Dynamic Gait Index

Objective

The DGI tests participants’ ability to maintain walking balance while responding to the demands of different tasks through various dynamic conditions. This is a useful test for people with vestibular and balance problems and those who are at risk of falls.

• It includes eight items that change speed by walking on a horizontal surface, turning your head to walk horizontally and vertically and turning 180 degrees to stop stepping over and around obstacles and going up and down stairs.
• Each item is scored on a scale of 0 to 3, where 3 indicates normal performance and 0 indicates severe impairment.
• The highest score for DGI is 24[1]

See also 4-item Dynamic Gait Index: Abbreviated form of the Dynamic Gait Index (8-item), used clinically to measure walking function in patients with balance and vestibular dysfunction.

Intended Population

People who have poor balance and are at risk of falls, such as:

• elderly population
• stroke
• Vestibular disorders
• Balance problems not due to vestibular causes
• Brain Injury

Reliability

• The DGI showed high reliability and showed evidence of simultaneous validity with other balance and activity scales. It is a useful clinical tool in assessing homeostasis [2].
• DGI total scores performed using published instructions showed moderate inter-rater reliability for subjects with vestibular disorders. Due to the lack of strong reliability, DGI should be used with caution in this population at this time [3]. Functional Gait Assessment (FGA) Yes A modification of the Dynamic Gait Index (DGI) that uses a higher-level task to increase the applicability of the test to patients with vestibular dysfunction and to remove the ceiling effect of the original test
• The DGI, a reliable functional assessment tool in multiple sclerosis, was negatively correlated with timed walks, showing its concurrent validity [4].

Validity

DGI, although susceptible to ceiling effects, appears to be an appropriate tool for assessing function in healthy older adults [5]

Responsiveness

Stroke: Moderate response when describing changes at 2 and 5 months after treatment [6].

In MS: Scores <12 differentiate losers from non-losers [7].

Method of Use

Subjects took an 8-item functional walk test and were labeled from three according to the lowest category applicable. 24 is the total possible individual score. A score of 19 or less was associated with an increased incidence of falls.

Equipment needed

Box (Shoe Box) Cone (2) Stairs 20′ Walkway 15″ Wide

Completion Time

15 minutes

Test Protocol [8] [9]

[10]

1. Gait level surface _____

Instructions: Walk at normal pace from here to the next marker (20′)

Rating: The lowest category to which the mark applies.

(3) Normal: 20 minutes of walking without assistive devices at high speed with no signs of imbalance with normal gait

(2) Mild impairment: Walk for 20 minutes using assistive equipment, at a slower pace, with a slight deviation in gait.

(1) Moderate Impairment: Evidence of abnormal gait pattern of imbalance with 20 feet of slow walking.

(0) Severe Impairment: Inability to walk 20′ without assistance with severe gait deviation or imbalance.

2. Change in gait speed _____

Instructions: When I tell you to “go,” start walking at your normal pace (5 minutes), walking as fast as you can (5 minutes). When I tell you to “slow”, go as slowly as you can (5 minutes).

Rating: The lowest category to which the mark applies.

(3) Normal: Gait speed changes smoothly without loss of balance or gait deviation. Shows a marked difference in walking speed between normal fast and slow.

(2) Mild Impairment: Able to change speed but exhibit slight gait deviation or no gait deviation but unable to achieve significant change in speed or use assistive devices.

(1) Moderate Impairment: Only minor adjustments to gait speed or complete speed change with significant deviation in gait or change in speed with significant gait deviation or change in speed but loss of balance but able to recover and continue walking.

(0) Severe Impairment: Unable to change speed or lose balance, must reach for wall or be caught.

3. Gait with horizontal head turns _____

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

Rating: The lowest category to which the mark applies.

(3) Normal: The head turns steadily and there is no change in gait.

(2) Mild impairment: smooth head rotation, slight changes in gait speed, i.e. minor disturbance to smooth gait path or use of a walker.

(1) Moderate impairment: performing head turning movements, moderate changes in gait speed, slowed wobbly speed, but can continue to walk after recovery.

(0) Major Impairment: Severely disrupted gait while performing task, ie, wobbles 15 inches out of path, loses balance, reaches for wall.

4. Gait with vertical head turns _____

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

Rating: The lowest category to which the mark applies.

(3) Normal: The head turns steadily and there is no change in gait.

(2) Mild impairment: smooth head rotation, slight changes in gait speed, i.e. minor disturbance to smooth gait path or use of a walker.

1) Moderate Impairment: Moderate change in gait while performing head turns slows staggering but resumes walking.

(0) Major Impairment: Severely disrupted gait while performing task, ie, wobbles 15 inches out of path, loses balance, reaches for wall.

5. Gait and pivot turn _____

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

Rating: The lowest category to which the mark applies.

(3) Normal: Pivot turns safely within 3 seconds and stops quickly without loss of balance.

(2) Minor Impairment: Pivot turns safely within > 3 seconds and stops without loss of balance.

(1) Moderate Obstacles: Slow turns require verbal cues and several small steps to maintain balance after turns and stops.

(0) Serious Impairment: Unable to turn safely. Needs assistance to turn and stop.

6. Step over obstacle ____

Instructions: Begin walking at your normal pace. When you come to the shoebox, step over it instead of going around it.

Rating: The lowest category to which the mark applies.

(3) Normal: Able to step over boxes without changing pace, with no signs of imbalance.

(2) Minor Handicap: Able to step over the box, but must slow down and adjust pace to move over the box safely.

(1) Moderate Impairment: Able to step over boxes, but must stop to step over. Verbal prompts may be required.

(0) Serious Impairment: Unable to perform without assistance.

7. Step around obstacles _____

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

Rating: The lowest category to which the mark applies.

(3) Normal: Able to safely negotiate cones without changing pace; no evidence of imbalance.

(2) Light Handicap: Able to get around two cones, but must slow down and adjust pace to clear the cones.

(1) Moderate Impairment: Able to clear cones, but must slow down significantly to complete task or require verbal prompting.

(0) Major Impairment: Unable to clear cone into one or both cones or requires physical assistance.

8. Steps _____

Instructions: Walk these stairs as you would at home, i.e. use the railing if necessary. Turn around at the top and walk down.

Rating: The lowest category to which the mark applies.

(3) Normal: Alternating feet, no rail.

(2) Light Handicap: Alternating feet must use the track.

(1) Moderate Impairment: Railings must be used for two-foot stairs.

(0) Severe Impairment: Cannot do safely.

TOTAL SCORE: ___ / 24

Scoring

Four-point ordinal scale with a range of 0-3. “0” indicates the lowest level of functionality, and “3” indicates the highest level of functionality.

Total Score = 24

Interpretation < 19/24 = predicting falls in older adults > 22/24 = safe ambulance

Evidence

Dynamic Gait Index The 4-item Dynamic Gait Index and the Functional Gait Assessment showed sufficient validity response and reliability to assess walking function in stroke patients undergoing rehabilitation, but the Functional Gait Assessment is recommended because of its psychometric Attributes [11].

Miscellaneous

Assessing an individual’s performance on a DGI item may be useful in identifying gait deviations and assessing gait improvement resulting from interventions [12].