of using a wearable sensor to obtain objective information about the performance for the iTUG subcomponents that would not be apparent from studying the total iTUG completion time alone. These findings suggest that the development of objective measures to assess different facets of functional mobility may allow for a more personalized approach to rehabilitation interventions that are able to target the specific needs of individuals with TBI.

Author Contributions

Conceptualization, S.M.P., N.A.H., K.A.W. and M.A.N.; Methodology, N.A.H., K.M.W., S.H.S. and M.A.N.; Software, N.A.H. and S.H.S.; Validation, N.A.H. and T.C.R.; Formal analysis, N.A.H., T.C.R. and M.D.; Investigation, S.M.P., N.A.H., K.M.W., K.A.W. and M.A.N.; Resources, S.M.P., N.A.H. and S.H.S.; Data curation, N.A.H., T.C.R., K.M.W., M.D., K.A.W. and M.A.N.; Writing—original draft, S.M.P., N.A.H., T.C.R. and M.A.N.; Writing—review & editing, S.M.P., N.A.H., T.C.R., K.M.W., M.D., K.A.W., S.H.S. and M.A.N.; Visualization, N.A.H. and T.C.R.; Supervision, S.M.P. and N.A.H.; Project administration, S.M.P. and T.C.R. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the continuing review approval administered by the Wake Forest University Health Sciences (protocol code IRB00084157 on 30 April 2025).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study. Written informed consent has been obtained from the participants to publish this paper.

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.

Acknowledgments

The authors would like to thank Taylor Lokai for her significant editorial contributions to our publication.

Conflicts of Interest

The authors declare no conflict of interest.

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Biomed 05 00016 g001
Figure 1. Inertial measurement unit (IMU) affixed to the sternum using elastic straps.
Figure 1. Inertial measurement unit (IMU) affixed to the sternum using elastic straps.
Biomed 05 00016 g001
Table 1. Demographic and injury-related variables for subjects. Values shown are mean (standard deviation) or median [interquartile range] for continuous variables and number (percentage) for categorical variables. TBI = traumatic brain injury; HC = healthy control; GCS = Glasgow Coma Scale; PTA = post-traumatic amnesia.
Table 1. Demographic and injury-related variables for subjects. Values shown are mean (standard deviation) or median [interquartile range] for continuous variables and number (percentage) for categorical variables. TBI = traumatic brain injury; HC = healthy control; GCS = Glasgow Coma Scale; PTA = post-traumatic amnesia.
Demographic VariableTBIHCDifference
(HC–TBI)		p-Value
Age (years)28.00 [21.00–41.00]28.00 [25.00–37.00]0.00 [−2.00–4.00]0.269
Female sex4 (26.67%)4 (26.67%)—1.000
BMI (kg/m2)23.13 [19.15–25.92]25.79 [22.80–26.62]2.45 [−0.09–5.49]0.0637
Left leg length (cm)87.00 [86.00–93.00]92.50 [88.50–96.50]3.40 (6.82)0.0740
Right leg length (cm)87.50 [86.00–93.00]93.00 [88.00–96.75]3.50 (6.55)0.0572
GCS at admission7.27 (3.03)———
Days taken for PTA to clear23 [15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30]———
Days from injury to test27 [17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39]———
Table 2. Comparison of performance for subcomponents of timed up and go (iTUG) between adults with traumatic brain injury (TBI) and healthy controls (HCs). Values shown are mean (standard deviation) or median [interquartile range] for continuous variables and number (percentage) for categorical variables. TBI = traumatic brain injury; HC = healthy control; Max Ang Displacement = maximum angular displacement; Max Chest FlexVel = maximum chest flexion velocity; Max Chest ExtVel = maximum chest extension velocity; Max Vert Accel = maximum vertical acceleration; Mean Turn Ang Vel = mean turn angular velocity; Pk Turn Ang Vel = peak turn angular velocity. a n = 11 pairs. b n = 13 pairs. c n = 14 pairs. d n = 12 pairs.
Table 2. Comparison of performance for subcomponents of timed up and go (iTUG) between adults with traumatic brain injury (TBI) and healthy controls (HCs). Values shown are mean (standard deviation) or median [interquartile range] for continuous variables and number (percentage) for categorical variables. TBI = traumatic brain injury; HC = healthy control; Max Ang Displacement = maximum angular displacement; Max Chest FlexVel = maximum chest flexion velocity; Max Chest ExtVel = maximum chest extension velocity; Max Vert Accel = maximum vertical acceleration; Mean Turn Ang Vel = mean turn angular velocity; Pk Turn Ang Vel = peak turn angular velocity. a n = 11 pairs. b n = 13 pairs. c n = 14 pairs. d n = 12 pairs.
iTUG VariableTBIHCDifference
(HC–TBI)		p-Value
Total iTUG Completion Time a14.50 (2.36)9.85 (1.71)−4.65 (2.75)0.0002
1st Transition: Sit-to-Stand
— Total Time Taken to Stand (s) b2.66 (0.39)2.18 (0.52)−0.47 (0.70)0.0325
— Max Ang Displacement (deg) b42.14 (12.86)39.46 (12.76)−2.68 (19.51)0.6290
— Max Chest FlexVel (deg/s) b63.52 (23.25)88.19 (29.20)24.67 (40.54)0.0486
— Max Chest ExtVel (deg/s) c−60.89 (20.16)−75.57 (22.26)−14.68 (30.71)0.0971
— Max Vert Accel (m/s2) b2.22 [1.23–2.74]3.89 [3.36–5.02]2.12 (1.63)0.0005
Turning Around
— Total Time Taken to Turn (s) b3.73 (0.47)3.09 (0.47)−0.65 (0.66)0.0041
— Mean Turn Ang Vel (deg/s) b51.63 [48.97–55.06]64.17 [57.10–71.17]11.52 (10.87)0.0024
— Pk Turn Ang Vel (deg/s) b107.48 (21.59)136.77 (24.01)29.30 (36.83)0.0142
2nd Transition: Stand-to-Sit
— Total Time Taken to Sit (s) d2.68 (0.42)2.30 (0.85)−0.38 (1.09)0.2545
— Max Chest FlexVel (deg/s) d45.07 (16.16)55.57 (21.41)10.50 (22.86)0.1399
— Max Chest ExtVel (deg/s) d−68.63 (26.95)−73.91 (24.43)−5.28 (34.71)0.6087
Table 3. Within-session intraclass correlation coefficient (ICC) values for timed up and go (iTUG) in adults with traumatic brain injury (TBI) and healthy controls (HCs). Values shown are ICC (95% confidence interval). TBI = traumatic brain injury; HC = healthy control; Max Ang Displacement = maximum angular displacement; Max Chest FlexVel = maximum chest flexion velocity; Max Chest ExtVel = maximum chest extension velocity; Max Vert Accel = maximum vertical acceleration; Mean Turn Ang Vel = mean turn angular velocity; Pk Turn Ang Vel = peak turn angular velocity. a n = 10 for TBI group and 15 for HC group. b n = 12 for TBI group and 15 for HC group. c n = 13 for TBI group and 15 group for HC. d n = 11 for TBI group and 15 for HC group.
Table 3. Within-session intraclass correlation coefficient (ICC) values for timed up and go (iTUG) in adults with traumatic brain injury (TBI) and healthy controls (HCs). Values shown are ICC (95% confidence interval). TBI = traumatic brain injury; HC = healthy control; Max Ang Displacement = maximum angular displacement; Max Chest FlexVel = maximum chest flexion velocity; Max Chest ExtVel = maximum chest extension velocity; Max Vert Accel = maximum vertical acceleration; Mean Turn Ang Vel = mean turn angular velocity; Pk Turn Ang Vel = peak turn angular velocity. a n = 10 for TBI group and 15 for HC group. b n = 12 for TBI group and 15 for HC group. c n = 13 for TBI group and 15 group for HC. d n = 11 for TBI group and 15 for HC group.
iTUG VariableTBIHC
Total iTUG Completion Time a0.906 (0.700–0.973)0.940 (0.841–0.978)
1st Transition: Sit-to-Stand
— Total Time Taken to Stand (s) b0.267 (−0.295–0.692)0.671 (0.290–0.869)
— Max Ang Displacement (deg) b0.825 (0.532–0.941)0.847 (0.623–0.942)
— Max Chest FlexVel (deg/s) b0.740 (0.355–0.910)0.917 (0.783–0.970)
— Max Chest ExtVel (deg/s) c0.710 (0.321–0.894)0.762 (0.451–0.908)
— Max Vert Accel (m/s2) b0.846 (0.580–0.949)0.836 (0.601–0.938)
Turning Around b
— Total Time Taken to Turn (s)0.356 (−0.203–0.740)0.757 (0.442–0.906)
— Mean Turn Ang Vel (deg/s)0.464 (−0.076–0.794)0.772 (0.469–0.912)
— Pk Turn Ang Vel (deg/s)0.880 (0.663–0.961)0.727 (0.387–0.893)
2nd Transition: Stand-to-Sit d
— Total Time Taken to Sit (s)0.769 (0.391–0.925)0.687 (0.316–0.876)
— Max Chest FlexVel (deg/s)0.722 (0.298–0.908)0.677 (0.299–0.871)
— Max Chest ExtVel (deg/s)0.833 (0.530–0.947)0.804 (0.533–0.925)
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MDPI and ACS Style

Pinto, S.M.; Habet, N.A.; Roomian, T.C.; Williams, K.M.; Duemmler, M.; Werts, K.A.; Sims, S.H.; Newman, M.A. Use of Instrumented Timed Up and Go in Adults with Traumatic Brain Injury. BioMed 2025, 5, 16. https://doi.org/10.3390/biomed5030016

AMA Style

Pinto SM, Habet NA, Roomian TC, Williams KM, Duemmler M, Werts KA, Sims SH, Newman MA. Use of Instrumented Timed Up and Go in Adults with Traumatic Brain Injury. BioMed. 2025; 5(3):16. https://doi.org/10.3390/biomed5030016

Chicago/Turabian Style

Pinto, Shanti M., Nahir A. Habet, Tamar C. Roomian, Kathryn M. Williams, Marc Duemmler, Kelly A. Werts, Stephen H. Sims, and Mark A. Newman. 2025. "Use of Instrumented Timed Up and Go in Adults with Traumatic Brain Injury" BioMed 5, no. 3: 16. https://doi.org/10.3390/biomed5030016

APA Style

Pinto, S. M., Habet, N. A., Roomian, T. C., Williams, K. M., Duemmler, M., Werts, K. A., Sims, S. H., & Newman, M. A. (2025). Use of Instrumented Timed Up and Go in Adults with Traumatic Brain Injury. BioMed, 5(3), 16. https://doi.org/10.3390/biomed5030016

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