Core Measure: Functional Gait Assessment (FGA)

Transcription

1 Cre Measure: Functinal Gait Assessment (FGA) Overview The FGA is used t assess pstural stability during walking and assesses an individual's ability t perfrm multiple mtr tasks while walking. The tl is a mdificatin f the 8-item Dynamic Gait Index, develped t imprve reliability and reduce ceiling effect. Number f Test Items 10 items: gait n level surface, change in gait speed, gait with hrizntal and vertical head turns, gait with 180 pivt turn, stepping ver bstacles, gait with narrw base f supprt, gait with eyes clsed, backwards gait and stairs. Scring Each item is scred n a 4-pint rdinal scale ranging frm 0-3, with 0 indicating severe impairment and 3 indicating nrmal ambulatin. All items are summed t calculate a ttal scre (max. 30). 3 = nrmal (n gait r balance impairment, cmpletin f task in a timely manner) 2 = mild impairment 1 = mderate impairment 0 = severe impairment (Cannt perfrm withut assistance, severe gait deviatins r imbalance; deviates frm walkway, increased time t perfrm task) Equipment Stpwatch Measuring device t mark ff area Marked walking area = 20 ft (6 m); width 12 in (30.48 cm) Obstacle f 9-in height (22.86 cm) using at least tw stacked shebxes Set f steps that are 7 ¾ -9 in high with bilateral rails Time (new clinician) Time (experienced clinician) Less than 20 minutes 5-10 minutes Cst Free Lgistics-Setup A dedicated space r designated pre-measured area is recmmended t cmplete the test t eliminate distractins and disruptins during administratin. Re-testing shuld be perfrmed in the same place/envirnment. A marked pathway f 20 ft (6 m); width 12 in (30.48 cm) in a designated area ver slid flring is required. Quiet cnditins Starting Psitin: Patient is standing quietly in a cmfrtable psitin at the start f the 20 ft (6 m) marked walking area, except fr the fllwing items listed belw 1 : Item 6: Step ver Obstacle Patient is standing quietly in a cmfrtable psitin at the start f the 20 ft (6 m) marked walking area with an bstacle (shebxes) psitined perpendicular t and halfway dwn the walkway Item 7: Gait with Narrw Base f Supprt Patient is standing quietly in a cmfrtable psitin with arms flded acrss chest at the start f a hallway allwing fr 12 ft (3.6 m) Item 9: Ambulating Backwards Patient is standing quietly in a cmfrtable psitin at the start f the 20 ft (6 m) marked walking area facing backwards

2 Item 10: Steps Patient is standing quietly in a cmfrtable psitin at the base f the steps Lgistics-Administratin Item 1: Gait Level Surfaces 1 Instructins: Walk at yur nrmal speed frm here t the next mark (20 ft [6 m]) Item 2: Change in Gait Speed Instructins: Begin walking at yur nrmal pace (fr 5 ft [1.5 m]). When I tell yu g, walk as fast as yu can (fr 5 ft [1.5 m]). When I tell yu slw, walk as slwly as yu can (fr 5 ft [1.5 m]). Item 3: Gait with Hrizntal Head Turns Instructins: Walk frm here t the next mark 20 ft (6 m) away. Begin walking at yur nrmal pace. Keep walking straight; after 3 steps, turn yur head t the right and keep walking straight while lking t the right. After 3 mre steps, turn yur head t the left and keep walking straight while lking left. Cntinuing alternating lking right and left every 3 steps until yu have cmpleted 2 repetitins in each directin. Item 4: Gait with Vertical Head Turns Instructins: Walk frm here t the next mark 20 ft (6 m) away. Begin walking at yur nrmal pace. Keep walking straight; after 3 steps, tip yur head up and keep walking straight while lking up. After 3 mre steps, turn yur head dwn and keep walking straight while lking dwn. Cntinuing alternating lking up and dwn every 3 steps until yu have cmpleted 2 repetitins in each directin. Item 5: Gait and Pivt Turn Instructins: Begin with walking at yur nrmal pace. When I tell yu, turn and stp, turn as quickly as yu can t face the ppsite directin and stp. Item 6: Step ver Obstacle Instructins: Begin walking at yur nrmal speed. When yu cme t the shebx, step ver it, nt arund it, and keep walking. Item 7: Gait with Narrw Base f Supprt Instructins: Walk n the flr with arms flded acrss the chest, feet aligned heel t te in tandem fr a distance f 12 ft [3.6 m]. The number f steps taken in a straight line are cunted fr a maximum f 10 steps. Item 8: Gait with Eyes Clsed Instructins: Walk at yur nrmal speed frm here t the next mark (20 ft [6 m]) with yur eyes clsed. Item 9: Ambulating Backwards Instructins: Walk backwards until I tell yu t stp. Item 10: Steps Instructins: Walk up these stairs as yu wuld at hme (i.e. using the rail if necessary). At the tp turn arund and walk dwn. Test may be perfrmed with r withut an assistive device as indicated belw. Re-test shuld be cmpleted using the same device. Individuals shuld walk withut physical assistance f anther persn Retest in the same designated area/envirnment When administering walking items, d nt walk in frnt f r directly beside the patient, as this paces the patient and can influence the speed they walk. Instead, walk at least a half step behind the patient.

3 Lgistics-Scring All items are summed t calculate a ttal scre. Item 1: Gait level Surface 1 3 Nrmal: Walks 20 ft (6 m) in less than 5.5 secnds, n assistive devices, gd speed, n evidence fr imbalance, nrmal gait pattern, deviates n mre than 6 in (15.24 cm) utside f the 12-in (30.48-cm) walkway width. 2 Mild Impairment: Walks 20 ft (6 m) in less than 7 secnds but greater than 5.5 secnds, uses assistive device, slwer speed, mild gait deviatins, r deviates 6-10 in ( cm) utside f the 12-in (30.48-cm) walkway width. 1 Mderate Impairment: Walks 20 ft (6 m); slw speed, abnrmal gait pattern, evidence fr imbalance, r deviates in ( cm) utside f the 12-in (30.48-cm) walkway width. Requires mre than 7 secnds t ambulate 20 ft (6 m). 0 Severe Impairment: Cannt walk 20 ft (6 m) withut assistance, severe gait deviatins r imbalance, deviates greater than 15 in (38.1 cm) utside f the 12-in (30.48-cm) walkway width r reaches and tuches the wall. Item 2: Change in Gait Speed 3 Nrmal: Able t smthly change walking speed withut lss f balance r gait deviatin. Shws a significant difference in walking speeds between nrmal, fast, and slw speeds. Deviates n mre than 6 in (15.24 cm) utside f the 12-in (30.48-cm) walkway width. 2 Mild Impairment: Is able t change speed but demnstrates mild gait deviatins, deviates 6-10 in ( cm) utside f the 12-in ( cm) walkway width, r n gait deviatins but unable t achieve a significant change in velcity, r uses an assistive device. 1 Mderate Impairment: Makes nly minr adjustments t walking speed, r accmplishes a change in speed with significant gait deviatins, deviates in ( cm) utside f the 12-in ( cm) walkway width, r changes speed but lses balance but is able t recver and cntinue walking. 0 Severe Impairment: Cannt change speeds, deviates greater than 15 in (38.1 cm) utside f the 12-in (30.48-cm) walkway width, r lses balance and has t reach fr wall r be caught. Item 3: Gait with Hrizntal Head Turns 3 Nrmal: Perfrms head turns smthly with n change in gait. Deviates n mre than 6 in (15.24 cm) utside f the 12-in (30.48-cm) walkway width 2 Mild Impairment: Perfrms head turns smthly with slight change in gait velcity (eg, minr disruptin t smth gait path), deviates 6-10 in ( cm) utside f the 12-in (30.48-cm) walkway width, r uses an assistive device. 1 Mderate Impairment: Perfrms head turns with mderate change in gait velcity, slws dwn, deviates in ( cm) utside f the 12-in (30.48-cm) walkway width but recvers, can cntinue t walk. 0 Severe Impairment: Perfrms task with severe disruptin f gait (eg, staggers 15 in (38.1 cm) utside f the 12-in (30.48-cm) walkway width, lses balance, stps, r reaches fr wall)

4 Item 4: Gait with Vertical Head Turns 3 Nrmal: Perfrms head turns smthly with n change in gait. Deviates n mre than 6 in (15.24 cm) utside f the 12-in (30.48-cm) walkway width. 2 Mild Impairment: Perfrms task with slight change in gait velcity (eg, minr disruptin t smth gait path), deviates 6-10 in ( cm) utside f the 12-in (30.48-cm) walkway width r uses assistive device. 1 Mderate Impairment: Perfrms task with mderate change in gait velcity, slws dwn, deviates in ( cm) utside f the 12- in (30.48-cm) walkway width but recvers, can cntinue t walk. 0 Severe Impairment: Perfrms task with severe disruptin f gait (eg, staggers 15 in (38.1 cm) utside f the 12-in (30.48-cm) walkway width, lses balance, stps, reaches fr wall). Item 5: Gait with Pivt Turn 3 Nrmal: Pivt turns safely within 3 secnds and stps quickly with n lss f balance. 2 Mild Impairment: Pivt turns safely in greater than 3 secnds and stps with n lss f balance, r pivt turns safely within 3 secnds and stps with mild imbalance, requires small steps t catch balance 1 Mderate Impairment: Turns slwly, requires verbal cueing, r requires several small steps t catch balance fllwing turn and stp. 0 Severe Impairment: Cannt turn safely, requires assistance t turn and stp. Item 6: Step ver Obstacle 3 Nrmal: Is able t step ver tw stacked she bxes taped tgether (9 in [22.86 cm] ttal height) withut changing gait speed; n evidence f imbalance. 2 Mild Impairment: Is able t step ver ne she bx (4.5 in [11.43 cm] ttal height) withut changing gait speed; n evidence f imbalance. 1 Mderate Impairment: Is able t step ver ne she bx (4.5 in [11.43 cm] ttal height) but must slw dwn and adjust steps t clear bx safely. May require verbal cueing. 0 Severe Impairment: Cannt perfrm withut assistance. Item 7: Gait with Narrw Base f Supprt 3 Nrmal: Is able t ambulate fr 10 steps heel t te with n staggering. 2 Mild Impairment: Ambulates 7-9 steps. 1 Mderate Impairment: Ambulates 4-7 steps. 0 Severe Impairment: Ambulates less than 4 steps heel t te r cannt perfrm withut assistance. Item 8: Gait with Eyes Clsed 3 Nrmal: Walks 20 ft (6 m), n assistive devices, gd speed, n evidence f imbalance, nrmal gait pattern, deviates n mre than 6 in (15.24 cm) utside f the 12-in (30.48-cm) walkway width. Ambulates 20 ft (6 m) in less than 7 secnds. 2 Mild Impairment: Walks 20 ft (6 m), uses assistive device, slwer speed, mild gait deviatins, deviates 6-10 in ( cm) utside f the 12-in (30.48-cm) walkway width. Ambulates 20 ft (6 m) in less than 9 secnds but greater than 7 secnds.

5 1 Mderate Impairment: Walks 20 ft (6 m), slw speed, abnrmal gait pattern, evidence fr imbalance, deviates in ( cm) utside f the 12-in (30.48-cm) walkway width. Requires mre than 9 secnds t ambulate 20 ft (6 m). 0 Severe Impairment: Cannt walk 20 ft (6 m) withut assistance, severe gait deviatins r imbalance, deviates greater than 15 in (38.1 cm) utside f the 12-in (30.48-cm) walkway width r will nt attempt task. Item 9: Ambulating Backwards 3 Nrmal: Walks 20 ft (6 m), n assistive devices, gd speed, n evidence fr imbalance, nrmal gait pattern, deviates n mre than 6 in (15.24 cm) utside the 12-in (30.48-cm) walkway width. 2 Mild Impairment: Walks 20 ft (6 m), uses assistive device, slwer speed, mild gait deviatins, deviates 6-10 in ( cm) utside f the 12-in (30.48-cm) walkway width. 1 Mderate Impairment: Walks 20 ft (6 m), slw speed, abnrmal gait pattern, evidence fr imbalance, deviates in ( cm) utside f the 12-in (30.48-cm) walkway width. 0 Severe Impairment: Cannt walk 20 ft (6 m) withut assistance, severe gait deviatins r imbalance, deviates greater than 15 in (38.1 cm) utside f the 12-in (30.48-cm) walkway width r will nt attempt task. Item 10: Steps 3 Nrmal: Alternating feet, n rail. 2 Mild Impairment: Alternating feet, must use rail. 1 Mderate Impairment: Tw feet t a stair, must use rail. 0 Severe Impairment: Cannt d safely. Additinal Recmmendatins T track change, it is recmmended that this measure is administered a minimum f tw times (admissin and discharge), and when feasible, between these perids, under the same test cnditins fr the patient. Recmmend review f this standardized prcedure and, n an annual basis, establish cnsistency within and amng raters using the tl. Cmmn Questins and Variatins 1. If I nly have fur steps with bilateral railings is that k r d I need an entire flight? a. The test can be accmplished with a set f fur r mre steps. The steps need t have bilateral rails and shuld be standard step height (apprximately 7 ¾ in [20.32 cm]). 2. What if I dn't have a set f stairs at all? a. If the patient des nt attempt all test items, this is a deviatin frm the standardized prcedure, therefre interpretatin f the scre with use f nrmative values r cut f scres wuld nt be apprpriate. b. Any partial scre shuld nt be included in any aggregate data analysis, if this data is used fr prgram evaluatin, fr example. c. Cmpletin f nly sme test items may be useful t the individual patient. Fr example, the patient may benefit frm educatin n the value f gait speed r a safety strategy during perfrmance f

6 multiple mtr tasks. The individual scre (partial scre) may be used t set an individual gal fr a future trial r sessin. 3. What if my patient requires assistance? a. If the patient requires assistance t cmplete any item, the scre is recrded as a What if my patient uses an assistive device? a. Mst items specify a specific scre based n use f an assistive device. If use f an assistive device is nt specified fr scring a particular item, and the patient requires use f that assistive device t cmplete the item, then the item is scred as a zer. 5. "Can I prvide verbal cues r demnstratin during the trial, t remind patients when t turn r tilt their head, fr example?" a. Yes, verbal cues r demnstratin are apprpriate t the extent that these are needed fr the patient t cmplete the necessary mvements. Cues shuld be kept t a minimum and dcumented as a cnditin f the trial(s). 6. Fr Item 7: Gait with Narrw Base f Supprt, is it apprpriate t have them walk n the line that marks the walkway? a. Yes. Per 2017 discussin with develping authrs Sue Whitney and Diane Wrisley (riginal authrs), tape was used n the grund fr this item when the test was first develped. 7. What if my patient cannt walk? a. The FGA shuld nt be administered fr patients that d nt have the capacity t walk; hwever, a scre f 0 may be dcumented in these instances. b. If a patient is unable t ambulate, but has the gals and capacity t imprve balance, a baseline scre f 0 shuld be dcumented fr the FGA. 8. What if my patient demnstrates a high scre? a. If a patient demnstrates a high scre near 30 ut f 30, r is likely t d s, the clinician may need t select a mre challenging utcme measure t assess change ver time. b. If a patient scres near the tp f the FGA scale, it may nt be necessary t re-administer the test. 9. We currently use the Dynamic Gait Index (DGI) in ur facility. Can I use this test as a substitutin since it is s similar? a. The FGA includes three items which are nt n the DGI: Gait with Narrw Base f Supprt, Gait with Eyes Clsed, and Ambulating Backwards. The Dynamic Gait Index has ne item which is nt n the FGA: Step Arund Obstacles. Thus, althugh these tests are similar, they are nt interchangeable. b. The FGA was selected instead f the DGI fr inclusin in the cre set fr the fllwing reasns: better reliability acrss acute, chrnic stable and chrnic prgressive ppulatins; inclusin f clinically relevant balance items f gait with narrw base f supprt, gait with eyes clsed, and ambulating backwards; and imprved respnse categries t facilitate cnsistency in utcme measure administratin.

7 References 1. Wrisley DM, Marchetti GF, Kuharsky DK, Whitney SL. Reliability, internal cnsistency, and validity f data btained with the functinal gait assessment. Phys Ther. 2004;84(10):