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Rehab Measures: Dynamic Gait Index

Link to instrument

 Available on Missouri.edu's website (external link) 

Title of Assessment

 Dynamic Gait Index 

Acronym
DGI

Instrument Reviewer(s)
Initially reviewed by Jason Raad, MS in 2010; Updated with references for the PD, chronic stroke, vestibular, and brain injury populations by Ali Garmisa, SPT and Melanie Goldstick, SPT in 2011; Updated by Candy Tefertiller PT, DPT, ATP, NCS, Jennifer Kahn PT, DPT, NCS and the SCI EDGE task force of the Neurology section of the APTA in 2012; Updated with references from the TBI population by Katie Hays, PT, DPT and the TBI EDGE task force of the Neurology Section of the APTA in 2012.

Summary Date

 1/18/2013 

Purpose
Assesses individual’s ability to modify balance while walking in the presence of external demands

Description
  • Performed with a marked distance of 20 feet
  • Can be performed with or without an assistive device.
  • Scores are based on a 4-point scale:
    • 3 = No gait dysfunction
    • 2 = Minimal impairment
    • 1 = Moderate impairment
    • 0 = Severe impairment
  • Highest possible score is 24 points. 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

Area of Assessment

 Balance Vestibular; Balance Non-Vestibular; Functional Mobility; Gait 

Body Part

 Not Applicable 

ICF Domain

 Activity 

Domain

 Motor 

Assessment Type

 Observer 

Length of Test

 06 to 30 Minutes 

Time to Administer
<10 minutes (may vary with the patient’s abilities)

Number of Items

 8 

Equipment Required
  • Shoe box
  • Two obstacles (must be same size)
  • Stairs
  • 20 foot pathway

Training Required
None

Type of training required

 No Training 

Cost

 Free 

Actual Cost
Free

Age Range

 Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode

 Paper/Pencil 

Diagnosis

 Geriatrics; Multiple Sclerosis; Parkinson’s Disease; Stroke; Vestibular Disorders 

Populations Tested
  • Geriatric 
  • Vestibular disorders
  • Multiple Sclerosis 
  • Stroke
  • Parkinson’s disease
  • Brain injury

Standard Error of Measurement (SEM)

Peripheral Vestibular Disorders: (Calculated from Hall & Herdman, 2006; n = 16; age 51.8 (13.4) years)

  • SEM calculated = 2.8 points

Community Dwelling Elderly: (Romero et al 2011;n=42; mean age=75.6 (range 59-88) years)

  • SEM=1.04 points

Chronic Stroke: (Jonsdottir & Cattaneo, 2007, n = 25; mean age = 61.6 (13.1) years; mean time since stroke= 4.2(7.5) years, range .5-35.3 years; Italian sample

  • SEM for test-retest condition=0.97
  • SEM for interrater reliability= 0.94

Multiple Sclerosis: (Cattaneo et al, 2007; n= 25, mean age=41.7(12.5) years; mean time since onset=8.7(8.8) years; Italian sample):

  • SEM=1.51-2.00 points

Minimal Detectable Change (MDC)

Parkinsons Disease: ( Huang et al, 2011); n=72; mean age= 67.5(11.6); range of disease duration=2 months-15 years; Hoehn-Yahr range I-III, Taiwanese sample):

  • MDC=2.9 points
  • MDC%= 13.3%

Community Dwelling Elderly: (Romero et al, 2011)

  • MDC = 2.9 points

Stroke: (Lin et al, 2010; n = 45; mean age = 60.7 (12.2) years; median time since stroke = 9 months (range 3 to 36 months); Taiwanese sample)

  • MDC = 4 points
  • Percent change = 16.6%

Peripheral Vestibular Disorders: (Calculated from Hall & Herdman, 2006)

  • MDC calculated = 3.2 points

Multiple Sclerosis: (Cattaneo et al, 2007)

  • MDC (Calculated from SEM)= 4.19 – 5.54

Minimally Clinically Important Difference (MCID)

Chronic Stroke: (Badke, MB, et al, 2011, n = 29; age 59 (14) years)

  • Statistically significant improvements occurred from baseline to posttest
  • 13 (44.8%) of subjects improved beyond MCID

Cut-Off Scores

Community Dwelling Elderly: (Shumway-Cook et al,1997; n = 44; age > 65)

  • <19 indicative of fall risks
  • scores of <19/24 are 2.58 times more like to have reported a fall in the previous 6 months than subjects with scores above 19 (Whitney et al, 2000)

Multiple Sclerosis: (Cattaneo et al, 2006; n = 51; relapsing-remitting or secondary progressive MS; mean age 45.3 (18.1) years; mean time since onset 15.6 (7.6) years)

  • <12 indicative of fall-risk

Parkinson’s Disease: (Cakit et. al, 2007; n=31; mean age 71.8 (6.4)

  • <16 high risk of fall
  • >19 decreased risk of falls

Parkinson’s Disease: (Landers et al, 2008; n=49; mean age= 70.9(8.9) years; fallers (mean duration since diagnosis=75.6(66.9) months vs. nonfallers (mean duration since diagnosis= 45.4(36.9 months))

  • Cutoff score=18.5

Normative Data

Acute and Chronic Stroke: (Lin et al, 2010)

 

Median Scores for DGI:

1 week

2 months

5 months

Median score

13

14

14

Range: 1st to 3rd quartile

10 - 18

10 - 20

11 - 20

 

Chronic Hemiparetic Stroke: (Hwang et al, 2010; n=11; mean age=48.09 (5.85) years; mean time post stroke=24.36 (10.84) months)

 

Mean DGI Score:
 
Mean
SD
Pretest
10.64
2.01
Posttest
11.64
3.36

 

Parkinson’s Disease: (Cakit et al, 2007; n=31; mean age 71.8 (6.4) years)

Mean DGI Score:
 
Mean
SD
Baseline
16.3
5.2
Outcome
16.54
3.35

Healthy Adults: (Vereeck et al, 2008; n = 318; mean age=49.2(18.7))

Decade

Mean

SD

Range

3

24.0

0.2

23-24

4

24.0

0.2

23-24

5

23.9

0.4

22-24

6

23.9

0.4

22-24

7

23.2

0.9

21-24

8

22.0

2.0

13-24

Test-retest Reliability
Acute and Chronic Stroke: (Lin et al, 2010; tested in separate sample of 48 patients with chronic stroke; mean age = 54.9(10.2) years)
  • Excellent test-retest reliability (ICC > 0.94; 0.91-0.97)
Chronic Stroke: (Jonsdottir & Cattaneo 2007, n = 25 mean age = 61.6 (13.1) years)
  • Excellent total score test re-test reliability (ICC = 0.96)
    • Individual items varied from 0.56 (gait and pivot turns) to 1.00 (stair climbing)

Vestibular population: (Hall et al, 2006; n = 16 patients with vestibular disorders; mean age = 51.8 (13.4) years)

  • Excellent test-retest reliability (ICC = 0.86 to 1.00); head movement induced dizziness demonstrated weaker reliability (ICC = 0.48)

(Herdman et al, 2003, n = 21 patients with unilateral vestibular hypofunction; mean age = 65.2 (16.5) years) 

  • Adequate test-retest reliability for oscillopsia using a visual analog scale was fair (ICC = 0.65)

Parkinson’s Disease: (Huang et al, 2010)

  • Excellent test-retest reliability (ICC = 0.84)

Multiple Sclerosis: (Cattaneo et al, 2007)

  • Excellent test-retest reliability (ICC = 0.85)

Interrater/Intrarater Reliability

Multiple Sclerosis:(McConvey and Bennett, 2005)  

  • Excellent interrater reliability (ICC = 0.983)
    • Range from r = 0.910-0.976 for individual test terms
  • Excellent intrarater reliability (ICC = 0.760 - 0.98)

Chronic Stroke:(Jonsdottir & Cattaneo, 2007)

  • Excellent interrater reliability (ICC = 0.96)

Community Dwelling Older Adults with Baseline Impairment: (Jønsson et al, 2011; n = 24 (Hospital), mean age = 79.4 (6.8) years; n = 26 (outpatient rehabilitation), mean age = 76.8 (6.4) years; assessed at a 1.5 hour interval, rated by 3 PT's at each site; Danish language sample)

Hospital:

  • Excellent intrarater reliability (ICC = .90)
  • Excellent  interrater reliability (ICC = .92)


Outpatient Rehabilitation:

  • Excellent  intrarater reliability (ICC = .89)
  • Excellent  interrater reliability (ICC = .82)

Internal Consistency
Not Established

Criterion Validity (Predictive/Concurrent)
Chronic Stroke: (Jonsdottir and Cattaneo, 2007)
  • Excellent concurrent validity with Berg Balance Scale (r = 0.83)
  • Excellent concurrent validity with the ABC (r = 0.68)

Acute and Chronic Stroke: (Lin et al, 2010)

  • Excellent concurrent validity amongst DGI, 4 itme DGI, and FGA (r >0.91)
Community-Dwelling Older Adults: (Shumway-Cook et al, 1997; n = 44; aged 65 to 94 years)
  • Excellent, Balance Self-Perceptions Test and DGI (r = 0.76)
  • Excellent, Berg Balance Scale and DGI (r = 0.67)
  • Adequate, Assistive Devices History and DGI (r = -0.44)
  • Adequate, History of imbalance and DGI (r = -0.46)
Vestibular: (Hall & Herdman, 2006; n = 16 patients with confirmed peripheral vestibular disorders; mean age = 51.8 (13.4) years)
  • Berg Balance Scale and DGI scores agreed 63% of the time on fall risk criteria
  • DGI appears to be more sensitive than the Berg Balance Scale in identifying fall risk in patients with vestibular disorders

Vestibular: Whitney et al. 2003 (n = 30 patients (aged 27 to 88) diagnosed with vestibular disorders)

  • Excellent concurrent validity (r = 0.71) between the DGI and the Berg Balance Scale
Multiple Sclerosis: (Cattaneo et al, 2006; Cattaneo et al, 2007)
  • Excellent concurrent validity with the Berg Balance Scale, TUG, DI, and ABC respectively (Spearman coefficient = 0.78, -0.80, -0.54)
  • Poor concurrent validity with the DHI (Spearman coefficient=-0.39)

Brain Injury: (Medley, A. et al, 2006; n = 26; mean age = 41.9 (12.4) years)

  • Found that a person who scores 19 out of 24 points on the DGI has a 28% probability of falling. A person who scores 24 out of 24 points would have a 6% chance of falling and a person who scores 0 out of 24 points would have a 100% change of falling.

(McConvey and Bennet, 2005)

  • Excellent concurrent validity with 6.1m timed walked test (r = -0.81)

Construct Validity (Convergent/Discriminant)

Acute and Chronic Stroke: (Lin et al, 2010)

  • Excellent with the 10 meter walk (r= -0.68, -0.87, -0.83) test and Postural Assessment Scale (r= 0.85, 0.76, 0.83) for Stroke at 1st week of PT, 2 months after PT, and 5 months after PT

Multiple Sclerosis: (Cattaneo et al, 2006)

  • Statistically significant difference of three points noted between fallers and non-fallers (P=0.025)

Parkinson’s Disease : (Landers et al, 2008)

  • Adequate discriminative validity between fallers and non-fallers with sensitivity scores of 0.68 and specificity scores of 0.708
  • AUC = 0.758

Content Validity
Not Established

Face Validity
Not Established

Floor/Ceiling Effects

Acute and Chronic Stroke: (Lin et al, 2010)

  • Excellent indicates minimal floor effects
  • Adequate indicates relatively little ceiling effects
Floor and Ceiling Effects:

Time Point

Floor Effect %

 Ceiling Effect %

1st week of  PT

2.2

4.4

2 months after PT

0

10.3

5 months after PT

0

11.4

Multiple Sclerosis: (Cattaneo et al, 2006)

  • Adequate ceiling effects (7.8%)

Responsiveness

Multiple Sclerosis : Cattaneo et al, 2006

  • Scores of less <12 discriminated between fallers and non fallers, however, Cattaneo (2006) reported that the BBS and DGI measures were not as good at discriminating between fallers and non-fallers compared to the Equiscale Test.

Acute and Chronic Stroke: (Lin et al, 2010)

  • Moderate responsiveness in depicting change at 2 months and 5 months after therapy (effect size 0.56, 0.62 respectively)

Parkinson’s Disease : (Landers et al, 2008)

  • Sensitivity = 0.680
  • Specificity = 0.708

Professional Association Recommendations

Considerations
  • Although psychometrics have not been evaluated in SCI population, this measure has been used to assess dynamic balance in 2 SCI studies (Fritz et al, 2011 & Day et al, 2012)
  • FGA shows less ceiling effect and is reccommended over DGI is stroke population (Lin et al, 2010)

Bibliography

Badke, M. B., Sherman, J., et al. (2011). "Tongue-based biofeedback for balance in stroke: results of an 8-week pilot study." Arch Phys Med Rehabil 92(9): 1364-1370. Find it on PubMed

Brown, K. E., Whitney, S. L., et al. (2001). "Physical therapy outcomes for persons with bilateral vestibular loss." Laryngoscope 111(10): 1812-1817. Find it on PubMed

Cakit, B. D., Saracoglu, M., et al. (2007). "The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson's disease." Clin Rehabil 21(8): 698-705. Find it on PubMed

Cattaneo, D., Jonsdottir, J., et al. (2007). "Reliability of four scales on balance disorders in persons with multiple sclerosis." Disability and Rehabilitation 29(24): 1920-1925. Find it on PubMed

Cattaneo, D., Regola, A., et al. (2006). "Validity of six balance disorders scales in persons with multiple sclerosis." Disability and Rehabilitation 28(12): 789-795. Find it on PubMed

Day, K. V., Kautz, S. A., et al. (2012). "Foot placement variability as a walking balance mechanism post-spinal cord injury." Clin Biomech (Bristol, Avon) 27(2): 145-150. Find it on PubMed

Fritz, S. L., Pittman, A. L., et al. (2007). "An intense intervention for improving gait, balance, and mobility for individuals with chronic stroke: a pilot study." J Neurol Phys Ther 31(2): 71-76. Find it on PubMed

Hall, C. D. and Herdman, S. J. (2006). "Reliability of clinical measures used to assess patients with peripheral vestibular disorders." J Neurol Phys Ther 30(2): 74-81. Find it on PubMed

Herdman, S. J., Schubert, M. C., et al. (2003). "Recovery of dynamic visual acuity in unilateral vestibular hypofunction." Arch Otolaryngol Head Neck Surg 129(8): 819-824. Find it on PubMed

Huang, S. L., Hsieh, C. L., et al. (2011). "Minimal detectable change of the timed "up & go" test and the dynamic gait index in people with Parkinson disease." Phys Ther 91(1): 114-121. Find it on PubMed

Hwang, S., Jeon, H. S., et al. (2010). "Locomotor imagery training improves gait performance in people with chronic hemiparetic stroke: a controlled clinical trial." Clin Rehabil 24(6): 514-522. Find it on PubMed

Jonsdottir, J. and 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. Find it on PubMed

Jonsson, L. R., Kristensen, M. T., et al. (2011). "Intra- and interrater reliability and agreement of the Danish version of the Dynamic Gait Index in older people with balance impairments." Archives of Physical Medicine and Rehabilitation 92(10): 1630-1635. Find it on PubMed

Landers, M. R., Backlund, A., et al. (2008). "Postural instability in idiopathic Parkinson's disease: discriminating fallers from nonfallers based on standardized clinical measures." J Neurol Phys Ther 32(2): 56-61. Find it on PubMed

Lin, J. H., Hsu, M. J., et al. (2010). "Psychometric comparisons of 3 functional ambulation measures for patients with stroke." Stroke 41(9): 2021-2025. Find it on PubMed 

McConvey, J. and Bennett, S. E. (2005). "Reliability of the Dynamic Gait Index in individuals with multiple sclerosis." Archives of Physical Medicine and Rehabilitation 86(1): 130-133. Find it on PubMed

Medley, A., Thompson, M., et al. (2006). "Predicting the probability of falls in community dwelling persons with brain injury: a pilot study." Brain Inj 20(13-14): 1403-1408. Find it on PubMed

Romero, S., Bishop, M. D., et al. (2011). "Minimum detectable change of the Berg Balance Scale and Dynamic Gait Index in older persons at risk for falling." Journal of Geriatric Physical Therapy 34(3): 131-137.

Shumway-Cook, A., Baldwin, M., et al. (1997). "Predicting the probability for falls in community-dwelling older adults." Physical Therapy 77(8): 812-819. Find it on PubMed 

Shumway-Cook, A., Gruber, W., et al. (1997). "The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults." Physical Therapy 77(1): 46-57. Find it on PubMed

Tinetti, M. E. (1986). "Performance-oriented assessment of mobility problems in elderly patients." Journal of the American Geriatrics Society 34(2): 119-126. Find it on PubMed

Tinetti, M. E., Mendes de Leon, C. F., et al. (1994). "Fear of falling and fall-related efficacy in relationship to functioning among community-living elders." Journal of Gerontology 49(3): M140-147. Find it on PubMed 

Vereeck, L., Wuyts, F., et al. (2008). "Clinical assessment of balance: normative data, and gender and age effects." Int J Audiol 47(2): 67-75. Find it on PubMed

Whitney, S. L., Hudak, M. T., et al. (2000). "The dynamic gait index relates to self-reported fall history in individuals with vestibular dysfunction." J Vestib Res 10(2): 99-105. Find it on PubMed

Wrisley, D. M., Walker, M. L., et al. (2003). "Reliability of the dynamic gait index in people with vestibular disorders." Archives of Physical Medicine and Rehabilitation 84(10): 1528-1533. Find it on PubMed

Year published

 2001 

Instrument in PDF Format

 Yes 
Approval Status Approved 
 
Attachments
Created at 10/30/2010 11:36 AM  by Dawood Ali 
Last modified at 1/22/2013 12:43 PM  by Jason Raad