Assessing walking adaptability in children with cerebral palsy: validity and reliability of the walking adaptability ladder test for kids

Abstract

Introduction: Assessing gait adaptation in children with cerebral palsy (CP) requires cost-effective and easily applicable methods. Objective: To evaluate the reliability and validity of the Walking Adaptability Ladder Test for Kids (WAL-K) in assessing gait adaptation in children with CP. Methods: Sixty-six participants (40 children with CP and 26 controls), aged 6-18 years, underwent WAL-K testing under single- and double-run conditions with video recording. Test-retest reliability, interrater reliability, concurrent validity, and known-group validity were assessed. Concurrent validity was assessed using the Timed Up and Go Test (TUGT), Four-Square Step Test (FSST), and Five Times Sit-to-Stand Test. Results: Interrater intraclass correlation coefficients (ICC3,k) values were > 0.999 for the WAL-K single- and double-run tests. The test-retest reliability ICC3,k values were 0.988 for the WAL-K single-run, and 0.963, 0.962, and 0.963 for the WAL-K double-run (p < .05). WAL-K double-run showed a strong correlation with FSST (r = 0.791), while WAL-K single-run correlated weakly with TUGT (r = 0.394) (p < .01). Moderate correlations were observed between other tests (p < .01). Children with CP had higher scores in all WAL-K tests compared to controls (p < .001). Conclusion: The WAL-K test demonstrated validity and reliability, making it suitable for clinical use without requiring specialized laboratory settings. It enables repeated assessments of gait adaptation in children with CP.