Dynamic Gait Index

Predicts fall risk in geriatric patients and those suffering from Parkinson’s and multiple sclerosis.

There is more information about the evaluation and the result interpretation in the text below the calculator.

The dynamic gait index is addressed to patients who are at risk of fall because of different causes, including old age, Parkinson’s disease, multiple sclerosis.

This is a simple evaluation of balance and ability to perform several activities and can help monitor the status of patients with vestibular conditions.

The patient’s ability to maintain their balance and perform the standard activities is rated on a 4 point scale from no gain impairment to severe impairment.

Therefore, the final result varies from 0 to 24 points, where the higher the score, the closer to normal the gait function is.

There is a cut off set at 19 points (67% sensitivity and 86% specificity) which means that scores below 19 indicate a high risk of prospective falls and those patients should be offered appropriate assistance.

Gait level surface – walking at normal speed

Normal: walks 20’, no assistive devices, good speed, no evidence for imbalance, normal gait pattern. (3)

Mild impairment: walks 20’, uses assistive devices, slower speed, mild gait deviations. (2)

Moderate impairment: walks 20’, slow speed, abnormal gait patterns, evidence for imbalance. (1)

Severe impairment: cannot walk 20’ without assistance, severe gait deviations or imbalance. (0)

Change in gait speed

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

Mild impairment: Is able to change speed but demonstrates mild gait deviations, or no gait deviations but unable to achieve a significant change in velocity, or uses an assistive device. (2)

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

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

Gait with horizontal head turns

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

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

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

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

Gait with vertical head turns

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

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

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

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

Gait and pivot turn

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

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

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

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

Step over obstacle

Normal: Is able to step over box without changing gait speed; no evidence for imbalance. (3)

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

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

Severe impairment: Cannot perform without assistance. (0)

Step around obstacles

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

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

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

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

Steps

Normal: Alternating feet, no rail. (3)

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

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

Severe impairment: Cannot do safely. (0)

Send Us Your Feedback

Steps on how to print your input & results:

1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.

The assessment method explained

This tool is an evaluation of gait and balance, based on eight functional walking tests, that is aimed at predicting risk of falls. The GTI was validated and is recommended for use in the following populations:

■ Vestibular disorders;

■ Geriatric patients;

■ Parkinson’s disease;

■ Multiple sclerosis.

The index can be administered in about 15 minutes and needs to take place in a space where stairs are easily available, as well as a 20’ walkaway that is 15” wide. Also, a box (shoebox) and 2 cones are used.

The eight activities and their instructions are introduced below:

1. Gait level surface: Walk at your normal speed from here to the next mark (20’).

2. Change in gait speed: 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’).

3. Gait with horizontal head turns: 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 centre.

4. Gait with vertical head turns: Begin walking at your normal pace. When I tell you to “look up”, keep walking straight, but tip your head and look up. Keep looking up until I tell you, “look down”. Then keep walking straight and turn your head down. Keep looking down until I tell you, “look straight”, then keep walking straight, but return your head to the centre.

5. Gait and pivot turn: 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.

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

7. Step around obstacles: 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.

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

These activities are designed to check the subject’s ability to shift balance as to accommodate a wide range of movements, concomitant to walking and without falling.

Each of the eight activities is followed by a specific description of 4 functional statuses, for example the “Change in gait speed” is described as:

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

■ Mild impairment: Is able to change speed but demonstrates mild gait deviations, or no gait deviations but unable to achieve a significant change in velocity, or uses an assistive device. (2)

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

■ Severe impairment: Cannot change speeds, or loss balance and has to reach for a wall or be caught. (0)

After the index was published, several studies have validated its use in the assessment and monitoring of patients at risk of falls.

DGI interpretation

As introduced above, each of the eight activities benefits from a customized 4 point scale which can be summarized as follows:

■ No gait dysfunction (3 points);

■ Minimal impairment (2 points);

■ Moderate impairment (1 point);

■ Severe impairment (0 points).

The highest possible score obtainable in the DGI is 24 and the lowest is 0. Scores closer to 24 indicate an almost or completely normal condition. Scores closer to 0 indicate a severe gait impairment.

A cut off of 19 points (with 67% sensitivity and 86% specificity) delimits patients at risk of falls (scoring below 19) and those who are unlikely to suffer from prospective falls.

When used in the evaluation of multiple sclerosis patients, a cut off of 12 points is recommended as opposed to that of 19, because of better discrimination between patients who are at risk of falls and those who have good balance.

This index may also be used in the evaluation of recovery of ambulatory patients who have suffered a stroke episode.

Original sources

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.

Validation

Jonsdottir J, Cattaneo D. Reliability and validity of the dynamic gait index in persons with chronic stroke. Arch Phys Med Rehabil. 2007; 88(11):1410-5.

Other references

1. Wrisley DM, Walker ML, Echternach JL, Strasnick B. Reliability of the dynamic gait index in people with vestibular disorders. Arch Phys Med Rehabil. 2003; 84(10):1528-33.

2. 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; 29(2):237-41.

3. Whitney SL, Hudak MT, Marchetti GF. The dynamic gait index relates to self-reported fall history in individuals with vestibular dysfunction. J Vestib Res. 2000; 10(2):99-105.

Specialty: Disability

System: Musculoskeletal

Objective: Risk Prediction

Type: Index

No. Of Items: 8

Year Of Study: 2000

Abbreviation: DGI

Article By: Denise Nedea

Published On: June 18, 2017 · 10:54 AM

Last Checked: June 18, 2017

Next Review: June 18, 2023