Functional Gait Assessment for Older Adults

Functional Gait Assessment for Older Adults

Functional Gait Assessment evaluates walking ability in older adults, focusing on balance, speed, and coordination. It includes various tasks such as walking straight, changing speed, and navigating obstacles to identify impairments. This assessment is crucial for healthcare professionals aiming to prevent falls and improve mobility in elderly patients. It provides a structured scoring system to quantify gait performance, making it an essential tool in geriatric rehabilitation. Designed for clinicians and therapists, it aids in developing tailored intervention strategies.

Key Points

  • Evaluates gait performance in older adults to identify fall risk.
  • Includes tasks like walking straight, speed changes, and head turns.
  • Structured scoring system quantifies mobility impairments.
  • Aids healthcare professionals in developing tailored rehabilitation strategies.
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Appendix.
Functional Gait Assessment
a
Requirements: A marked 6-m (20-ft) walkway that is marked with a 30.48-cm (12-in) width.
______1. GAIT LEVEL SURFACE
Instructions: Walk at your normal speed from here to the next mark (6 m
[20 ft]).
Grading: Mark the highest category that applies.
(3) Normal—Walks 6 m (20 ft) in less than 5.5 seconds, no assistive
devices, good speed, no evidence for imbalance, normal gait
pattern, deviates no more than 15.24 cm (6 in) outside of the
30.48-cm (12-in) walkway width.
(2) Mild impairment—Walks 6 m (20 ft) in less than 7 seconds but
greater than 5.5 seconds, uses assistive device, slower speed,
mild gait deviations, or deviates 15.24 –25.4 cm (6–10 in)
outside of the 30.48-cm (12-in) walkway width.
(1) Moderate impairment—Walks 6 m (20 ft), slow speed, abnor-
mal gait pattern, evidence for imbalance, or deviates 25.4–
38.1 cm (10–15 in) outside of the 30.48-cm (12-in) walkway
width. Requires more than 7 seconds to ambulate 6 m (20 ft).
(0) Severe impairment—Cannot walk 6 m (20 ft) without assistance,
severe gait deviations or imbalance, deviates greater than 38.1
cm (15 in) outside of the 30.48-cm (12-in) walkway width or
reaches and touches the wall.
______2. CHANGE IN GAIT SPEED
Instructions: Begin walking at your normal pace (for 1.5 m [5 ft]). When
I tell you “go,” walk as fast as you can (for 1.5 m [5 ft]). When I tell you
“slow,” walk as slowly as you can (for 1.5 m [5 ft]).
Grading: Mark the highest category that applies.
(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. Devi-
ates no more than 15.24 cm (6 in) outside of the 30.48-cm
(12-in) walkway width.
(2) Mild impairment—Is able to change speed but demonstrates
mild gait deviations, deviates 15.24–25.4 cm (6–10 in) outside
of the 30.48-cm (12-in) walkway width, or no gait deviations but
unable to achieve a significant change in velocity, or uses an
assistive device.
(1) Moderate impairment—Makes only minor adjustments to walk-
ing speed, or accomplishes a change in speed with significant
gait deviations, deviates 25.4 –38.1 cm (10–15 in) outside the
30.48-cm (12-in) walkway width, or changes speed but loses
balance but is able to recover and continue walking.
(0) Severe impairment—Cannot change speeds, deviates greater
than 38.1 cm (15 in) outside 30.48-cm (12-in) walkway width,
or loses balance and has to reach for wall or be caught.
_______3. GAIT WITH HORIZONTAL HEAD TURNS
Instructions: Walk from here to the next mark 6 m (20 ft) away. Begin
walking at your normal pace. Keep walking straight; after 3 steps, turn
your head to the right and keep walking straight while looking to the
right. After 3 more steps, turn your head to the left and keep walking
straight while looking left. Continue alternating looking right and left
every 3 steps until you have completed 2 repetitions in each direction.
Grading: Mark the highest category that applies.
(3) Normal—Performs head turns smoothly with no change in gait.
Deviates no more than 15.24 cm (6 in) outside 30.48-cm (12-in)
walkway width.
(2) Mild impairment—Performs head turns smoothly with slight
change in gait velocity (eg, minor disruption to smooth gait
path), deviates 15.24–25.4 cm (6–10 in) outside 30.48-cm
(12-in) walkway width, or uses an assistive device.
(1) Moderate impairment—Performs head turns with moderate
change in gait velocity, slows down, deviates 25.4–38.1 cm
(10–15 in) outside 30.48-cm (12-in) walkway width but recov-
ers, can continue to walk.
(0) Severe impairment—Performs task with severe disruption of gait
(eg, staggers 38.1 cm [15 in] outside 30.48-cm (12-in) walkway
width, loses balance, stops, or reaches for wall).
_______4. GAIT WITH VERTICAL HEAD TURNS
Instructions: Walk from here to the next mark (6 m [20 ft]). Begin walking
at your normal pace. Keep walking straight; after 3 steps, tip your head
up and keep walking straight while looking up. After 3 more steps, tip
your head down, keep walking straight while looking down. Continue
alternating looking up and down every 3 steps until you have completed
2 repetitions in each direction.
Grading: Mark the highest category that applies.
(3) Normal—Performs head turns with no change in gait. Deviates
no more than 15.24 cm (6 in) outside 30.48-cm (12-in) walkway
width.
(2) Mild impairment—Performs task with slight change in gait
velocity (eg, minor disruption to smooth gait path), deviates
15.24–25.4 cm (6–10 in) outside 30.48-cm (12-in) walkway
width or uses assistive device.
(1) Moderate impairment—Performs task with moderate change in
gait velocity, slows down, deviates 25.4–38.1 cm (10–15 in)
outside 30.48-cm (12-in) walkway width but recovers, can
continue to walk.
(0) Severe impairment—Performs task with severe disruption of gait
(eg, staggers 38.1 cm [15 in] outside 30.48-cm (12-in) walkway
width, loses balance, stops, reaches for wall).
_______5. GAIT AND PIVOT TURN
Instructions: Begin with 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.
Grading: Mark the highest category that applies.
(3) Normal—Pivot turns safely within 3 seconds and stops quickly
with no loss of balance.
(2) Mild impairment—Pivot turns safely in ⬎3 seconds and stops
with no loss of balance, or pivot turns safely within 3 seconds
and stops with mild imbalance, requires small steps to catch
balance.
(1) Moderate impairment—Turns slowly, requires verbal cueing, or
requires several small steps to catch balance following turn and
stop.
(0) Severe impairment—Cannot turn safely, requires assistance to
turn and stop.
_______6. STEP OVER OBSTACLE
Instructions: Begin walking at your normal speed. When you come to the
shoe box, step over it, not around it, and keep walking.
Grading: Mark the highest category that applies.
(3) Normal—Is able to step over 2 stacked shoe boxes taped
together (22.86 cm [9 in] total height) without changing gait
speed; no evidence of imbalance.
(2) Mild impairment—Is able to step over one shoe box (11.43 cm
[4.5 in] total height) without changing gait speed; no evidence
of imbalance.
(1) Moderate impairment—Is able to step over one shoe box (11.43
cm [4.5 in] total height) but must slow down and adjust steps to
clear box safely. May require verbal cueing.
(0) Severe impairment—Cannot perform without assistance.
(Continued)
Physical Therapy . Volume 84 . Number 10 . October 2004 Wrisley et al . 917
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ў
Appendix.
Continued
_______7. GAIT WITH NARROW BASE OF SUPPORT
Instructions: Walk on the floor with arms folded across the chest, feet
aligned heel to toe in tandem for a distance of 3.6 m [12 ft]. The number
of steps taken in a straight line are counted for a maximum of 10 steps.
Grading: Mark the highest category that applies.
(3) Normal—Is able to ambulate for 10 steps heel to toe with no
staggering.
(2) Mild impairment—Ambulates 7–9 steps.
(1) Moderate impairment—Ambulates 4–7 steps.
(0) Severe impairment—Ambulates less than 4 steps heel to toe or
cannot perform without assistance.
_______8. GAIT WITH EYES CLOSED
Instructions: Walk at your normal speed from here to the next mark (6 m
[20 ft]) with your eyes closed.
Grading: Mark the highest category that applies.
(3) Normal—Walks 6 m (20 ft), no assistive devices, good speed,
no evidence of imbalance, normal gait pattern, deviates no more
than 15.24 cm (6 in) outside 30.48-cm (12-in) walkway width.
Ambulates 6 m (20 ft) in less than 7 seconds.
(2) Mild impairment—Walks 6 m (20 ft), uses assistive device,
slower speed, mild gait deviations, deviates 15.24–25.4 cm
(6–10 in) outside 30.48-cm (12-in) walkway width. Ambulates
6 m (20 ft) in less than 9 seconds but greater than 7 seconds.
(1) Moderate impairment—Walks 6 m (20 ft), slow speed, abnor-
mal gait pattern, evidence for imbalance, deviates 25.4–38.1
cm (10–15 in) outside 30.48-cm (12-in) walkway width.
Requires more than 9 seconds to ambulate 6 m (20 ft).
(0) Severe impairment—Cannot walk 6 m (20 ft) without assistance,
severe gait deviations or imbalance, deviates greater than 38.1
cm (15 in) outside 30.48-cm (12-in) walkway width or will not
attempt task.
______9. AMBULATING BACKWARDS
Instructions: Walk backwards until I tell you to stop.
Grading: Mark the highest category that applies.
(3) Normal—Walks 6 m (20 ft), no assistive devices, good speed,
no evidence for imbalance, normal gait pattern, deviates no
more than 15.24 cm (6 in) outside 30.48-cm (12-in) walkway
width.
(2) Mild impairment—Walks 6 m (20 ft), uses assistive device,
slower speed, mild gait deviations, deviates 15.24–25.4 cm
(6–10 in) outside 30.48-cm (12-in) walkway width.
(1) Moderate impairment—Walks 6 m (20 ft), slow speed, abnor-
mal gait pattern, evidence for imbalance, deviates 25.4–38.1
cm (10–15 in) outside 30.48-cm (12-in) walkway width.
(0) Severe impairment—Cannot walk 6 m (20 ft) without assistance,
severe gait deviations or imbalance, deviates greater than 38.1
cm (15 in) outside 30.48-cm (12-in) walkway width or will not
attempt task.
________10. STEPS
Instructions: Walk up these stairs as you would at home (ie, using the rail
if necessary). At the top turn around and walk down.
Grading: Mark the highest category that applies.
(3) Normal—Alternating feet, no rail.
(2) Mild impairment—Alternating feet, must use rail.
(1) Moderate impairment—Two feet to a stair; must use rail.
(0) Severe impairment—Cannot do safely.
TOTAL SCORE: ______ MAXIMUM SCORE 30
a
Adapted from Dynamic Gait Index.
1
Modified and reprinted with permission of authors and Lippincott Williams & Wilkins (http://lww.com).
918 . Wrisley et al Physical Therapy . Volume 84 . Number 10 . October 2004
Walker,M.L.(2007).ReferenceGroupDatafortheFunctionalGaitAssessment.
PhysicalTherapy(87)11,1468‐1477.
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FAQs of Functional Gait Assessment for Older Adults

What tasks are included in the Functional Gait Assessment?
The Functional Gait Assessment includes various tasks designed to evaluate different aspects of gait and balance. These tasks involve walking straight, changing speeds, performing head turns while walking, and stepping over obstacles. Each task assesses specific components of mobility, such as stability and coordination, which are critical for preventing falls in older adults. The assessment provides a comprehensive overview of an individual's gait performance.
How is the Functional Gait Assessment scored?
The Functional Gait Assessment uses a structured scoring system ranging from 0 to 3 for each task, with 3 indicating normal performance and 0 indicating severe impairment. Each task is evaluated based on criteria such as speed, balance, and the ability to navigate obstacles. The total score helps clinicians determine the level of mobility impairment and fall risk, guiding intervention strategies. This scoring system is essential for tracking progress over time.
Who can benefit from the Functional Gait Assessment?
The Functional Gait Assessment is beneficial for healthcare professionals working with older adults, including physical therapists, occupational therapists, and geriatricians. It helps identify individuals at risk of falls and guides the development of personalized rehabilitation programs. Additionally, caregivers and family members can use insights from the assessment to better understand mobility challenges faced by their loved ones. Overall, it serves as a vital tool in promoting safety and independence in the elderly.
What is the significance of gait assessment in older adults?
Gait assessment in older adults is significant for several reasons, primarily related to fall prevention and maintaining independence. As individuals age, changes in balance and mobility can increase the risk of falls, which can lead to serious injuries. By identifying gait impairments early through assessments like the Functional Gait Assessment, healthcare providers can implement targeted interventions to improve strength, balance, and overall mobility. This proactive approach enhances quality of life and reduces healthcare costs associated with fall-related injuries.
What are the implications of a low score on the Functional Gait Assessment?
A low score on the Functional Gait Assessment indicates significant mobility impairments and a higher risk of falls. This score suggests that the individual may require assistance with daily activities and may benefit from targeted rehabilitation interventions. Clinicians can use this information to develop personalized exercise programs aimed at improving strength, balance, and coordination. Additionally, understanding the implications of a low score can help caregivers provide better support and ensure a safer living environment.

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