Dynamic Gait Index

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Contents

Objective

The Dynamic Gait Index (DGI) was developed as a clinical tool to assess gait, balance and fall risk. It evaluates not only usual steady-state walking, but also walking during more challenging tasks.

See the Dynamic Gait Index

Intended Population

Those with poor balance and at risk of falling such as:

Method of Use

8 functional walking tests are performed by the subject and marked out of three according to the lowest category which applies. 24 is the total individual score possible. Scores of 19 or less have been related to increase incidence of falls.


Equipment needed

Box (Shoebox), Cones (2), Stairs, 20' walkway, 15” wide


Completion Time

15 minutes

Test Protocol [1] [2]

[3]

1. Gait level surface _____

Instructions: Walk at your normal speed from here to the next mark (20')

Grading: Mark the lowest category that applies.

(3) Normal: Walks 20', no assistive devices, good sped, no evidence for imbalance, normal gait pattern

(2) Mild Impairment: Walks 20', uses assistive devices, slower speed, mild gait deviations.

(1) Moderate Impairment: Walks 20', slow speed, abnormal gait pattern, evidence for imbalance.

(0) Severe Impairment: Cannot walk 20' without assistance, severe gait deviations or imbalance.


2. Change in gait speed _____

Instructions: Begin walking at your normal pace (for 5'), when I tell you “go,” walk as fast as you can (for 5'). When I tell you “slow,” walk as slowly as you can (for 5').

Grading: Mark the lowest category that applies.

(3) Normal: Able to smoothly change walking speed without loss of balance or gait deviation. Shows a significant difference in walking speeds between normal, fast and slow speeds.

(2) Mild Impairment: Is able to change speed but demonstrates mild gait deviations, or not gait deviations but unable to achieve a significant change in velocity, or uses an assistive device.

(1) Moderate Impairment: Makes only minor adjustments to walking speed, or accomplishes a change in speed with significant gait deviations, or changes speed but has significant gait deviations, or changes speed but loses balance but is able to recover and continue walking.

(0) Severe Impairment: Cannot change speeds, or loses balance and has to reach for wall or be caught.


3. Gait with horizontal head turns _____

Instructions: Begin walking at your normal pace. When I tell you to “look right,” keep walking straight, but turn your head to the right. Keep looking to the right until I tell you, “look left,” then keep walking straight and turn your head to the left. Keep your head to the left until I tell you “look straight,“ then keep walking straight, but return your head to the center.

Grading: Mark the lowest category that applies.

(3) Normal: Performs head turns smoothly with no change in gait.

(2) Mild Impairment: Performs head turns smoothly with slight change in gait velocity, i.e., minor disruption to smooth gait path or uses walking aid.

(1) Moderate Impairment: Performs head turns with moderate change in gait velocity, slows down, staggers but recovers, can continue to walk.

(0) Severe Impairment: Performs task with severe disruption of gait, i.e., staggers outside 15” path, loses balance, stops, reaches for wall.


4. Gait with vertical head turns _____

Instructions: Begin walking at your normal pace. When I tell you to “look up,” keep walking straight, but tip your head up. Keep looking up until I tell you, “look down,” then keep walking straight and tip your head down. Keep your head down until I tell you “look straight,“ then keep walking straight, but return your head to the center.

Grading: Mark the lowest category that applies.

(3) Normal: Performs head turns smoothly with no change in gait.

(2) Mild Impairment: Performs head turns smoothly with slight change in gait velocity, i.e., minor disruption to smooth gait path or uses walking aid.

1) Moderate Impairment: Performs head turns with moderate change in gait velocity, slows down, staggers but recovers, can continue to walk.

(0) Severe Impairment: Performs task with severe disruption of gait, i.e., staggers outside 15” path, loses balance, stops, reaches for wall.


5. Gait and pivot turn _____

Instructions: Begin walking at your normal pace. When I tell you, “turn and stop,” turn as quickly as you can to face the opposite direction and stop.

Grading: Mark the lowest category that applies.

(3) Normal: Pivot turns safely within 3 seconds and stops quickly with no loss of balance.

(2) Mild Impairment: Pivot turns safely in > 3 seconds and stops with no loss of balance.

(1) Moderate Impairment: Turns slowly, requires verbal cueing, requires several small steps to catch balance following turn and stop.

(0) Severe Impairment: Cannot turn safely, requires assistance to turn and stop.


6. Step over obstacle ____

Instructions: Begin walking at your normal speed. When you come to the shoebox, step over it, not around it, and keep walking.

Grading: Mark the lowest category that applies.

(3) Normal: Is able to step over the box without changing gait speed, no evidence of imbalance.

(2) Mild Impairment: Is able to step over box, but must slow down and adjust steps to clear box safely.

(1) Moderate Impairment: Is able to step over box but must stop, then step over. May require verbal cueing.

(0) Severe Impairment: Cannot perform without assistance.


7. Step around obstacles _____

Instructions: Begin walking at normal speed. When you come to the first cone (about 6' away), walk around the right side of it. When you come to the second cone (6' past first cone), walk around it to the left.

Grading: Mark the lowest category that applies.

(3) Normal: Is able to walk around cones safely without changing gait speed; no evidence of imbalance.

(2) Mild Impairment: Is able to step around both cones, but must slow down and adjust steps to clear cones.

(1) Moderate Impairment: Is able to clear cones but must significantly slow, speed to accomplish task, or requires verbal cueing.

(0) Severe Impairment: Unable to clear cones, walks into one or both cones, or requires physical assistance.


8. Steps _____

Instructions: Walk up these stairs as you would at home, i.e., using the railing if necessary. At the top, turn around and walk down.

Grading: Mark the lowest category that applies.

(3) Normal: Alternating feet, no rail.

(2) Mild Impairment: Alternating feet, must use rail.

(1) Moderate Impairment: Two feet to a stair, must use rail.

(0) Severe Impairment: Cannot do safely.


TOTAL SCORE: ___ / 24


Scoring

A four-point ordinal scale, ranging from 0-3. “0” indicates the lowest level of function and “3” the highest level of function.

Total Score = 24

Interpretation  < 19/24 = predictive of falls in the elderly,   > 22/24 = safe ambulators

Evidence

Dynamic Gait Index, the 4-item Dynamic Gait Index, and the Functional Gait Assessment show sufficient validity, responsiveness, and reliability for assessment of walking function in patients with stroke undergoing rehabilitation, but the Functional Gait Assessment is recommended for its psychometric properties[4].

Reliability

The DGI showed high reliability and showed evidence of concurrent validity with other balance and mobility scales. It is a useful clinical tool for evaluating dynamic balance in ambulatory people with chronic stroke[5].

DGI total scores, administered by using the published instructions, showed moderate interrater reliability with subjects with vestibular disorders. The DGI should be used with caution in this population at this time, because of the lack of strong reliability[6].

The DGI is a reliable functional assessment tool for multiple sclerosis that correlates inversely with timed walk, showing its concurrent validity[7].

Validity

The DGI, although susceptible to ceiling effects, appears to be an appropriate tool for assessing function in healthy older adults[8]

Responsiveness

In stroke: Moderate responsiveness in depicting change at 2 months & 5 months after treatment[9].

In MS: Scores <12 discriminate between fallers and non-fallers[10].

Miscellaneous

Evaluating a person's performance on items of the DGI may be useful in identifying gait deviations and in evaluating gait improvements as a result of interventions[11].

Recent Related Research (from Pubmed)

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References

  1. Herdman SJ. Vestibular Rehabilitation. 2nd ed. Philadelphia, PA: F.A.Davis Co; 2000.
  2. Shumway-Cook A, Woollacott M. Motor Control Theory and Applications, Williams and Wilkins Baltimore, 1995: 323-324.
  3. AV Verleih. Dynamic Gait Index.AVI. Available from: http://www.youtube.com/watch?v=JtnjfsVnPsY[last accessed 25/05/13]
  4. Lin JH, Hsu MJ, Hsu HW, Wu HC, Hsieh CL. Psychometric Comparisons of 3 Functional Ambulation Measures for Patients With Stroke. Stroke. 2010 Jul 29; online article ahead of print
  5. Jonsdottir J, Cattaneo D. Reliability and validity of the dynamic gait index in persons with chronic stroke. Arch Phys Med Rehabil. 2007 Nov;88(11):1410-5.
  6. Wrisley D, Walker M, Echternach J, Strasnick B. Reliability of the Dynamic Gait Index in people with vestibular disorders. Arch Phys Med Rehabil. 2003;84:1528–1533
  7. 16McConvey J, Bennett S. Reliability of the Dynamic Gait Index in individuals with multiple sclerosis. Arch Phys Med Rehabil. 2005;86:130–133.
  8. Herman T, Inbar-Borovsky N, Brozgol M, Giladi N, Hausdorff JM. The Dynamic Gait Index in healthy older adults: the role of stair climbing, fear of falling and gender. Gait Posture. 2009 Feb;29(2):237-41. Epub 2008 Oct 8.
  9. Lin, J. H., Hsu, M. J., et al. (2010). Psychometric comparisons of 3 functional ambulation measures for patients with stroke. Stroke 41(9): 2021-2025
  10. Cattaneo, D., Regola, A., et al. (2006). Validity of six balance disorders scales in persons with multiple sclerosis. Disability and Rehabilitation 28(12): 789-795
  11. Marchetti GF, Whitney SL, Blatt PJ, Morris LO, Vance JM. Temporal and spatial characteristics of gait during performance of the Dynamic Gait Index in people with and people without balance or vestibular disorders. Physical Therapy, 2008 May;88(5):640-51.