Advertisement

Observational Gait Assessments in People With Neurological Disorders: A Systematic Review

Published:August 05, 2015DOI:https://doi.org/10.1016/j.apmr.2015.07.018

      Abstract

      Objective

      To analyze the clinical and psychometric properties of observational gait assessment scales in people with neurological disorders.

      Data Sources

      The databases used for the literature search were MEDLINE, the Cochrane Central Register of Controlled Trial, Web of Science, and the Cumulative Index to Nursing and Allied Health. The search was conducted between September 15 and November 30, 2014.

      Study Selection

      Studies that investigate and validate observational gait assessment scales in people with central nervous system disorders.

      Data Extraction

      General characteristics of the studies, including number of patients and observational gait assessment scales analyzed and their psychometric properties, were extracted.

      Data Synthesis

      After the literature search, 15 articles were included in this review. Seven of the 15 articles studied the Tinetti Gait Scale (TGS), 2 studied the Rivermead Visual Gait Assessment (RVGA), 1 studied the Gait Assessment and Intervention Tool (G.A.I.T.), 3 studied the Wisconsin Gait Scale, and one of them compared the TGS and the G.A.I.T.

      Conclusions

      The scale that appears to be the most suitable for both clinical practice and research is the G.A.I.T. because it has shown to be valid, reliable, and sensitive to change, homogeneous, and comprehensive, containing a large number of items that assess most components of the gait pattern. The RVGA was studied in those with diverse neurological disorders, including multiple sclerosis. For those with Parkinson disease, the TGS showed sensitivity and the Tinetti Performance-Oriented Mobility Assessment (POMA) showed predictive capability for falls and mortality as well as intra- and interrater reliability. The Tinetti POMA was also studied in those with normal pressure hydrocephalus, showing sensitivity and in those with Huntington disease, showing reliability and validity. More research is needed to more comprehensively analyze the psychometric properties of the RVGA, Wisconsin Gait Scale, TGS, and G.A.I.T. in patients with diverse neurological disorders, other than stroke.

      Keywords

      List of abbreviations:

      G.A.I.T. (Gait Assessment and Intervention Tool), HGAF (Hemiplegic Gait Analysis Form), ICC (intraclass correlation coefficient), POMA (Performance-Oriented Mobility Assessment), RVGA (Rivermead Visual Gait Assessment), TGS (Tinetti Gait Scale), UPDRS (Unified Parkinson's Disease Rating Scale), WGS (Wisconsin Gait Scale)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Pike J.
        • Jones E.
        • Rajagopalan K.
        • Piercy J.
        • Anderson P.
        Social and economic burden of walking and mobility problems in multiple sclerosis.
        BMC Neurol. 2012; 12: 94
        • Pundik S.
        • Holcomb J.
        • McCabe J.
        • Daly J.J.
        Enhanced life-role participation in response to comprehensive gait training in chronic-stroke survivors.
        Disabil Rehabil. 2012; 34: 1535-1539
        • Tan D.
        • Danoudis M.
        • McGinley J.
        • Morris M.E.
        Relationships between motor aspects of gait impairments and activity limitations in people with Parkinson’s disease: a systematic review.
        Parkinsonism Relat Disord. 2012; 18: 117-124
        • Larocca N.G.
        Impact of walking impairment in multiple sclerosis: perspectives of patients and care partners.
        Patient. 2011; 4: 189-201
        • Morris M.E.
        • Huxham F.
        • McGinley J.
        • Dodd K.
        • Iansek R.
        The biomechanics and motor control of gait in Parkinson disease.
        Clin Biomech (Bristol, Avon). 2001; 16: 459-470
        • Esquenazi A.
        Evaluation and management of spastic gait in patients with traumatic brain injury.
        J Head Trauma Rehabil. 2004; 19: 109-118
        • Balaban B.
        • Tok F.
        Gait disturbances in patients with stroke.
        PM R. 2014; 6: 635-642
        • Crenshaw S.J.
        • Royer T.D.
        • Richards J.G.
        • Hudson D.J.
        Gait variability in people with multiple sclerosis.
        Mult Scler. 2006; 12: 613-619
        • Schmid S.
        • Schweizer K.
        • Romkes J.
        • Lorenzetti S.
        • Brunner R.
        Secondary gait deviations in patients with and without neurological involvement: a systematic review.
        Gait Posture. 2013; 37: 480-493
        • Gronley J.K.
        • Perry J.
        Gait analysis techniques: Rancho Los Amigos Hospital gait laboratory.
        Phys Ther. 1984; 64: 1831-1838
        • Bethoux F.
        • Bennett S.
        Evaluating walking in patients with multiple sclerosis: which assessment tools are useful in clinical practice?.
        Int J MS Care. 2011; 13: 4-14
        • Van Bloemendaal M.
        • van de Water A.T.
        • van de Port I.G.
        Walking tests for stroke survivors: a systematic review of their measurement properties.
        Disabil Rehabil. 2012; 34: 2207-2221
        • Coutts F.
        Gait analysis in the therapeutic environment.
        Man Ther. 1999; 4: 2-10
        • Krebs D.E.
        • Edelstein J.E.
        • Fishman S.
        Reliability of observational kinematic gait analysis.
        Phys Ther. 1985; 65: 1027-1033
        • Eastlack M.E.
        • Arvidson J.
        • Snyder-Mackler L.
        • Danoff J.V.
        • McGarvey C.L.
        Interrater reliability of videotaped observational gait-analysis assessments.
        Phys Ther. 1991; 71: 465-472
      1. Task Force on Standards for Measurement in Physical Therapy. Standards for tests and measurements in physical therapy practice.
        Phys Ther. 1991; 71: 589-622
        • Fermanian J.
        Validation of assessment scales in physical medicine and rehabilitation: how are psychometric properties determined? [French].
        Ann Readapt Med Phys. 2005; 48: 281-287
        • Toro B.
        • Nester C.
        • Farren P.
        A review of observational gait assessment in clinical practice.
        Physiother Theory Pract. 2003; 19: 137-149
        • Ferrarello F.
        • Bianchi V.A.
        • Baccini M.
        • et al.
        Tools for observational gait analysis in patients with stroke: a systematic review.
        Phys Ther. 2013; 93: 1673-1685
        • Salter K.
        • Jutai J.W.
        • Teasell R.
        • Foley N.C.
        • Bitensky J.
        • Bayley M.
        Issues for selection of outcome measures in stroke rehabilitation: ICF activity.
        Disabil Rehabil. 2005; 27: 315-340
        • Portney L.G.
        • Watkins M.P.
        Foundations of clinical research: applications to practice.
        Appleton and Lange, Norwalk1993: 442
        • Sivan M.
        • O’Connor R.J.
        • Makower S.
        • Levesley M.
        • Bhakta B.
        Systematic review of outcome measures used in the evaluation of robot-assisted upper limb exercise in stroke.
        J Rehabil Med. 2011; 43: 181-189
      2. Ball C, Sackett D, Phillips B, Haynes B, Straus S. Levels of evidence and grades of recommendations. Available at: http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Accessed April 20, 2015.

        • Lord S.E.
        • Halligan P.W.
        • Wade D.T.
        Visual gait analysis: the development of a clinical assessment and scale.
        Clin Rehabil. 1998; 12: 107-119
        • Lord S.E.
        • Wade D.T.
        • Halligan P.W.
        A comparison of two physiotherapy treatment approaches to improve walking in multiple sclerosis: a pilot randomized controlled study.
        Clin Rehabil. 1998; 12: 477-486
        • Daly J.J.
        • Nethery J.
        • McCabe J.P.
        • et al.
        Development and testing of the Gait Assessment and Intervention Tool (G.A.I.T.): a measure of coordinated gait components.
        Neurosci Methods. 2009; 178: 334-339
        • Zimbelman J.
        • Daly J.J.
        • Roenigk K.L.
        • Butler K.
        • Burdsall R.
        • Holcomb J.P.
        Capability of 2 gait measures for detecting response to gait training in stroke survivors: Gait Assessment and Intervention Tool and the Tinetti Gait Scale.
        Arch Phys Med Rehabil. 2012; 93: 129-136
        • Rodriquez A.A.
        • Black P.O.
        • Kile K.A.
        • et al.
        Gait training efficacy using a home-based practice model in chronic hemiplegia.
        Arch Phys Med Rehabil. 1996; 77: 801-805
        • Turani N.
        • Kemiksizoğlu A.
        • Karataş M.
        • Ozker R.
        Assessment of hemiplegic gait using the Wisconsin Gait Scale.
        Scand J Caring Sci. 2004; 18: 103-108
        • Pizzi A.
        • Carlucci G.
        • Falsini C.
        • Lunghi F.
        • Verdesca S.
        • Grippo A.
        Gait in hemiplegia: evaluation of clinical features with the Wisconsin Gait Scale.
        J Rehabil Med. 2007; 39: 170-174
        • Yaliman A.
        • Kesiktas N.
        • Ozkaya M.
        • Eskiyurt N.
        • Erkan O.
        • Yilmaz E.
        Evaluation of intrarater and interrater reliability of the Wisconsin Gait Scale with using the videotaped stroke patients in a Turkish sample.
        NeuroRehabilitation. 2014; 34: 253-258
        • Tinetti M.E.
        Performance-oriented assessment of mobility problems in elderly patients.
        J Am Geriatr Soc. 1986; 34: 119-126
        • Behrman A.L.
        • Light K.E.
        • Miller G.M.
        Sensitivity of the Tinetti Gait Assessment for detecting change in individuals with Parkinson’s disease.
        Clin Rehabil. 2002; 16: 399-405
        • Morita Y.
        • Osaki Y.
        • Doi Y.
        Factors associated with falling in patients with Parkinson’s disease and atypical parkinsonism: an assessment using the Tinetti Gait and Balance Scale.
        Geriatr Gerontol Int. 2006; 6: 234-243
        • Kegelmeyer D.A.
        • Kloos A.D.
        • Thomas K.M.
        • Kostyk S.K.
        Reliability and validity of the Tinetti Mobility Test for individuals with Parkinson disease.
        Phys Ther. 2007; 87: 1369-1378
        • Gray W.K.
        • Hildreth A.
        • Bilclough J.A.
        • Wood B.H.
        • Baker K.
        • Walker R.H.
        Physical assessment as a predictor of mortality in people with Parkinson’s disease: a study over 7 years.
        Mov Disord. 2009; 24: 1934-1940
        • Feick D.
        • Sickmond J.
        • Liu L.
        • et al.
        Sensitivity and predictive value of occupational and physical therapy assessments in the functional evaluation of patients with suspected normal pressure hydrocephalus.
        Rehabil Med. 2008; 40: 715-720
        • Kloos A.D.
        • Kegelmeyer D.A.
        • Young G.S.
        • Kostyk S.K.
        Fall risk assessment using the Tinetti mobility test in individuals with Huntington’s disease.
        Mov Disord. 2010; 25: 2838-2844
        • Canbek J.
        • Fulk G.
        • Nof L.
        • Echternach J.
        Test-retest reliability and construct validity of the Tinetti Performance-Oriented Mobility Assessment in people with stroke.
        J Neurol Phys Ther. 2013; 37: 14-19
        • Vandenberg J.M.
        • George D.R.
        • O’Leary A.J.
        • Olson L.C.
        • Strassburg K.R.
        • Hollman J.H.
        The modified gait abnormality rating scale in patients with a conversion disorder: a reliability and responsiveness study.
        Gait Posture. 2015; 41: 125-129
        • Hale L.
        • McIlraith L.
        • Miller C.
        • Stanley-Clarke T.
        • George R.
        The interrater reliability of the modified Gait Abnormality Rating Scale for use with people with intellectual disability.
        J Intellect Dev Disabil. 2010; 35: 77-81
        • VanSwearingen J.M.
        • Paschal K.A.
        • Bonino P.
        • Chen T.W.
        Assessing recurrent fall risk of community-dwelling, frail older veterans using specific tests of mobility and the physical performance test of function.
        J Gerontol A Biol Sci Med Sci. 1998; 53: 457-464
        • VanSwearingen J.M.
        • Paschal K.A.
        • Bonino P.
        • Yang J.F.
        The modified Gait Abnormality Rating Scale for recognizing the risk of recurrent falls in community-dwelling elderly adults.
        Phys Ther. 1996; 76: 994-1002
        • Wolfson L.
        • Whipple R.
        • Amerman P.
        • Tobin J.N.
        Gait assessment in the elderly: a gait abnormality rating scale and its relation to falls.
        J Gerontol. 1990; 45: 12-19
        • Seymour C.J.
        • Dybel G.J.
        The effectiveness of three teaching methods for gait analysis using the Rancho Los Amigos Gait Analysis Checklist.
        J Phys Ther Educ. 1998; 12: 3-9
        • Busse M.
        • Quinn L.
        • Khalil H.
        • McEwan K.J.
        Optimising mobility outcome measures in Huntington’s disease.
        J Huntingtons Dis. 2014; 3: 175-188
        • Senden R.
        • Savelberg H.H.
        • Grimm B.
        • Heyligers I.C.
        • Meijer K.
        Accelerometry-based gait analysis, an additional objective approach to screen subjects at risk for falling.
        Gait Posture. 2012; 36: 296-300
        • Kerr G.K.
        • Worringham C.J.
        • Cole M.H.
        • Lacherez P.F.
        • Wood J.M.
        • Silburn P.A.
        Predictors of future falls in Parkinson disease.
        Neurology. 2010; 75: 116-124
        • Macgilchrist C.
        • Paul L.
        • Ellis B.M.
        • Howe T.E.
        • Kennon B.
        • Godwin J.
        Lower-limb risk factors for falls in people with diabetes mellitus.
        Diabet Med. 2010; 27: 162-168
        • Sterke C.S.
        • Huisman S.L.
        • van Beeck E.F.
        • Looman C.W.
        • van der Cammen T.J.
        Is the Tinetti Performance Oriented Mobility Assessment (POMA) a feasible and valid predictor of short-term fall risk in nursing home residents with dementia?.
        Int Psychogeriatr. 2010; 22: 254-263
        • Chiba Y.
        • Simada A.
        • Yoshida F.
        • et al.
        Risk of fall for individuals with intellectual disability.
        Am J Intellect Dev Disabil. 2009; 114: 225-236
        • Pieper B.
        • Templin T.N.
        • Birk T.J.
        • Kirsner R.S.
        Chronic venous disorders and injection drug use: impact on balance, gait, and walk speed.
        J Wound Ostomy Continence Nurs. 2008; 35: 301-310
        • Siegel A.B.
        • Lachs M.
        • Coleman M.
        • Leonard J.P.
        Lymphoma in elderly patients: novel functional assessment techniques provide better discrimination among patients than traditional performance status measures.
        Clin Lymphoma Myeloma. 2006; 7: 65-69
        • Montero-Odasso M.
        • Schapira M.
        • Duque G.
        • Soriano E.R.
        • Kaplan R.
        • Camera L.A.
        Gait disorders are associated with non-cardiovascular falls in elderly people: a preliminary study.
        BMC Geriatr. 2005; 5: 15
        • Shore W.S.
        • deLateur B.J.
        • Kuhlemeier K.V.
        • Imteyaz H.
        • Rose G.
        • Williams M.A.
        A comparison of gait assessment methods: Tinetti and GAITRite electronic walkway.
        J Am Geriatr Soc. 2005; 53: 2044-2045
        • Chu L.W.
        • Chi I.
        • Chiu A.Y.
        Incidence and predictors of falls in the Chinese elderly.
        Ann Acad Med Singapore. 2005; 34: 60-72
        • Reuben D.B.
        • Siu A.L.
        • Kimpau S.
        The predictive validity of self-report and performance-based measures of function and health.
        J Gerontol. 1992; 47: M106-M110
        • Formiga F.
        • Ferrer A.
        • Chivite D.
        • Montero A.
        • Sanz H.
        • Pujol R.
        Utility of geriatric assessment to predict mortality in the oldest old: the Octabaix study 3-year follow-up.
        Rejuvenation Res. 2013; 16: 279-284
        • Gai J.
        • Gomes L.
        • Nóbrega Ode T.
        • Rodrigues M.P.
        Factors related to falls of elderly women residents in a community.
        Rev Assoc Med Bras. 2010; 56: 327-332
        • Thapa P.B.
        • Gideon P.
        • Brockman K.G.
        • Fought R.L.
        • Ray W.A.
        Clinical and biomechanical measures of balance as fall predictors in ambulatory nursing home residents.
        J Gerontol A Biol Sci Med Sci. 1996; 51: 239-246
        • McGinty S.M.
        • Masters L.D.
        • Till D.B.
        Inter-tester reliability using the Tinetti gait and balance assessment scale.
        Issues Aging. 1999; 22: 3-5