scholarly journals Temporal and Spatial Characteristics of Gait During Performance of the Dynamic Gait Index in People With and People Without Balance or Vestibular Disorders

2008 ◽  
Vol 88 (5) ◽  
pp. 640-651 ◽  
Author(s):  
Gregory F Marchetti ◽  
Susan L Whitney ◽  
Philip J Blatt ◽  
Laura O Morris ◽  
Joan M Vance
Keyword(s):  
Intraclass Correlation ◽  
Vestibular Dysfunction ◽  
Vestibular Disorders ◽  
Cross Sectional ◽  
Control Subjects ◽  
Gait Characteristics ◽  
Gait Parameters ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

Background and Purpose Understanding underlying gait characteristics during performance of the Dynamic Gait Index (DGI) could potentially guide interventions. The purpose of this study was to describe the characteristics and reliability of gait performance during the level walking items of the DGI in people with balance or vestibular dysfunction. The study was a cross-sectional investigation with 2-group comparisons. Subjects and Methods Forty-seven subjects (mean age=59.2 years, SD=8.5, range=24–90) participated in the study; 26 were control subjects, and 21 were subjects with balance or vestibular dysfunction. Three trials of each level gait item were administered to subjects as they ambulated on an instrumented walkway. Test-retest reliability was determined by use of an intraclass correlation coefficient (3,1) 2-way random-effects model for gait parameters associated with continuous walking and the item requiring turning and stopping quickly. Mean gait parameter differences between control subjects and subjects with balance or vestibular disorders were compared by use of a multivariate analysis of variance for each gait task. Results The reliability of most gait parameters during DGI performance were fair to excellent between trials. Subjects with balance or vestibular disorders demonstrated differences in gait characteristics compared with control subjects. The heterogeneity of the group of subjects with balance or vestibular disorders does not permit inferences to be drawn regarding the relationship between gait and any specific balance or vestibular diagnosis. The results are most pertinent to people with chronic balance or vestibular disorders. Discussion and Conclusion Gait parameters underlying dynamic walking appeared to be relatively reliable across multiple trials and distinguished subjects with balance or vestibular disorders. Evaluating a person's performance on items of the DGI may be useful in identifying gait deviations and in evaluating gait improvements as a result of interventions.

scholarly journals Construction and Validation of the 4-Item Dynamic Gait Index

2006 ◽  
Vol 86 (12) ◽  
pp. 1651-1660 ◽  
Author(s):  
Gregory F Marchetti ◽  
Susan L Whitney
Keyword(s):  
Psychometric Properties ◽  
Short Form ◽  
Vestibular Disorders ◽  
Factor Analyses ◽  
Clinical Measurement ◽  
Control Subjects ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Difficulty Walking ◽  
Gait Index

Background and PurposePeople with balance disorders often have difficulty walking. The purpose of this study was to develop and test the psychometric properties of a short form of the Dynamic Gait Index (DGI) for the clinical measurement of walking function in people with balance and vestibular disorders. Subjects. A total of 123 subjects with such disorders (test subjects) and 103 control subjects were included in this study. Methods. Rasch and factor analyses were used to create a short form of the DGI. Internal consistency and discriminative validity for test subjects versus control subjects and for falling versus nonfalling test subjects were evaluated. Results. Four items were selected for the shorter version of the test: gait on level surfaces, changes in gait speed, and horizontal and vertical head turns. Discussion and Conclusion. The clinical psychometric properties of the 4-item DGI were equivalent or superior to those of the 8-item test. The 4-item DGI can be used by clinicians to measure gait in people with balance and vestibular disorders without compromising important clinical measurement characteristics.

The sensitivity and specificity of the Timed "Up & Go" and the dynamic gait index for self-reported falls in persons with vestibular disorders

2004 ◽  
Vol 14 (5) ◽  
pp. 397-409 ◽  
Author(s):  
Susan L. Whitney ◽  
Gregory F. Marchetti ◽  
Annika Schade ◽  
Diane M. Wrisley
Keyword(s):  
Physical Therapy ◽  
Sensitivity And Specificity ◽  
Fall Risk ◽  
Vestibular Dysfunction ◽  
Initial Assessment ◽  
Vestibular Disorders ◽  
Patient Chart ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

The purpose of this study was to determine the sensitivity and specificity of the Timed "Up & Go" (TUG) and Dynamic Gait Index in identifying self-reported fallers among persons with vestibular dysfunction. One hundred three patient charts were included from a tertiary vestibular physical therapy practice. The patients ranged in age from 14–90 years and had vestibular diagnoses, falls reported in the patient chart, and completed the TUG and/or the Dynamic Gait Index (DGI). Thirty-one persons reported falling one or more times in the previous 6 months during their initial assessment. Persons who took longer than 13.5 seconds to perform the TUG test were 3.7 times more likely to have reported a fall in the previous 6 months. Those persons with scores less than or equal to 18 on the DGI were 2.7 times (p = 0.03) more likely to have reported a fall in the previous 6 months. The sensitivity of the DGI at 18 or less was 70% and the specificity was 51%. People who scored greater than 11.1 seconds on the TUG were 5times (p = 0.001) more likely to have reported a fall in the previous 6 months. Sensitivity (80%) and specificity (56%) were calculated for TUG scores of greater than 11.1 seconds. The TUG and the DGI appear to be helpful in identifying fall risk in persons with vestibular dysfunction. Slower scores on the TUG (> 11.1 seconds) and lower scores on the DGI (18) correlated with reports of falls in persons with vestibular dysfunction.

The dynamic gait index relates to self-reported fall history in individuals with vestibular dysfunction

2000 ◽  
Vol 10 (2) ◽  
pp. 99-105 ◽  
Author(s):  
S.L. Whitney ◽  
M.T. Hudak ◽  
G.F. Marchetti
Keyword(s):  
Vestibular Dysfunction ◽  
Vestibular Disorders ◽  
Vestibular Disorder ◽  
Odds Ratios ◽  
Chi Square ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
The Relationship ◽  
Gait Index

The purpose of this study was to determine the relationship between gait instability and falls history in people with vestibular disorders. A total of 247 people (164 women, 83 men) participated in the study (mean age = 62.5). Falls history within the last 6 months and scores on the Dynamic Gait Index (DGI) were compared using the Mantel-Hantzel Chi-square statistic. Thirty-seven percent of all subjects reported falling within the last 6 months. Odds ratios in favor of falls with DGI scores of 19 or lower was 2.58 (95% were 2.58 times more likely to have reported a fall in the previous 6 months than subjects with scores above 19. Younger subjects (those under 65 years of age) with vestibular disorders reported more falls than persons 65 years of age or over. Younger people may be more willing to risk a fall while actively having a vestibular disorder. The DGI appears to be a good indicator of fall status in persons with vestibular disorders, regardless of age.

scholarly journals Examining the Relationship Between Medical Diagnoses and Patterns of Performance on the Modified Dynamic Gait Index

2015 ◽  
Vol 95 (6) ◽  
pp. 854-863 ◽  
Author(s):  
Patricia Noritake Matsuda ◽  
Catherine Taylor ◽  
Anne Shumway-Cook
Keyword(s):  
Gait Pattern ◽  
Control Cohort ◽  
Cross Sectional ◽  
Medical Diagnoses ◽  
Total Performance ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
The Relationship ◽  
And Task ◽  
Gait Index

Background In the original and modified Dynamic Gait Index (mDGI), 8 tasks are used to measure mobility; however, disagreement exists regarding whether all tasks are necessary. The relationship between mDGI scores and Centers for Medicare & Medicaid Services (CMS) severity indicators in the mobility domain has not been explored. Objective The study objectives were to examine the relationship between medical diagnoses and mDGI scores, to determine whether administration of the mDGI can be shortened on the basis of expected diagnostic patterns of performance, and to create a model in which mDGI scores are mapped to CMS severity modifiers. Design This was a cross-sectional, descriptive study. Methods The 794 participants included 140 people without impairments (control cohort) and 239 people with stroke, 140 with vestibular dysfunction, 100 with traumatic brain injury, 91 with gait abnormality, and 84 with Parkinson disease. Scores on the mDGI (total, performance facet, and task) for the control cohort were compared with those for the 5 diagnostic groups by use of an analysis of variance. For mapping mDGI scores to 7 CMS impairment categories, an underlying Rasch scale was used to convert raw scores to an interval scale. Results There was a main effect of mDGI total, time, and gait pattern scores for the groups. Task-specific score patterns based on medical diagnosis were found, but the range of performance within each group was large. A framework for mapping mDGI total, performance facet, and task scores to 7 CMS impairment categories on the basis of Rasch analysis was created. Limitations Limitations included uneven sample sizes in the 6 groups. Conclusions Results supported retaining all 8 tasks for the assessment of mobility function in older people and people with neurologic conditions. Mapping mDGI scores to CMS severity indicators should assist clinicians in interpreting mobility performance, including changes in function over time.

Investigating the Validity of the Environmental Framework Underlying the Original and Modified Dynamic Gait Index

2015 ◽  
Vol 95 (6) ◽  
pp. 864-870 ◽  
Author(s):  
Anne Shumway-Cook ◽  
Patricia Noritake Matsuda ◽  
Catherine Taylor
Keyword(s):  
Factor Analysis ◽  
Functional Mobility ◽  
Environmental Model ◽  
Cross Sectional ◽  
Total Study Population ◽  
Gait Abnormality ◽  
Mobility Function ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

BackgroundThe modified Dynamic Gait Index (mDGI), developed from a person-environment model of mobility disability, measures mobility function relative to specific environmental demands. The framework for interpreting mDGI scores relative to specific environmental dimensions has not been investigated.ObjectiveThe aim of this study was to examine the person-environmental model underlying the development and interpretation of mDGI scores.DesignThis was a cross-sectional, descriptive study.MethodsThere were 794 participants in the study, including 140 controls. Out of the total study population, 239 had sustained a stroke, 140 had vestibular dysfunction, 100 had sustained a traumatic brain injury, 91 had gait abnormality, and 84 had Parkinson disease. Exploratory factor analysis was used to investigate whether mDGI scores supported the 4 environmental dimensions.ResultsFactor analysis showed that, with some exceptions, tasks loaded on 4 underlying factors, partially supporting the underlying environmental model.LimitationsLimitations of this study included the uneven sample sizes in the 6 groups.ConclusionsSupport for the environmental framework underlying the mDGI extends its usefulness as a clinical measure of functional mobility by providing a rationale for interpretation of scores that can be used to direct treatment and infer change in mobility function.

Assessing the Validity of the Dynamic Gait Index in a Balance Disorders Clinic: An Application of Rasch Analysis

2013 ◽  
Vol 93 (6) ◽  
pp. 809-818 ◽  
Author(s):  
Deanna C. Dye ◽  
Aaron M. Eakman ◽  
Kayla M. Bolton
Keyword(s):  
Rating Scale ◽  
Item Difficulty ◽  
Ceiling Effect ◽  
Scale Model ◽  
Vestibular Disorders ◽  
Present Sample ◽  
Medical Diagnoses ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

BackgroundThe Dynamic Gait Index (DGI) has emerged as a valid indicator of functional gait abilities for people with balance and vestibular disorders. Recent Rasch-based analyses have indicated possible concerns for multidimensionality and a ceiling effect within the DGI.ObjectiveThe aim of this study was to evaluate the DGI in a sample of patients from a dizziness and balance clinic to determine whether patient features such as dizziness or fall history influence the measurement characteristics of the DGI.DesignThis study used a retrospective design.MethodsA sample of 117 patients' charts was reviewed, and patients were grouped according to a primary impairment of dizziness only or imbalance and were categorized based on a history of falls. A one-parameter Rasch-Andrich rating scale model was used with thorough analyses, including rating scale analysis, item-difficulty hierarchy, scale unidimensionality, and differential item functioning (DIF).ResultsThe DGI demonstrated an effective rating scale design and was found to be a unidimensional measurement of dynamic gait. The DGI displayed a modest ceiling effect, primarily with patients with higher functional levels displaying symptoms of dizziness. Three items (“vertical head nods,” “gait on level surface,” and “stepping over obstacles”) demonstrated DIF based on categories of patient characteristics, although the effects on measurement were negligible.LimitationsFunctional categories were based on impairments and not underlying medical diagnoses derived from a retrospective chart review, whereas the limited sample size may have underestimated statistically significant DIF.ConclusionsResults from this study offer additional evidence supporting the validity of the DGI as a measure of gait ability. The present findings also are in agreement with prior research that has shown a ceiling effect for the DGI in people with balance or vestibular disorders. Effects of DIF were found to be negligible, yet the presence of DIF within the present sample helped to explain some differences in DGI item-difficulty hierarchies from prior studies. Continued research is needed to determine how population differences may affect performance on the DGI and to develop and test assessments capable of measuring a broader range of gait abilities.

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