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Subsections
Dynamic Gait Index (DGI)

Equations

(Open Calc)Dynamic Gait Index (DGI)

Background

  1. The Dynamic Gait Index (DGI) assess gait, balance and fall risk in the elderly patients by evaluating usual steady-state walking and walking during more challenging tasks
  2. Intended population are the elderly, stroke patients, and vestibular disorder patients who display poor balance and are at risk for fall
  3. Gait index measures are 8 functional walking tests performed by the patient, and scored on the scale of 0 to 3. Scores of 19 or less have been related to increase incidence of falls
  4. Highest score achievable is 24 which indicates safe ambulators
  5. Each question is scored with the lowest category that applies
  6. Time for completion of the exam is 15 minutes

Questions

  1. Gait level surface
    • Walk at your normal speed from here to the next mark (20')
      • (0) Severe Impairment: Cannot walk 20' without assistance, severe gait deviations or imbalance.
      • (1) Moderate Impairment: Walks 20', slow speed, abnormal gait pattern, evidence for imbalance.
      • (2) Mild Impairment: Walks 20', uses assistive devices, slower speed, mild gait deviations.
      • (3) Normal: Walks 20', no assistive devices, good speed, no evidence for imbalance, normal gait pattern
  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').
      • (0) Severe Impairment: Cannot change speeds, or loses balance and has to reach for wall or be caught.
      • (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.
      • (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.
      • (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.
  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 center.
      • (0) Severe Impairment: Performs task with severe disruption of gait, i.e., staggers outside 15” path, loses balance, stops, reaches for wall.
      • (1) Moderate Impairment: Performs head turns with moderate change in gait velocity, slows down, staggers but recovers, can continue to walk.
      • (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.
      • (3) Normal: Performs head turns smoothly with no change in gait.
  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 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.
      • (0) Severe Impairment: Performs task with severe disruption of gait, i.e., staggers outside 15” path, loses balance, stops, reaches for wall.
      • (1) Moderate Impairment: Performs head turns with moderate change in gait velocity, slows down, staggers but recovers, can continue to walk.
      • (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.
      • (3) Normal: Performs head turns smoothly with no change in gait.
  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.
      • (0) Severe Impairment: Cannot turn safely, requires assistance to turn and stop.
      • (1) Moderate Impairment: Turns slowly, requires verbal cueing, requires several small steps to catch balance following turn and stop.
      • (2) Mild Impairment: Pivot turns safely in > 3 seconds and stops with no loss of balance.
      • (3) Normal: Pivot turns safely within 3 seconds and stops quickly with no loss of balance.
  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.
      • (0) Severe Impairment: Cannot perform without assistance.
      • (1) Moderate Impairment: Is able to step over box but must stop, then step over. May require verbal cueing.
      • (2) Mild Impairment: Is able to step over box, but must slow down and adjust steps to clear box safely.
      • (3) Normal: Is able to step over the box without changing gait speed, no evidence of imbalance.
  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.
      • (0) Severe Impairment: Unable to clear cones, walks into one or both cones, or requires physical assistance.
      • (1) Moderate Impairment: Is able to clear cones but must significantly slow, speed to accomplish task, or requires verbal cueing.
      • (2) Mild Impairment: Is able to step around both cones, but must slow down and adjust steps to clear cones.
      • (3) Normal: Is able to walk around cones safely without changing gait speed; no evidence of imbalance.
  8. Steps
    • Walk up these stairs as you would at home, i.e., using the railing if necessary. At the top, turn around and walk down.
      • (0) Severe Impairment: Cannot do safely.
      • (1) Moderate Impairment: Two feet to a stair, must use rail.
      • (2) Mild Impairment: Alternating feet, must use rail.
      • (3) Normal: Alternating feet, no rail.

Interpretation

  1. 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 and multiple sclerosis patients undergoing rehabilitation
  2. The DGI has shown high reliability and validity with other balance and mobility scales.
  3. Patients with vestibular disorders have resulted in moderate interrater reliability and should be used with caution in this population
  4. Scoring system
    • 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

References

  1. Marchetti GF, Whitney SL, Blatt PJ, Morris LO, et al. Temporal and spatial characteristics of gait during performance of the Dynamic Gait Index in people with and people without balance or vestibular disorders. Phys Ther. 2008;88(5):640-651.
  2. Lin JH, Hsu MJ, Hsu HW, Wu HC, et al. Psychometric comparisons of 3 functional ambulation measures for patients with stroke. Stroke. 2010;41(9):2021-2025.
  3. Herdman SJ. Vestibular Rehabilitation. 2nd ed. Philadelphia, PA: F.A.Davis Co; 2000.
  4. Shumway-Cook A, Woollacott M. Motor Control Theory and Applications, Williams and Wilkins. Baltimore: 1995;323-324.
  5. Jonsdottir J, Cattaneo D. Reliability and validity of the dynamic gait index in persons with chronic stroke. Arch Phys Med Rehabil. 2007;88(11):1410-1415.

Updated/Reviewed: October 2018