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Functional Gait Assessment

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Infographic for Functional Gait Assessment

Purpose

The FGA is used to assess postural stability during walking and assesses an individual's ability to perform multiple motor tasks while walking. The tool is a modification of the 8-item Dynamic Gait Index, developed to improve reliability and reduce ceiling effect. 

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Instrument Details

Acronym FGA

Area of Assessment

Balance – Vestibular
Balance – Non-vestibular
Gait

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Parkinson's Disease & Movement Disorders
  • Spinal Cord Injury
  • Stroke Recovery
  • Vestibular Disorders

Populations

Vestibular Disorders
Stroke
Parkinson's Disease
Older Adults and Geriatric Care
Non-Specific Patient Population

Key Descriptions

  • This test is a modification of the Dynamic Gait Index developed to improve reliability and decrease the ceiling effect.
  • Recent changes:
    1) 10-item test that comprises 7 of the 8 items from the original DGI
    2) Eliminated 1 item from original DGI, ambulation around obstacles
    3) Added 3 new items to the original DGI, including gait with narrow base of support, ambulating backwards, and gait with eyes closed
  • Each item is scored on an ordinal scale from 0 to 3, with
    0 = severe impairment
    1 = moderate impairment
    2 = mild impairment
    3 = normal ambulation
  • Highest score = 30
  • The assessment may be performed with or without an assistive device.
  • Individuals should walk without physical assistance of another person.
  • When administering walking items, do not walk in front of or directly beside the patient, as this "paces" the patient and can influence the speed they walk. Instead, walk at least a half step behind the patient.

Number of Items

10

Equipment Required

  • Stopwatch
  • Measuring device to mark off area
  • Marked walking area: Length = 20 feet (6 meters); width 12 inches (30.48 cm)
  • Obstacle of 9 inch height (22.86 cm) using at least 2 stacked shoe boxes
  • Set of steps that are 7.75 - 9 inch high with bilateral rails

Time to Administer

5-20 minutes

New Clinician: less than 20 minutes
Experienced Clinician: 5-10 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team in 2010; Updated with references from the SCI and PD populations by Tamara Alie, SPT and Stephanie Austin, SPT in 2011; Updated by Candy Tefertiller, PT, DPT, ATP, NCS, Jennifer Kahn, PT, DPT, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 2012; Updated with references for Stroke and PD populations by Marissa Gruber, SPT, Sally Stelsel, SPT, and Laura Vazquez, SPT in 2012; Updated by Cathy Harro PT, MS, NCS and the PD EDGE task force of the Neurology Section of APTA in 2013; Updated by Diane Wrisley, PT, PhD, NCS and Elizabeth Dannenbaum MScPT for Vestibular EDGE task force 2013; Updated by Kimberly Okechukwu, OTR/L, 2016.

ICF Domain

Activity

Measurement Domain

Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

(Vestibular > 6 weeks post)

SCI EDGE

LS

LS

NR

Vestibular EDGE

LS

 

HR

Recommendations Based on Parkinson Disease Hoehn and Yahr stage:

 

I

II

III

IV

V

PD EDGE

HR

HR

HR

HR

NR

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

UR

UR

UR

UR

UR

TBI EDGE

LS

LS

LS

LS

LS

Recommendations based on SCI AIS Classification:

 

AIS A/B

AIS C/D

SCI EDGE

LS

LS

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

LS

LS

NR

NR

Recommendations based on EDSS Classification: 

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

UR

UR

NR

NR

Recommendations based on vestibular diagnosis:

 

Peripheral

Central

Benign Paroxysmal Positional Vertigo (BPPV)

Other

Vestibular EDGE

HR

HR

LS

LS

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

MS EDGE

No

No

No

Yes

PD EDGE

Yes

Yes

Yes

Not reported

SCI EDGE

No

Yes

No

Not reported

TBI EDGE

Yes

Yes

Yes

Not reported

Vestibular EDGE

Yes

Yes

Yes

Yes

Considerations

  • Position of therapist did not make difference in interrater reliability (Wrisley et al., 2004).

  • Addressed the ceiling effect of the DGI in persons with vestibular dysfunction (Wrisley et al., 2004).

  • Medication adjustment after the FGA evaluation may have led to a different cutoff score for patients at risk of falling (Yang et al., 2014).

  • When considering the timing of the individual’s primary PD medication, Foreman et al. (2011) reported predictive validity was better during off timing than during on. Therefore, they recommended testing individuals with PD off medication to improve fall predictions (Petersen et al., 2016).

Stroke

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Standard Error of Measurement (SEM)

Stroke: (Lin, Hsu, Hsu Wu, & Hsieh, 2010; n = 45; mean age = 60.0 (12.6) years; median time since stroke = 9 months (range 3 to 36 months); tested while undergoing OP PT at 1 week, 2 months, and 5 months; Taiwanese sample, Stroke)

  • SEM = 1.52 (calculated from MDC - 4.2 points)

Minimal Detectable Change (MDC)

Stroke: (Lin et al., 2010) 

  • MDC = 4.2 points (clinically: 5 point change)

  • Percent change = 14.1%

Normative Data

Stroke: (Lin et al., 2010, Acute and Chronic Stroke)

 

1 week

N = 45

2 months

N = 39

Median score

13

12

Range: 1st to 3rd quartile

8 - 18

9 - 20

Test/Retest Reliability

Stroke: (Lin et al., 2010; n = 45; mean age = 54.9 (10.2) years, Acute and Chronic Stroke)

  • Excellent test-retest reliability (ICC = 0.95)

Interrater/Intrarater Reliability

Stroke: (Thieme, Ritschel, & Zange, 2009; n = 28; mean age 69.9 (9.5) years; max 6 months post CVA, Subacute Stroke, German version) 

  • Excellent interrater reliability (ICC = 0.94) (individual items Kendall's W = 0.77-0.96) 

  • Excellent intrarater reliability (ICC = 0.97) (individual items Kendall's W = 0.88-0.98)

Criterion Validity (Predictive/Concurrent)

Stroke:

(Lin et al., 2010, Acute and Chronic Stroke)

  • Excellent correlation with 10MWT and PASS (r = -0.66-0.83)

(Thieme et al., 2009; 6 months post CVA, Subacute Stroke)

  • Excellent correlation with Functional Ambulatory Category (r = 0.83), gait speed (r = 0.82), Berg Balance Scale (r = 0.93), Rivermead Mobility Index (r = 0.85) and Barthel Index (r = 0.71)

Construct Validity

Stroke: 

(Lin et al., 2010, Acute and Chronic Stroke)

  • Excellent convergent validity with 10MWT (r = -0.66, -0.85, -0.81) and PASS (r = 0.83, 0.75, 0.83) during 1st week of therapy, 2 months and 5 months after therapy 

(Thieme et al., 2009; n = 28; mean age 69.9 (9.5) years; max 6 months post CVA)

  • Excellent correlations between FGA and FAC (ρ = 0.83, p < 0.001)

  • Excellent correlations between FGA and Gait speed (ρ = 0.82, p < 0.001)

  • Excellent correlations between FGA and BBS (ρ = 0.93, p < 0.001)

  • Excellent correlations between FGA and RMI (ρ = 0.85, p < 0.001)

  • Excellent correlations between FGA and BI (ρ = 0.71, p < 0.001)

Floor/Ceiling Effects

Stroke:(Lin et al., 2010, Acute and Chronic Stroke)

  • Excellent floor and ceiling effects

Time Point

Floor Effect %

 Ceiling Effect %

1st week of  PT

2.0

0

2 months after PT

0

0

5 months after PT

0

5.7

Responsiveness

Stroke: (Lin et al., 2010, Acute and Chronic Stroke) 

  • FGA: Moderate responsiveness in detecting change at the 2 and 5 months of rehabilitation 

Periods of Follow-Up 

Effect Size d 

Wilcoxon Z 

2 months 

0.50 

3.0* 

5 months 

0.54 

2.8* 

*p < 0.01

Vestibular Disorders

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Minimal Detectable Change (MDC)

Vestibular Disorders: (Marchetti et al., 2014; n=326 patinets; mean age =60 (18.3); 69% female)

  • MDC95 = 6 points

Interrater/Intrarater Reliability

Vestibular Disorders: (Wrisley, Walker, Echternacht., & Stasnik, 2004; n = 6; mean (SD) ages 58.7 (12.4) years; 10 raters, 3 students, 7 experienced PTs)

  • Excellent interrater reliability (ICC = 0.84) (individual items k = 0.34-0.78) 

  • Excellent intrarater reliability (ICC = 0.83) (individual items k = 0.16-0.83)

Internal Consistency

Vestibular Disorders: (Wrisley et al., 2004, Vestibular Disorders)

  • Excellent internal consistency (Cronbach's alpha = 0.79)

Criterion Validity (Predictive/Concurrent)

Vestibular Disorders: (Wrisley et al., 2004)

  • Excellent concurrent validity: 

    • Perception Dizziness Symptoms (r = -0.70) 

    • Dizziness Handicap Inventory (r = -0.64) 

    • Activities-specific Balance Confidence Scale (r = 0.64) 

    • Number of falls in previous 4-weeks (r = -0.66) 

    • Dynamic Gait Index (r = 0.80) 

  • Adequate concurrent validity with Timed Up and Go Test (r = -0.50)

Older Adults and Geriatric Care

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Minimally Clinically Important Difference (MCID)

Community-Dwelling Older Adults: (Beninato, Fernandes, & Plummer, 2014; n = 135; mean age = 78.8 years)

  • 4 points from interim episode of care to the end episode of care

Cut-Off Scores

Community-Dwelling Older Adults: (Wrisley & Kumar, 2010; n = 35; aged 60 to 90)

  • Scores of ≤ 22/30 on the FGA were effective in predicting falls, Sensitivity 85%, Specificity 86%

  • Scores of ≤ 20/30 on the FGA were optimal to predict older adults residing in community dwellings who would sustain unexplained falls in the next 6 months, Sensitivity 100%, Specificity 76%

Community-Dwelling Older Adults: (Beninato et al., 2014; n = 135; mean age = 78.8 years)

  • Scores of ≤ 22/30 on the FGA were established as a fall risk, Sensitivity = 0.66 and Specificity = 0.84)

Test/Retest Reliability

Community Dwelling Adults with Parkinson’s Disease: (Leddy, Crowner, & Earhart, 2011; FGA and BEST; subset of subjects n = 24, MDS-UPDRS = 71 (21.9), disesase duration mean = 6.9 (3.38), 21% fallers) 

  • Excellent test-retest reliability administered by PT (ICC = 0.91; 95% CI = 0.80 - 0.96) 

  • Excellent test-retest reliability administered by student (ICC = 0.80; 95% CI = 0.58 - 0.91)

Interrater/Intrarater Reliability

Community-Dwelling Adults: (Walker et al., 2007; aged 40-89) 

  • Excellent interrater reliability (ICC = 0.93; p < 0.001)

 

Criterion Validity (Predictive/Concurrent)

Community Dwelling Older Adults with Parkinson’s Disease: (Wrisley et al., 2010; aged 60-90 years) 

  • Excellent concurrent validity and statistical significance with: 

    • Berg Balance Scale (r = 0.84, p < 0.001)

    • Timed Up and Go Test (r = 0.84, p < 0.000)

  • Adequate concurrent validity and statistical significant with: 

    • Activities-specific Balance Confidence Scale (r = 0.53, p < 0.001) 

  • Predictive Validity: FGA correctly identified 6/7 unexplained falls in the 6 months following testing

Construct Validity

Older Adults: (Wrisley & Kumar, 2010; n = 35; aged 60 to 90) 

  • FGA correctly classified fall risk based on the DGI 93% of the time (DGI ≤ 19/24) 

    • Individuals scoring ≤ 22 on FGA are 4.5 times more likely to fall based on the DGI 

  • FGA correctly classified fall risk based on the TUG 87% of the time (TUG: ≥ 11 seconds) 

    • Individuals scoring ≤ 22 on FGA are 6 times more likely classified as a fall risk based on TUG

Parkinson's Disease

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Minimal Detectable Change (MDC)

Parkinson’s Disease: (Petersen, Steffen, Paly, Dvorak, & Nelson, 2016; FGA, STS Tests; n = 22)

  • MDC = 4 points

Cut-Off Scores

Parkinson’s Disease: (Leddy et al., 2011; n = 80; mean disease duration = 6.9 years (3.38), Parkinson's Disease)

  • Scores of 15/30 on the FGA indicate predictive ability to clinically identify fallers in Parkinson’s patients when sensitivity and specificity was maximized

Parkinson’s Disease: (Yang et al., 2014; n = 121, inpatients)

  • Scores of ≤ 18/30 on FGA identifies a fall risk, Sensitivity = 80.6%, and Specificity = 80.0%

Test/Retest Reliability

Community Dwelling Adults with Parkinson’s Disease: 

(Leddy et al., 2011; FGA and BEST; subset of subjects n = 24, MDS-UPDRS = 71 (21.9), disesase duration mean = 6.9 (3.38), 21% fallers) 

  • Excellent test-retest reliability administered by PT (ICC = 0.91; 95% CI = 0.80 - 0.96) 

  • Excellent test-retest reliability administered by student (ICC = 0.80; 95% CI = 0.58 - 0.91)

Parkinson’s Disease: 

(Yang et al., 2016; FGA; n = 121 inpatients; aged 41-79; raters: 2 physical therapists)

  • Excellent: Inter-rater reliability (ICC = 0.99); 95% CI = 0.99–1.00). (single items k = 0.49 to 0.98) (items 3 k = 0.49, items 4 k = 0.60, other items were substantial or almost perfect

  • Excellent: intrarater reliability (ICC = 0.99; 95% CI = 0.99–1.00). (single items, k = 0.91 (item 4) to 0.99 (items 6–10). Intrarater reliability for all items was almost perfect

(Petersen et al., 2016; FGA, STS Tests; n = 22)

  • Excellent test-retest reliability administered by 18 PT students (ICC = 0.86)

Interrater/Intrarater Reliability

Community Dwelling Adults with Parkinson’s Disease: (Leddy et al., 2011; n =15 people with PD; mean disease duration = 6.8 (3.26) years; MDS-UPDRS mean score = 74.2 (18.6); H&Y scale stage 1 = 2, stage 2 = 7, stage 2.5 = 3, stage 3 = 2, and stage 4 = 1) 

  • Excellent interrater reliability (ICC = 0.93; 95% CI = 0.84 - 0.98

Internal Consistency

Parkinson’s Disease: (Yang et al., 2016; FGA; n = 121 inpatients; aged 41-79)

  • Excellent internal consistency (Cronbach's alpha = 0.94)

Criterion Validity (Predictive/Concurrent)

Parkinson’s Disease: (Yang et al., 2014; n = 121, inpatients)

  • Concurrent validity: Moderate to strong correlation for FGA compared with BBS, FAC, TUG, ABC, MDS-UPDRS-3, BI, fast walking speed, and modified Hoehn and Yahr scale (r = .57-.85, p < .001)

  • Predictive validity: the cutoff point for predicting falls with the FGA was 18.

Parkinson’s Disease: (Ellis et al., 2011; n = 263 with idiopathic PD; mean age = 67.7 (9.2); mean duration of PD = 6.22 (4.8) years, H& Y stages (1-16, 1.5 = 4, 2 = 113, 2.5 - 62, 3 = 52, 4 = 15); mean FGA score for cohort = 20.5 (6.4))

  • Excellent concurrent validity between FGA scores and the following: Berg Balance Scale (r = 0.77), PDQ-39 mobility subsection (r = -0.66), postural instability gait disorder score (r = -0.68)

  • Adequate concurrent validity between FGA scores and the following: PDQ_39 total score (r = -0.57), age (r = -0.44), bradykinesia composite score (r = -0.55), freezing of gait score (r = -0.54), functional reach (r = 0.52), 9 hole peg test (r = -0.52)

  • FGA scores were significant contributor to PDQ-39 motor score in stepwise regression analysis (R^2 change = 0.06, p < 0.001)

Construct Validity

Parkinson’s Disease: (Duncan et al., 2012; 6-month prospective group n = 51; mean age = 67.5 (8.8) years; mean duration of PD = 7.7 (3.9) years, mean UPDRS-motor score = 39.3 (13.3), mean H&Y stage = 2.4 (0.6); 12-month prospective group n = 40; mean age = 67.3 (9.5), mean duration of PD = 7.2 (4.1); mean UPDRS-motor score = 37.8 (13.1;, mean H&Y stage = 2.3 (0.6))

  • Adequate predictive validity of FGA to identify fall risk with cutoff score < 15/30 is as follows:

    • 6-month prospective falls (AUC = 0.80 (95% CI, 0.62-0.90), Sensitivity = 0.64, specificity = 0.81, +LR = 3.37 (CI, 2.19-5.18), -LR = 0.44 (CI, 0.34-0.59), Posttest probability with test < cutoff value = 0.56, with test score > cut off value = 0.15

    • 12 month prospective falls {AUC = 0.70 (95% CI, 0.50-0.83), sensitivity = 0.46, specificity = 0.81, +LR = 2.42 (CI, 1.53-3.82), -LR = 0.67 (CI, (0.54-0.82), Post test probability with test < cutoff value = 0.54, with test score > cutoff value= 0.24

    • FGA was inferior to BESTest in predictive validity and AUC (6- and 12-months)

(Foreman et al., 2011a; n = 36 persons with PD who were ambulatory but clinical signs of gait hypokinesia; Grouped as, Fallers = 22 & non-fallers = 14; Fallers characteristics {14 male/8 female, mean age = 70.95 (11.4), mean duration of PD = 8.18 (4.58) mean UPDRS motor score on/off medications = 17.0 (8.07)/27.29 (7.96), mean H&Y stage = 2.5/3 range 1.5 - 4} Non-fallers characteristics {10 male/4 female, mean age 66.64 (10.05), mean duration PD 4.64 (3.25), mean UPDRS-motor score on/off meds = 11.57 (6.43) / 25.36(9.9), mean H&Y score 2.25/2.5 range 1.5 - 3) 

  • FGA scores were significantly different on vs. off medications (on meds 18.77 (8.38), off meds 13.67 (6.93), p < 0.006. Effect size = 0.47

  • FGA has better predictive validity for identifying fallers when scored “off meds” as compared to “on meds” {Adequate responsiveness AUC = 0.81 (0.66-0.95) on meds; 0.89 (0.78 - 0.99) off meds. FGA scores were better at predicting fallers than TUG or pull test both on and off meds

(Foreman et al., 2011b; n = 15, 9 male/6 female, mean age 67 (13) years, mean duration of PD = 7.5 (5.0) years, mean H&Y stage = 2.5 (range 2 - 4) on meds, mean UPDRS-motor on meds = 13.7 (6.8) and off meds mean H&Y stage 3.0 (2.5 - 4) and mean UPDRS-motor = 27.6 (7.0), 8 fallers)

  • Significantly higher FGA scores on meds = 23.67 (4.59) 95% CI 21.1-26.21 as compared to off meds = 18.8 (4.8), 95% CI 16.4-21.46, p < 0.008 

(Leddy et al., 2011; community dwelling adults with PD)

  • Scores < 15/30 identified subjects with a history of falling (Sensitivity 0.72, Specificity 0.78, AUC 0.80)

(Yang et al., 2014; n = 121, inpatients)

  • Good construct validity: One common factor (functional gait status) was extracted for construct validity, which cumulatively explained 64.0% of the total variance

Responsiveness

Parkinson’s Disease:

(Duncan et al., 2012; n = 51; mean age for fallers in 6 months = 67.5 (8.8); disease duration: 7.7 (3.9) years; mean Hoehn & Yahr score = 2.4 (0.6)(range 1-4); also assessed at 12 months: n = 40; mean age for fallers at 12 months = 67.3 (9.5); disease duration: 7.2 (4.1) years; mean H & Y score = 2.3 (0.6), Parkinson’s Disease)

  • At 6 months: 

    • AUC = 0.80

    • Sensitivity = 64%

    • Specificity = 81%

  • At 12 months:

    • AUC = 0.70

    • Sensitivity = 46%

    • Specificity = 81% 

(Foreman, Addison, Kim, & Dibble, 2011; n = 36; mean age of fallers = 70.95(11.41) years and of non-fallers = 66.64(10.05) years, Parkinson’s Disease) 

  • ROC curve (Sensitivity vs. 1-Specificity)

    • AUC = 0.8052 (subjects on meds) 

    • AUC = 0.8861 (subjects off meds) 

(Foreman et al., 2011)

  • Moderate effect size in response to measure mobility functions on vs. off PD meds (ES = 0.47)

(Foreman et al., 2012)

  • Effect of dopamine replacement meds, large effect size on total FGA score = 1.07. FGA items that were more reponsive to dopamine replacement (effect size > 0.7) were gait on level surface, change in gait speed, gait with vertical head turns, gait with narrow base. FGA items that were less responsive were walk with head turns, pivot turn, walk with eyes closed and steps.

Non-Specific Patient Population

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Normative Data

Community-Dwelling Adults: (Walker et al., 2007; n = 200; aged 40 to 89; unimpaired adults)

Age

n

Min score

Max score

Mean

SD

95% CI

40-49 

27 

24 

30 

28.9 

1.5 

28.3-29.5 

50-59

33 

25 

30 

28.4 

1.6 

27.9-29.0 

60-69

63 

20 

30 

27.1 

2.3 

26.5-27.7 

70-79

44 

16 

30 

24.9 

3.6 

23.9-26.0 

80-89

33 

10 

28 

20.8 

4.7 

19.2-22.6 

Total

200 

10 

30 

26.1 

4.0 

25.5-26.6 

  • Mean total FGA scores demonstrate an overall decrease with increased age.

  • Increased variability in scores noted with each decade increase in age (increased SDs).

Bibliography

Beninato, M., Fernandes, A., Plummer, L. S. (2014).” Minimal Clinically Important Difference of the Functional Gait Assessment in Older Adults”. Physical Therapy 94 :11 1594- 1603

Duncan, R. P., Leddy, A. L., et al. (2012). "Accuracy of fall prediction in Parkinson disease: six-month and 12-month prospective analyses." Parkinsons Dis 2012: 237673. 

Ellis, T., Cavanaugh, J. T., et al. (2011). "Which measures of physical function and motor impairment best predict quality of life in Parkinson's disease?" Parkinsonism Relat Disord 17(9): 693-697. 

Foreman, K. B., Addison, O., et al. (2011). "Testing balance and fall risk in persons with Parkinson disease, an argument for ecologically valid testing." Parkinsonism Relat Disord 17(3): 166-171. 

Foreman, K. B., Wisted, C., et al. (2012). "Improved Dynamic Postural Task Performance without Improvements in Postural Responses: The Blessing and the Curse of Dopamine Replacement." Parkinsons Dis 2012: 692150. 

Leddy, A. L., Crowner, B. E., et al. (2011). "Functional gait assessment and balance evaluation system test: reliability, validity, sensitivity, and specificity for identifying individuals with Parkinson disease who fall." Phys Ther 91(1): 102-113. 

Lin, J. H., Hsu, M. J., et al. (2010). "Psychometric comparisons of 3 functional ambulation measures for patients with stroke." Stroke 41(9): 2021-2025. 

Marchetti, G. F., Lin, C., Alghadir, A., Whitney, S. L. (2014). "Responsiveness and minimal detectable change of the Dynamic Gait Index and Functional Gait Index in persons with balance and vestibular disorders." Journal of Neurologic Physical Therapy, 38; 119-124.

Petersen, C. C., Steffen, T., Paly, E., Dvorak, L., Nelson, R. (2016) “Reliability and Minimal Detectable Change for Sit-to-Stand Tests and the Functional Gait Assessment for Individuals With Parkinson Disease”. Journal of geriatric physical therapy. 00:1-4.

Thieme, H., Ritschel, C., et al. (2009). "Reliability and validity of the functional gait assessment (German version) in subacute stroke patients." Arch Phys Med Rehabil 90(9): 1565-1570. 

Walker, M., Austin, A., et al. (2007). "Reference group data for the functional gait assessment." Physical Therapy 87(11): 1468. 

Wrisley, D. M. and Kumar, N. A. (2010). "Functional gait assessment: concurrent, discriminative, and predictive validity in community-dwelling older adults." Physical Therapy 90(5): 761-773. 

Wrisley, D. M., Marchetti, G. F., et al. (2004). "Reliability, internal consistency, and validity of data obtained with the functional gait assessment." Physical Therapy 84(10): 906-918. 

Wrisley, D. M., Walker, M. L., et al. (2003). "Reliability of the dynamic gait index in people with vestibular disorders." Arch Phys Med Rehabil 84(10): 1528-1533. 

Yang, Y. Y., Wang, Y., Zhou, Y. Chen C., Xing D., Chunxue Wang (2014) Validity of the Functional Gait Assessment in patients with Parkinson disease: construct, concurrent, and predictive validity. Physical therapy. 94: 3 392-400.

Yang Y., Wang Y., Zhou Y., Chen C., Xing D. (2016). “Reliability of functional gait assessment in patients with Parkinson disease: Interrater and intrarater reliability and internal consistency”. Medicine. 95(34): e4545.

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We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.

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