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.

scholarly journals Evidence for the Validity of the Modified Dynamic Gait Index Across Diagnostic Groups

2014 ◽  
Vol 94 (7) ◽  
pp. 996-1004 ◽  
Author(s):  
Patricia Noritake Matsuda ◽  
Catherine S. Taylor ◽  
Anne Shumway-Cook
Keyword(s):  
Psychometric Properties ◽  
Differential Item Functioning ◽  
Gait Pattern ◽  
Minimal Detectable Change ◽  
Cross Sectional ◽  
Gait Abnormality ◽  
Item Functioning ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

BackgroundThe modified Dynamic Gait Index (mDGI) measures the capacity to adapt gait to complex tasks utilizing 8 tasks and 3 facets of performance. The measurement stability of the mDGI in specific diagnostic groups is unknown.ObjectiveThis study examined the psychometric properties of the mDGI in 5 diagnostic groups.DesignThis was a cross-sectional, descriptive study.MethodsA total of 794 participants were included in the study: 140 controls, 239 with stroke, 140 with vestibular dysfunction, 100 with traumatic brain injury, 91 with gait abnormality, and 84 with Parkinson disease. Differential item functioning analysis was used to examine the comparability of scores across diagnoses. Internal consistency was computed using Cronbach alpha. Factor analysis was used to examine the factor loadings for the 3 performance facet scores. Minimal detectable change at the 95% confidence level (MDC95%) was calculated for each of the groups.ResultsLess than 5% of comparisons demonstrated moderate to large differential item functioning, suggesting that item scores had the same order of difficulty for individuals in all 5 diagnostic groups. For all 5 patient groups, 3 factors had eigenvalues >1.0 and explained 80% of the variability in scores, supporting the importance of characterizing mobility performance with respect to time, level of assistance, and gait pattern.LimitationsThere were uneven sample sizes in the 6 groups.ConclusionsThe strength of the psychometric properties of the mDGI across the 5 diagnostic groups further supports the validity and usefulness of scores for clinical and research purposes. In addition, the meaning of a score from the mDGI, regardless of whether at the task, performance facet, or total score level, was comparable across the 5 diagnostic groups, suggesting that the mDGI measured mobility function independent of medical diagnosis.

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 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.

scholarly journals Expanding the Scoring System for the Dynamic Gait Index

2013 ◽  
Vol 93 (11) ◽  
pp. 1493-1506 ◽  
Author(s):  
Anne Shumway-Cook ◽  
Catherine S. Taylor ◽  
Patricia Noritake Matsuda ◽  
Michael T. Studer ◽  
Brady K. Whetten
Keyword(s):  
Psychometric Properties ◽  
Scoring System ◽  
Internal Validity ◽  
Control Group ◽  
Minimal Detectable Change ◽  
Detectable Change ◽  
Cross Sectional ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

BackgroundThe Dynamic Gait Index (DGI) measures the capacity to adapt gait to complex tasks. The current scoring system combining gait pattern (GP) and level of assistance (LOA) lacks clarity, and the test has a limited range of measurement.ObjectiveThis study developed a new scoring system based on 3 facets of performance (LOA, GP, and time) and examined the psychometric properties of the modified DGI (mDGI).DesignA cross-sectional, descriptive study was conducted.MethodsNine hundred ninety-five participants (855 patients with neurologic pathology and mobility impairments [MI group] and 140 patients without neurological impairment [control group]) were tested. Interrater reliability was calculated using kappa coefficients. Internal consistency was computed using the Cronbach alpha coefficient. Factor analysis and Rasch analysis investigated unidimensionality and range of difficulty. Internal validity was determined by comparing groups using multiple t tests. Minimal detectable change (MDC) was calculated for total score and 3 facet scores using the reliability estimate for the alpha coefficients.ResultsInterrater agreement was strong, with kappa coefficients ranging from 90% to 98% for time scores, 59% to 88% for GP scores, and 84% to 100% for LOA scores. Test-retest correlations (r) for time, GP, and LOA were .91, .91, and .87, respectively. Three factors (time, LOA, GP) had eigenvalues greater than 1.3 and explained 79% of the variance in scores. All group differences were significant, with moderate to large effect sizes. The 95% minimal detectable change (MDC95) was 4 for the mDGI total score, 2 for the time and GP total scores, and 1 for the LOA total score.LimitationsThe limitations included uneven sample sizes in the 2 groups. The MI group were patients receiving physical therapy; therefore, they may not be representative of this population.ConclusionsThe mDGI, with its expanded scoring system, improves the range, discrimination, and facets of measurement related to walking function. The strength of the psychometric properties of the mDGI warrants its adoption for both clinical and research purposes.

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.

Identification of modified dynamic gait index cutoff scores for assessing fall risk in people with Parkinson disease, stroke and multiple sclerosis

2022 ◽  
Vol 91 ◽  
pp. 1-6
Author(s):  
Alessandro Torchio ◽  
Chiara Corrini ◽  
Denise Anastasi ◽  
Riccardo Parelli ◽  
Matteo Meotti ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Parkinson Disease ◽  
Fall Risk ◽  
Cutoff Scores ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

Rehabilitation after acute vestibular disorders

2008 ◽  
Vol 123 (4) ◽  
pp. 397-402 ◽  
Author(s):  
R Teggi ◽  
D Caldirola ◽  
B Fabiano ◽  
P Recanati ◽  
M Bussi
Keyword(s):  
Visual Analogue Scale ◽  
Postural Control ◽  
Analogue Scale ◽  
Visual Cues ◽  
Control Group ◽  
Index Test ◽  
Supervised Exercise ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

AbstractObjectives:To assess the efficacy of rehabilitation for dizzy patients after recent acute vestibular disturbance.Methods:Forty patients recently hospitalised for an acute episode of rotational vertigo which lasted days were randomly divided into two groups. The first group (20 patients; group R) underwent active rehabilitation, while the second group (20 patients; group C) were told only to ‘perform their daily activities’. Group R subjects underwent a total of 10 sessions of rehabilitation, including exercises on a stabilometric platform, point de mire and a series of five exercises repeated five times daily. All patients performed static stabilometry (posturography), undertook the dynamic gait index test, and completed a dizziness handicap questionnaire and a visual analogue scale for anxiety, at baseline and on completion.Results:At 25 days, the rehabilitated patients obtained better results for all recorded outcomes, compared with the control group. The greatest difference in the rehabilitated subjects, compared with the control group, was for the dynamic gait index test; however, this difference was not statistically significant. The visual analogue scale anxiety score was statistically significantly more reduced in rehabilitated patients compared with control patients. Control patients maintained a higher visual dependence for postural control.Conclusions:These results would appear to support the effectiveness of a supervised exercise programme for patients following acute onset of vestibular disturbance. A correlation was found in both groups between dynamic gait index results and anxiety. In our experience, a rehabilitation programme seems to reduce dependence on visual cues for postural control.

Dynamische Posturografie zur Quantifizierung der posturalen Kontrolle

2018 ◽  
Vol 45 (10) ◽  
pp. 714-725
Author(s):  
Heinz Reichmann ◽  
Martin Gerber ◽  
Markus Reckhardt ◽  
Fritjof Reinhardt
Keyword(s):  
Morbus Parkinson ◽  
Berg Balance Scale ◽  
Eine Hohe ◽  
Balance Scale ◽  
Stadium I ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

ZusammenfassungDie erfolgreiche Haltungskontrolle setzt eine effektive und effiziente Interaktion aller posturalen Systeme voraus, die sowohl aktiv als auch reaktiv mittels muskulärer Kräfte den Körper im Gleichgewicht halten. Eine Störung dieses komplexen Posturalsystems auf sensorischer, zentraler oder motorischer Ebene führt in der Folge zu einer zunehmenden Instabilität und zu einer erhöhten Sturzneigung. Insofern scheinen die zuverlässige Erhebung der posturalen Kontrolle und die damit verbundene Sturzprävalenz ein wichtiges Element der ambulanten und stationären Versorgung zu sein. Die motorisch-funktionellen Assessments, die sich aus verschiedenen Gleichgewichts- und Stabilitätsaufgaben ergeben, stellen noch immer den Goldstandard zur Quantifizierung der posturalen Kontrolle dar. Diese Verfahren sind jedoch oftmals nicht in der Lage, die Gleichgewichtsfähigkeit eines Patienten vollumfänglich abzubilden, oder sind aufgrund der subjektiven Bewertung oder unzureichender Standardisierung nur bedingt vergleichbar. Das Ziel der vorliegenden Studie war daher die Entwicklung eines quantitativen Messverfahrens zur Überprüfung der posturalen Kontrolle, basierend auf dem neuroorthopädischen Therapiegerät Posturomed®. Das Messsystem wurde in Form eines reaktiven Screeningverfahrens ausgeführt. Bei diesem werden mechanische Perturbationen erzeugt mittels Elektromagneten, die an der Unterstützungsfläche des Probanden appliziert werden. Der Eignungsnachweis dieses Systems für eine Quantifizierung der posturalen Kontrolle erfolgte durch eine zweiarmige Querschnittsstudie mit 115 gesunden Probanden (Referenzgruppe) und 149 neurologischen Patienten.Die Gruppe der neurologischen Patienten setzte sich zusammen aus– 69 Patienten mit zerebraler Mikroangiopathie (ZMA) mit in den letzten 12 Monaten klinisch eher leichter, aber chronisch progredienter Symptomatik,– 31 Patienten mit Morbus Parkinson Stadium I bis III nach Hoehn & Yahr als chronisch progrediente, multilokuläre Netzwerkerkrankung und – 49 Patienten mit klinisch vordergründig restierender Hemiparese bei Zustand nach zerebraler Embolie (Kraftgrad des betroffenen Beins 4/5 oder latente Parese) außerhalb der Subakutphase. Die Ergebnisse der Studie belegen, dass Perturbationsversuche zur Quantifizierung der posturalen Kontrolle für ein breites Spektrum neurologischer Patienten geeignet sind. Die Validität des Verfahrens konnte durch eine hohe inhaltliche Übereinstimmung zwischen der dynamischen Posturografie und den konvergenten Maßen der Motorik (Berg Balance Scale; Dynamic Gait Index) nachgewiesen werden. Das vorgestellte System erscheint folglich geeignet, das reaktive Gleichgewicht als eine Eigenschaft der motorischen Standkontrolle zu bestimmen. Die dynamische Posturografie auf Basis eines Perturbationsversuchs kann im klinischen und therapeutischen Umfeld zur Quantifizierung der posturalen Kontrolle eingesetzt werden. Zielgruppenlimitationen und damit verbundene Einschränkungen der Generalisierbarkeit von motorisch-funktionellen Testverfahren werden mit ihm überwunden. Darüber hinaus können auf der Basis der reaktiven posturalen Kompetenz individuelle Rückschlüsse auf das Sturzrisiko gezogen werden. Die Prognosegüte dieser Sturzrisikobewertung entspricht denen der motorisch-funktionellen Testverfahren und ist je nach Zielgruppe teilweise sogar besser. Für Patienten mit Morbus Parkinson konnte für den Dämpfungskoeffizienten bei einem Grenzwert von Δτ = − 0,45 s die höchste Güte ermittelt werden. Eine Sensitivität von 79 % und Spezifität von 78 % lassen eine gute Verwendung als sturzbezogenes Assessment erkennen. Der routinemäßige klinische Einsatz zur Quantifizierung der Sturzgefährdung, z. B. im Rahmen einer Krankenhausaufnahme, erscheint auf Grundlage der Ergebnisse empfehlenswert. Eine Grundvoraussetzung dafür, dass sich ein Assessment für eine Verlaufsbestimmung im Rahmen von Behandlungen einer Erkrankung eignet, ist seine ausreichende Reliabilität. Die laterale Perturbation und dann die Wertung von mittlerer Schwingungsgeschwindigkeit und Schwingungsdistanz sind geeignet für die Beurteilung der posturalen Stabilität im Verlauf neurologischer Erkrankungen und damit auch für eine quantitative Erfassung auftretender Therapieeffekte.

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