Functional Gait Assessment

The Functional Gait Assessment (FGA) is an extended and improved version of the original Dynamic Gait Index (DGI), developed to better detect gait-related balance impairments in patients with vestibular disorders and other neurological conditions. FGA evaluates postural stability during various walking tasks and is considered an important clinical tool for assessing functional mobility.

Advantages and Limitations

• Advantages: Quick (5–10 minutes), requires minimal equipment, validated across multiple populations including Parkinson’s disease, stroke, and vestibular disorders¹. Reduces the ceiling effect often observed in simpler tests like the DGI.

• Limitations: Requires space for a 6-meter walkway and scoring competency by a trained clinician.

Purpose and Target Population

The main purpose of the FGA is to evaluate functional balance and gait patterns under dynamic conditions, including head turns, narrow base of support, eyes closed, and backward walking.

Relevant patient groups include:

• Older adults with balance problems

• Patients with vestibular disorders

• Post-stroke patients

• Individuals with Parkinson’s disease

FGA is used for diagnosis, fall-risk screening, and outcome evaluation after interventions.

Method and Test Procedure

The FGA consists of 10 walking tasks, each scored on a 0–3 scale:

• 3 = Normal performance

• 2 = Mild impairment

• 1 = Moderate impairment

• 0 = Severe impairment

Total score: 0–30 (lower score = higher fall risk).

Required equipment:

• A 6-meter walkway (30 cm wide marked line)

• Stairs (real or simulated)

• Shoebox or small obstacle

• Stopwatch

Test tasks:

1. Walk on a level surface (6 m)

2. Change walking speed (normal → fast → slow)

3. Walk with horizontal head turns

4. Walk with vertical head nods

5. Tandem walk (heel-to-toe on line)

6. Walk with eyes closed

7. Walk backward (6 m)

8. Stair climbing (up and down steps)

9. Walk around obstacles (right and left)

10. Pivot turn (180° quickly, then walk back)

The therapist records performance, deviations, use of assistive devices, and stability.

Interpretation and Clinical Relevance

Cut-off values for fall risk in older adults²:

• 26–30 points: Low risk

• 22–25 points: Moderate risk

• < 22 points: High fall risk

Clinicians should also note which tasks score lowest, as these reveal system-specific deficits (sensory, visual, motor).

Evidence and Measurement Properties

Reliability:

• Inter-rater reliability: ICC = 0.84

• Intra-rater reliability: ICC = 0.83

• Internal consistency: Cronbach’s α = 0.79¹

Validity:Strong construct validity shown through correlations with:

• Activities-specific Balance Confidence Scale (r = -0.70)

• Dynamic Gait Index (r = 0.80)

• Number of falls (r = -0.66)

• Timed Up and Go (r = -0.50)¹

Responsiveness:

FGA is responsive to rehabilitation outcomes, especially in neurological and vestibular populations³.

International use:Validated and translated into multiple languages (including Norwegian) without loss of psychometric quality⁴.

Summary

The Functional Gait Assessment (FGA) is a validated, reliable, and clinically useful tool for assessing dynamic balance and gait function in adults and older patients with neurological or vestibular challenges. It is suitable for screening, diagnosis, and rehabilitation outcome evaluation.

Sources:

1. Wrisley DM, Marchetti GF, Kuharsky DK, Whitney SL. Reliability, internal consistency and validity of data obtained with the Functional Gait Assessment. Physical Therapy. 2004;84(10):906–918.

2. Rehab Measures Database. Functional Gait Assessment. Hentet fra: http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=893. Sist brukt: 05.07.2025

3. Mission Gait. Functional Gait Assessment – Setup and Instruction. Hentet fra: http://www.youtube.com/watch?v=kqQ_nigCJkQ. Sist brukt: 05.07.2025

4. Kirkwood RN, Batista NC, Marques LB, de Melo Ocarino J, Neves LL, de Souza Moreira B. Cross-cultural adaptation and reliability of the Functional Gait Assessment in older Brazilian adults. Brazilian Journal of Physical Therapy. 2021 Jan 1;25(1):78–85.

5. Lin JH, Hsu MJ, Hsu HW, Wu HC, Hsieh CL. Psychometric comparisons of 3 functional ambulation measures for patients with stroke. Stroke. 2010 Jul 29; publisert online før trykk.