Dynamic Gait Index: A Comprehensive Guide

What is the Dynamic Gait Index?

The Dynamic Gait Index (DGI) was developed as a clinical tool to assess gait, balance, and fall risk. The DGI tests the patient’s ability to maintain walking balance while responding to different task demands, through various dynamic conditions. It is a beneficial test for individuals with vestibular and balance problems, and those at risk of falling or who fear falling. 

The DGI includes eight items, they are: 

• Walking on level surfaces
• Changing gait speeds
• Walking with horizontal head turns
• Walking with vertical head turns
• Walking and turning 180 degrees to stop
• Stepping over obstacles
• Stepping around obstacles
• Walking up stairs

Each item is scored on a scale of 0 to 3. 3 Indicates a normal performance while 0 represents severe impairment. The best possible score on the DGI is 24. A score of 19 or below predicts falls in the elderly, while a score greater than 22 means that the patient is a safe ambulator.

Intended Population

The intended population for the DGI includes: 

• The elderly population
• Stroke patients
• Vestibular disorders
• Balance issues due to non-vestibular causes
• Brain injury patients
• Individuals with Parkinson’s Disease
• Multiple Sclerosis patients

What Equipment is Required for the Dynamic Gait Index?

Minimal items are required to perform the DGI. You will need: 

• A shoe box
• Two obstacles of equal size
• Stairs
• 20-foot pathway

How Long Will the Dynamic Gait Index Take to Complete?

It generally takes about 15 minutes to complete the 8 tests in the Dynamic Gait Index.

How Reliable is the Dynamic Gait Index?

The DGI showed high reliability and evidence of validity with other balance and mobility scales. It is a useful clinical tool for evaluating dynamic balance in ambulatory people. The DGI is a reliable functional assessment tool, especially for multiple sclerosis, because it correlates inversely with a timed walk, showing its concurrent validity.

Tests

Download the following guide to conveniently use with your patients!

You can also refer to the following video for step-by-step instructions on administering the DGI.

1. Gait Level Surface

Instructions: Walk at your normal speed from here to the next mark (20’)

Grading: Mark the lowest category that applies

(3) Normal: Walks 20’, no assistive devices, good speed, no evidence for imbalance, normal gait pattern.

(2) Mild Impairment: Walks 20’, uses assistive devices, slower speed, mild gait deviations.

(1) Moderate Impairment: Walks 20’, slow speed, abnormal gait pattern, evidence for imbalance. 

(0) Severe Impairment: Cannot walk 20’ without assistance, severe gait deviations or imbalance.

2. Change in Gait Speed

Instructions: Begin walking at your normal pace (for 5’), when I tell you to “go” walk as fast as you can (for 5’). When I tell you “slow,” walk as slowly as you can (for 5’). 

Grading: Mark the lowest 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. 

(2) Mild Impairment: Can change speed but demonstrates mild gait deviations, 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 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 can recover and continue walking. 

(0) Severe Impairment: Cannot change speeds, or loses balance and has to reach for a wall or be caught.

3. Gait with Horizontal Head Turns

Instructions: 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.

Grading: Mark the lowest category that applies. 

(3) Normal: Performs head turns smoothly with no change in gait.

(2) Mild Impairment: Performs head turns smoothly with a slight change in gait velocity, i.e., minor disruption to smooth gait path or uses walking aid.

(1) Moderate Impairment: Performs head turns with moderate change in gait velocity, slows down, staggers but recovers, and can continue to walk.

(0) Severe Impairment: Performs task with severe disruption of gait, i.e., staggers outside 15” path, loses balance, stops, reaches for wall.

4. Gait with Vertical Head Turns

Instructions: 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.

Grading: Mark the lowest category that applies.

(3) Normal: Performs head turns smoothly with no change in gait.

(2) Mild Impairment: Performs head turns smoothly with a slight change in gait velocity, i.e., minor disruption to smooth gait path or uses walking aid.

1) Moderate Impairment: Performs head turns with moderate change in gait velocity, slows down, staggers but recovers, and can continue to walk.

(0) Severe Impairment: Performs task with severe disruption of gait, i.e., staggers outside 15” path, loses balance, stops, reaches for wall.

5. Gait and Pivot Turn

Instructions: 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.

Grading: Mark the lowest 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.

(1) Moderate Impairment: Turns slowly, requires verbal cueing, requires several small steps to catch balance following turn and stop.

(0) Severe Impairment: Cannot turn safely, and requires assistance to turn and stop.

6. Step Over Obstacle

Instructions: Begin walking at your normal speed. When you come to the shoebox, step over it, not around it, and keep walking.

Grading: Mark the lowest category that applies.

(3) Normal: Can step over the box without changing gait speed, no evidence of imbalance.

(2) Mild Impairment: Can step over box, but must slow down and adjust steps to clear box safely.

(1) Moderate Impairment: Can step over the box but must stop, then step over. May require verbal cueing.

(0) Severe Impairment: Cannot perform without assistance.

7. Step Around Obstacles

Instructions: 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 the first cone), walk around it to the left.

Grading: Mark the lowest category that applies.

(3) Normal: Can walk around cones safely without changing gait speed; no evidence of imbalance.

(2) Mild Impairment: Can step around both cones, but must slow down and adjust steps to clear cones.

(1) Moderate Impairment: Can clear cones but must significantly slow, speed to accomplish task, or requires verbal cueing.

(0) Severe Impairment: Unable to clear cones, walks into one or both cones, or requires physical assistance.

8. Steps

Instructions: Walk up these stairs as you would at home, i.e., using the railing if necessary. At the top, turn around and walk down.

Grading: Mark the lowest 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 be done safely.

Scoring

A four-point ordinal scale, ranging from 0-3. “0” indicates the lowest level of function, and “3” is the highest level of function.

The highest total score possible is 24.

Interpretation  < 19/24 = predictive of falls in the elderly,   > 22/24 = safe ambulators

Prevent Falls with Solo-Step

Preventing falls is a paramount concern, especially for individuals with compromised balance or mobility. Incorporating innovative solutions like Solo-Step into rehabilitation programs can significantly mitigate fall risks and enhance patient safety. Solo-Step is a versatile overhead track and harness system designed to provide secure support and assistance during therapy sessions. By affording patients a sense of security and stability while practicing various dynamic movements, Solo-Step instills confidence and promotes greater engagement in rehabilitation activities. When integrated with assessments like the Dynamic Gait Index (DGI), Solo-Step complements the evaluation process by offering real-time support and protection, thereby allowing clinicians to tailor interventions more effectively. Together, the Dynamic Gait Index and Solo-Step form a comprehensive approach to fall prevention, empowering individuals to regain mobility and independence with reduced fear of falling.

In conclusion, the Dynamic Gait Index (DGI) serves as a valuable clinical tool for assessing gait, balance, and fall risk in various populations, including the elderly, individuals with neurological conditions, and those recovering from injuries such as strokes or brain trauma. With its straightforward administration and minimal equipment requirements, the DGI offers clinicians a reliable means of evaluating dynamic balance and mobility. Its scoring system provides clear insights into a patient’s functional abilities, aiding in the identification of fall risks and guiding appropriate interventions. Overall, the DGI’s high reliability and validity make it an indispensable asset in rehabilitation and geriatric care settings, contributing to improved patient outcomes and enhanced quality of life.

Click the button below to learn how you can protect your patients from falls during gait and balance training!