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The Functional Gait Assessment evaluates dynamic balance during complex walking tasks, predicting fall risk with ≤22/30 cutoff score across neurological populations.
Research demonstrates that mean FGA scores range from 29/30 for adults in their 40s to 21/30 for adults in their 80s, highlighting the assessment's sensitivity to age-related changes in gait performance. The American Physical Therapy Association (APTA) recognizes the Functional Gait Assessment as a highly recommended tool for evaluating postural stability during various walking tasks in neurological populations. An FGA score of ≤22/30 provides both discriminative and predictive validity, with 100% sensitivity, 72% specificity, and a positive likelihood ratio of 3.6 for predicting prospective falls. This assessment serves as a cornerstone for fall risk identification and treatment planning in physical therapy practice.
The Functional Gait Assessment transcends basic mobility evaluation by examining dynamic balance control during complex walking tasks. The FGA is a modification of the Dynamic Gait Index (DGI) that uses higher-level tasks to increase the applicability of the test to people with vestibular disorders and to eliminate the ceiling effect of the original test. This comprehensive tool addresses the clinical need for sensitive gait assessment that can detect subtle balance impairments often missed by traditional measures.
The FGA's clinical significance lies in its ability to predict fall risk across multiple neurological conditions. Excellent correlations exist between FGA and other validated measures including Functional Ambulatory Category (r = 0.83), gait speed (r = 0.82), Berg Balance Scale (r = 0.93), and Rivermead Mobility Index (r = 0.85). These strong correlations validate the FGA as an integral component of comprehensive mobility assessment while offering unique insights into dynamic balance control.
The Functional Gait Assessment employs a standardized 10-item protocol that evaluates progressively challenging gait tasks. Each item is scored on an ordinal scale from 0 to 3, with 0 = severe impairment, 1 = moderate impairment, 2 = mild impairment, and 3 = normal ambulation. The maximum possible score is 30 points, with higher scores indicating better functional gait performance.
Equipment Requirements:
Testing Environment:The assessment requires a safe, well-lit space with adequate room for turning and maneuvering. The assessment may be performed with or without an assistive device, allowing for realistic evaluation of each patient's typical ambulation pattern.
Item 1: Gait Level SurfaceInstruct: "Walk at your normal speed from here to the next mark." Normal performance involves walking 6m in less than 5.5 seconds with no aids, good speed, and no evidence of imbalance.
Item 2: Change in Gait SpeedBegin walking at normal pace for 1.5m, then "go" (fast) for 1.5m, then "slow" for 1.5m. Normal performance shows smooth speed changes without loss of balance, with significant differences between speeds.
Item 3: Gait with Horizontal Head TurnsWalk straight while turning head right after 3 steps, then left, then center. Maintain straight walking path throughout.
Items 4-10: Continue through remaining tasks including vertical head turns, pivot turns, stepping over obstacles, narrow base walking, eyes closed ambulation, backwards walking, and stair climbing.
Each item receives a score of 0-3 based on standardized criteria. Severe impairment (0) typically involves inability to complete the task or significant safety concerns, while normal performance (3) demonstrates smooth, controlled movement without deviations.
The FGA score directly informs clinical decision-making and treatment planning. An FGA score of ≤22/30 is effective in classifying fall risk in older adults and predicting unexplained falls in community-dwelling populations. This cutoff score provides clinicians with a clear threshold for identifying patients requiring intensive balance interventions.
Treatment Documentation Applications:
Population-Specific Considerations:EDGE documents highly recommend FGA use in patients with Parkinson disease (except Hoehn and Yahr Stage V), vestibular disorders, and indicate reasonable use in stroke, traumatic brain injury, and other neurological conditions. Different cutoff scores may apply to specific populations, with Parkinson disease showing adequate predictive validity with cutoff score < 15/30.
Several factors can influence FGA performance and interpretation. Medication timing significantly impacts results, particularly in Parkinson disease where testing during "off" medication periods improves fall prediction accuracy. Cognitive status, fear of falling, and environmental factors may also affect performance.
Ceiling Effect Limitations:While the FGA was designed to reduce ceiling effects compared to the Dynamic Gait Index, healthy individuals, especially younger populations, tend to reach the upper limit of the test. This limitation should be considered when selecting assessment tools for high-functioning individuals.
Reliability Considerations:Excellent interrater reliability (ICC = 0.94) and intrarater reliability (ICC = 0.97) have been demonstrated, supporting consistent scoring across different evaluators and time points.
The Functional Gait Assessment represents a sophisticated, evidence-based tool for evaluating dynamic balance and gait performance across diverse clinical populations. By incorporating challenging, real-world mobility tasks, the FGA provides clinicians with sensitive, reliable data for fall risk assessment and treatment planning. Its strong psychometric properties, combined with established cutoff scores and population-specific guidelines, make it an indispensable component of comprehensive neurological rehabilitation assessment.
Q1. What is the cutoff score for fall risk on the FGA?
An FGA score of ≤22/30 is effective in classifying fall risk in community-dwelling older adults, providing 100% sensitivity and 72% specificity for predicting prospective falls.
Q2. How does the FGA differ from the Dynamic Gait Index?
The FGA is a 10-item modification of the 8-item Dynamic Gait Index, comprising 7 original DGI items plus 3 new items (narrow base walking, backwards ambulation, and eyes closed gait) to reduce ceiling effects and improve reliability.
Q3. Which patient populations benefit most from FGA assessment?
EDGE documents highly recommend FGA for patients with Parkinson disease, vestibular disorders, and indicate reasonable use in stroke, traumatic brain injury, and other neurological conditions requiring dynamic balance assessment.
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