Dynamic Gait Index Calculator

How does this dynamic gait index calculator work?

This health tool assesses the gait function in elderly patients or patients suffering from Parkinson’s or multiple sclerosis.

The dynamic gait index calculator is based on the original 8 activities in the index and offers the answer scales for each and instructions on how they should be performed during the tests.

The activities are designed as to address the individual’s ability to modify balance as to accommodate a varied range of motion, all at the same time with walking.

The test doesn’t need to take more than 10 - 15 minutes and requires a clear marked surface of 20 feet (6.1 meter), a shoe box, same size obstacles and stairs. If necessary, the activities can be performed with the help of an assistive device.

Tasks include:

■ Steady state walking;

■ Walking with changing speeds;

■ Walking with head turns both horizontally and vertically;

■ Walking while stepping over and around obstacles;

■ Pivoting while walking;

■ Stair climbing.

Each of the 8 items have different instructions to be followed when assessing them:

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 some 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.

Several studies have certified the use of the dynamic gait index in the assessment and monitoring of patients after stroke or of patients that have been diagnosed with multiple sclerosis or Parkinson’s disease. At the same time, the tool addresses to patients with vestibular disorder and is often used in geriatrics.

DGI score interpretation

Answers for each of the 8 activities are based on a 4 point scale:

■ No gait dysfunction (3 points);

■ Minimal impairment (2 points);

■ Moderate impairment (1 point);

■ Severe impairment (0 points).

The highest possible score is 24, suggesting normal gait function and a cut off at 19 was established (with 67% sensitivity and 86% specificity) as to delineate between prospective fall risk and normal condition.

Therefore scores below 19 suggest that the subject assessed has a higher risk of prospective falls and should be monitored and given the appropriate assistance.

In multiple sclerosis patients scores lower than 12 are said to have a better discrimination between patients who are at risk of falls and those who have good balance.

The index shows high reliability compared to other balance and mobility scales. It is recommended to be used in ambulatory balance evaluation of patients who are in rehabilitation after a stroke event.

References

1) Chiu YP, Fritz SL, Light KE, Velozo CA. (2006) Use of item response analysis to investigate measurement properties and clinical validity of data for the dynamic gait index. Phys Ther; 6(6):778-87.

2) Fritz SL, Pittman AL, Robinson AC, Orton SC, Rivers ED. (2007) An intense intervention for improving gait, balance, and mobility for individuals with chronic stroke: a pilot study. J Neurol Phys Ther; 31(2):71-6.

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

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

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