Validity of the Four Square Step Test to Assess Dynamic Balance, Step Velocity and Displacement

  • N. LythgoEmail author
  • J. Hunter
  • A. Benson
  • B. Gordon
Conference paper
Part of the IFMBE Proceedings book series (IFMBE, volume 63)


The four square step test (FSST) is commonly used to assess dynamic standing balance in elderly adult populations. To date, only the time (recorded by a stop-watch) to complete the test has been used. Other important dynamic balance information such as step velocity and step displacement can be extracted. This study re-examined the validity of recording the FSST time with a stop-watch by comparing it to a “gold standard” method (Vicon) and investigated the relationship between FSST stop-watch time and measures of step velocity, step displacement, and age. After familiarization, fourty-one healthy adults (42 ± 12 yrs.) completed three FSST trials. The FSST time was recorded by a stop-watch and the participants’ foot movements were simultaneously recorded by a Vicon motion system (120 Hz). Measures extracted from the Vicon system were FSST time, step velocity (four directions) and step displacement (four directions). A paired t-test was used to compare FSST time recorded by each system. Pearson’s correlation analyses were conducted to identify relationships between measures. No significant difference was found between the FSST time recorded by the methods (mean difference = 0.02 ± 0.11 s). Moreover, a strong positive linear relationship (r = 0.99, p < 0.0001) was found between the FSST time recorded by the methods. A moderate linear relationship was found between the FSST time (Vicon) and step velocity (r = 0.67, p < 0.0001). Poor linear relationships were found between (1) step velocity and step displacement, (2) FSST time (Vicon) and step displacement, (3) FSST time (both methods) and age, (4) age and step velocity, and (5) age and step displacement. In conclusion, the FSST stop-watch method is valid. Moreover, it may be used to predict step velocity but not step displacement. No relationship was found between age and the FSST time, step velocity or step displacement.


Dynamic balance Step velocity Aging Falls 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1706CrossRefGoogle Scholar
  2. 2.
    O’Loughlin JL, Robitaille Y, Bolvin JF et al (1993) Incidence of and risk factors for falls and injurious falls among community dwelling elderly. Am J Epidemiol 137:342–354CrossRefGoogle Scholar
  3. 3.
    Lord S, Ward J, Williams P et al (1994) Physiological factors associated with falls in older community-dwelling women. J Am Geriatr Soc 42:1110–1117CrossRefGoogle Scholar
  4. 4.
    Hill KD (1997) Studies of balance in older people [dissertation]. Univ Melbourne, Melbourne (Aust)Google Scholar
  5. 5.
    Berg W, Alessio H, Mills E et al (1997) Circumstances and consequences of falls in independent community-dwelling older adults. Age Ageing 26:261–268CrossRefGoogle Scholar
  6. 6.
    Topper AK, Maki BE, Holliday PJ (1993) Are activity based assessments of balance and gait in the elderly predictive of risk of falling and or type of fall. J Am Geriatr Soc 41:479–487CrossRefGoogle Scholar
  7. 7.
    Dite W, Temple VA (2002) A clinical test of stepping and change of direction to identify multiple falling older adults. Arch Phys Med and Rehabil 83(11):1566–1571CrossRefGoogle Scholar
  8. 8.
    Middleton A, Fritz SL, Lusardi M (2015) Walking speed: the functional vital sign. J Aging Phys Activ 23:314–322CrossRefGoogle Scholar
  9. 9.
    Studenski et al (2011) Gait speed and survival in older adult. JAMA 305(1):50–55CrossRefGoogle Scholar
  10. 10.
    Patla AE, Frank JS, Winter DA et al (1993) Age-related changes in balance control system: initiation of stepping. Clin Biomech 8:179–184CrossRefGoogle Scholar
  11. 11.
    Medell J, Alexander N (2000) A clinical measure of maximal and rapid stepping in older women. J Gerontol A-Biol Sci Med Sci 55:M429–M433CrossRefGoogle Scholar
  12. 12.
    Wojcik L, Thelen DG, Schultz AB et al (1999) Age and gender differences in single-step recovery from a forward fall. J Gerontol Med Sci 54A:44–50CrossRefGoogle Scholar
  13. 13.
    Wojcik LA, Thelen DG, Schultz AB et al (2001) Age and gender differences in peak lower extremity joint torques and ranges of motion used during single-step balance recovery from a forward fall. J Biomech 34:67–73CrossRefGoogle Scholar
  14. 14.
    Hultsch DF, McDonald SW, Dixon RA (2002) Variability in reaction time performance of younger and older adults. J Gerontol B-Psychol Sci Soc 57:101–115CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.RMIT UniversityMelbourneAustralia

Personalised recommendations