Dynamic Gait Index (DGI) vs Functional Gait Assessment (FGA): Scoring & Fall Risk
In short
The Dynamic Gait Index (DGI) and Functional Gait Assessment (FGA) evaluate dynamic balance during complex walking tasks. Learn scoring, cut-off values and clinical differences.
In this guide (5 sections)
Introduction: Assessing Dynamic Balance During Locomotion
While static balance tests like the Romberg or Single Leg Stance evaluate stationary postural sway, most real-world falls occur while walking, turning or altering gaze.
The Dynamic Gait Index (DGI), designed by Anne Shumway-Cook in 1997, assesses an individual ability to modify gait in response to complex task demands. The Functional Gait Assessment (FGA), developed by Wrisley et al. in 2004, modified the DGI to eliminate ceiling effects in vestibular and neurological patients.
DGI vs FGA: Task Comparison and Scoring Rules
The DGI comprises 8 walking tasks scored on a 4-point ordinal scale from 0 (severe impairment) to 3 (normal). The maximum score is 24 points.
The FGA retains 7 DGI tasks, modifies 1 task (ambulation with narrow base of support replaces ambulation around obstacles), and adds 3 challenging new tasks: gait with eyes closed, walking backwards, and narrow base tandem walking. Maximum score is 30 points.
| Task Description | Included in DGI (0-3) | Included in FGA (0-3) | Clinical Balance Domain | |
|---|---|---|---|---|
| Gait on level surface (20 feet / 6m) | Yes | Yes | Steady-state locomotor control | |
| Change in gait speed (normal to fast to slow) | Yes | Yes | Adaptive motor acceleration / braking | |
| Gait with horizontal head turns | Yes | Yes | Vestibulo-ocular reflex (VOR) during walking | |
| Gait with vertical head turns (up and down) | Yes | Yes | Vertical canal stimulation during walking | |
| Gait and pivot turn (quick stop & 180 deg turn) | Yes | Yes | Axial rotation and post-turn stabilization | |
| Step over obstacles (2 shoe boxes) | Yes | Yes | Obstacle clearance and limb elevation | |
| Step around obstacles | Yes | No (removed in FGA) | Navigational steering control | |
| Steps / stairs (up and down with rails) | Yes | Yes | Eccentric and concentric staircase control | |
| Gait with narrow base of support (tandem) | No | Yes (added in FGA) | Dynamic tandem balance / mediolateral stability | |
| Gait with eyes closed | No | Yes (added in FGA) | Somatosensory & vestibular reliance | |
| Ambulating backwards | No | Yes (added in FGA) | Non-visual retro-walking motor control |
Cut-Off Scores and Fall Risk Stratification
Validated cut-off thresholds allow physiotherapists to immediately identify patients at high risk of falling in community and domestic environments.
- DGI Fall Risk Cut-Off: A score of 19 or less out of 24 indicates high fall risk in community-dwelling older adults (sensitivity 59%, specificity 64%). In Parkinson disease, <=19 indicates a fall risk.
- FGA Fall Risk Cut-Off: A score of 22 or less out of 30 predicts falls in community-dwelling older adults (sensitivity 100%, specificity 76%). In stroke survivors, <=15/30 indicates high risk.
- Vestibular disorders: Patients with unilateral vestibular hypofunction typically show the greatest score drops on horizontal and vertical head turn tasks.
Indian Household Environmental Obstacles
Indian homes frequently have threshold dividers (chaukhat) between rooms and bathrooms, uneven terrazzo or tiled floors, and narrow stairwells lacking continuous handrails.
The obstacle crossing and pivot turn items directly test an elder capacity to negotiate these architectural features safely without tripping.
Frequently Asked Questions
When should a therapist choose FGA over DGI?
Choose the FGA for higher-functioning older adults, vestibular disorders, or early-stage Parkinson disease where the DGI shows a ceiling effect. The FGA includes tandem walking, eyes-closed walking and retro-walking, which uncover subtle balance deficits.
Can assistive devices like walking sticks be used?
Yes. Note the device on the score sheet. Using a walking aid automatically limits the score on several items to 2 (mild impairment) according to scoring criteria.
What is the MCID for the Functional Gait Assessment?
The MCID for the FGA is 4 points in stroke patients and 8 points in community-dwelling older adults.
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