Dynamic Gait Index

## **The importance of examining gait, balance, and fall risk** For physical therapists, neurologists, and similar healthcare professionals, they must evaluate dynamic balance, gait, posture, and fall risk of their patients. By assessing these, they are able to determine specific problems in patients, like the following (‍South University, 2024): - Balance and vestibular disorders/vestibular dysfunction - If they can walk stably in diagonal, horizontal, and vertical directions - Muscle weakness - Gait instability - Postural instability - Balance problems - Joint restrictions - Musculoskeletal injuries - If they need assistance with activities of daily living By assessing function and all these other factors, they can also determine what tools to use for a more comprehensive clinical assessment (e.g., gait analysis, mobility scales, and balancing exercises), what kinds of treatment they should provide (e.g., vestibular rehabilitation, bone deformities, bone injuries, etc.), and what interventions they can organize to assist those who can't restore their gait, balance, and posture to normal (e.g., determining which assistive devices they need, if they need a caregiver, etc.).

## **What is a Dynamic Gait Index (DGI)?** The Dynamic Gait Index, also known as DGI, is an assessment developed to evaluate and document the likelihood of falling in older adults. It is used to assess gait, walking function, and dynamic balance (Shumway-Cook & Woollacott, 1995). It's also one of the most widely used six balance disorder scales (the others are the Berg Balance Scale, Timed Up and Go Test, Hauser Deambulation Index, Dizziness Handicap Inventory, and Activities-Specific Balance Confidence). What can I expect from this clinical tool? It tests the eight types of gait, namely: - Gait level surface - Change in gait speed - Gait with horizontal head turns - Gait with vertical head turns - Gait and pivot turn - Step over obstacles - Steps around obstacles - Steps (stair climbing) These tasks are everyday movements a client may encounter, from walking with and without obstacles to abrupt turning/stopping and even various head movements. This tool is used to see if the patient can handle different task demands. The test utilizes equipment such as shoeboxes, stairs, a stopwatch, and a marked walkway, and each test shouldn't take longer than 30 minutes. By the end of the test, the rater must be able to identify the fall risk and possible challenges a client may face outside the test setup, or if they have normal performance across the board. This clinical tool is essential for general practitioners, neurologists, physical and occupational therapists, and rehabilitation nurses. It can assess patients who have suffered a brain injury or stroke, those with vestibular disorders, or those with Parkinson's disease or multiple sclerosis. It can also be used in conjunction with the Functional Gait Assessment and other similar useful clinical tools, like the other balance assessment tools indicated earlier. ### **Is this tool reliable?** If you're wondering if this tool is reliable, the answer is yes! The tool has been validated by various professionals. The Dynamic Gait Index, along with the other five popular balance tests indicated earlier in this guide, was used to assess patients who have multiple sclerosis. It, along with the other five, was found to have acceptable concurrent validity (Cattaneo et al., 2006), though they are not great at discriminating between people who are prone to falling and those who don't fall. It also has good test-retest and interrater reliability of total scores were high, and it works well with other balance and mobility scales when assessing ambulatory people with chronic stroke for dynamic balance (Jonsdottir & Cattaneo, 2007). Please note that it would be best to use this test alongside other balance and gait measures to cover more ground and to ensure that results are consistent.

## **How does this Dynamic Gait Index template work?** Practitioners can use this template when the client manifests disorder symptoms that affect their gait or balance and interfere with everyday activities. However, even before manifestation, a practitioner may conduct the assessment when the client verbalizes concerns and problems doing any of the movements in the test in a real-life setting. Aside from those, one must only use the template and conduct the test with the following considerations: - **Environment**: To reduce distractions, the practitioner must consider administering the test in a standardized testing environment such as a doctor's office, hospital, or an outpatient/rehab clinic. - **Medical history**: A practitioner may consider asking or reviewing the medical history in case the template is to be used as a baseline, a progress tracker, or a point of comparison. Moreover, if the client is diagnosed with other conditions, more appropriate tests may be needed to check their gait instead. - **Client's age**: The test may be designed for older adults, but can be administered to anyone of any age. Considering your client's age will make it easier for you to filter out conditions and disorders a client may have. To incorporate this test template into your practice, follow these steps: ### **Step 1: Download the template** You can access the template by clicking “Download” or searching for “Dynamic Gait Index” in Carepatron's template library. You can also print it in advance to have it readily available during the assessment. ### **Step 2: Prepare the template and equipment** Fill out the essential details at the top of the form. Afterward, prepare the following equipment you need for carrying out the test: - Shoebox - Two cones - Stairs - 20-foot pathway, which is 15 inches wide You should familiarize yourself with the instructions, scoring, and descriptions. ### **Step 3: Conduct the test** Instruct your client to perform the movements written on the template from top to bottom, taking short breaks in between if necessary. The test should take 20 minutes to complete. Feel free to be on guard and half a step behind your client, just in case they need physical assistance. This will allow you to catch them if they lose their balance. ### ****Step 4: Compute and interpret the score**** After every test, check off the score corresponding to the level of function based on the description provided on the template. When you've finished with the eight facets, compute the total score by adding the scores obtained from the tests. We've provided a space in our template where you can write comments or observations. For example, if the patient's Dynamic Gait Index (DGI) score is 14, you can write that they are at fall risk. That section also allows you to indicate any observations (e.g., the patient can smoothly change walking speed, demonstrates mild gait deviations, has shown a significant difference in results compared to the last test, has severe gait deviations, etc.). ### **Step 5: Formulate a clinical impression or diagnosis** Once you've finished scoring and writing down your assessment, you may proceed to formulate a clinical impression or diagnosis. However, clients should undergo further testing since certain disorders (like vestibular disorders) need complementary tests before diagnosis.

## **Scoring and interpretation** Scoring a Dynamic Gait Index (DGI) is as simple as observing your client during the test and giving them the corresponding score based on how fast or accurately they perform the movement with or without assistance. The test uses an ordinal scale from 0-3, with 3 being the highest and 0 being the lowest. The corresponding level of function per score is as follows: - Zero (0): Severe impairment - One (1): Moderate impairment - Two (2): Mild impairment - Three (3): Normal Generally, you can score a client a three (3) if they can fully follow instructions to the dot without delay or assistance, and a zero (0) if they cannot follow instructions or refuse due to pain. Giving a one (1) or two (2) score will depend heavily on your observational skills. You may refer to the template for detailed descriptions. Scoring relies on the rater's comprehension of the provided criteria and their observational skills. In some situations, a second slower or a tilt towards a particular side can be the basis of a higher or lower score. The total possible score is 24, and a score of ≤19 is predictive of falls in the elderly.

## **Other similar tools you can use** Here are other similar tools you can use that are similar to the Dynamic Gait Index: - **[Functional Gait Assessment](https://www.carepatron.com/templates/functional-gait-assessment)**: This assessment is meant to have patients walk a certain distance and a certain pace based on instructions per item. Each item also has additional instructions, such as looking up while walking or stepping over an obstacle (a shoebox). All of these will indicate how strong or weak the patient's gait function is. - **[Timed Up and Go Test](https://www.carepatron.com/templates/timed-up-and-go-test)**: This is mostly conducted on elderly people, but it can still be used on anyone who is suspected or confirmed to have balancing and mobility issues. This test checks if a person is able to safely stand up from a chair, walk straight in a certain direction, turn around, and safely sit down. This is a nifty assessment for checking on someone's fall risk. - **[Berg Balance Scale](https://www.carepatron.com/templates/berg-balance-scale)**: This assessment is one of the six balance tests indicated earlier. For this one, you will assess patients for specific movements/switching positions, like standing up to sitting down, reaching for things, turning around, etc. This is meant to examine a patient for balancing issues and see if there are issues that could impact their activities of daily living, balance, and gait.

## **References** Cattaneo, D., Regola, A., & Meotti, M. (2006). Validity of six balance disorders scales in persons with multiple sclerosis. Disability and Rehabilitation, 28(12), 789–795. https://doi.org/10.1080/09638280500404289 Jonsdottir, J., & Cattaneo, D. (2007). Reliability and validity of the Dynamic Gait Index in persons with chronic stroke. Archives of Physical Medicine and Rehabilitation, 88(11), 1410–1415. https://doi.org/10.1016/j.apmr.2007.08.109 Shumway-Cook, A., & Woollacott, M. (1995). Motor control theory and practical applications (pp. 322–324). Williams & Wilkins. https://www.scirp.org/reference/referencespapers South University. (2024). Studying gait in physical therapy. https://www.southuniversity.edu/news-and-blogs/2024/10/studying-gait-in-physical-therapy