CDE Detailed Report

Disease: content
Sub-Domain: Functional Outcomes
CRF: welcome

Displaying 1 - 24 of 24
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (Question Text) Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C54450 Functional Gait Assessment (FGA) - Gait head turn horizontal task score FGAGaitHeadTurnHrzntTskScore Score for the subject/participant's performance on the Gait with Horizontal Head Turns task, as part of the Functional Gait Assessment (FGA) Score for the subject/participant's performance on the Gait with Horizontal Head Turns task, as part of the Functional Gait Assessment (FGA) FGA: 3;2;1;0 Normal: Performs head turns smoothly with no change in gait. Deviates no more than 6 in outside 12-in walkway width.;Mild impairment: Performs head turns smoothly with slight change in gait velocity (e.g., minor disruption to smooth gait path), deviates 6-10 in outside 12-in walkway width, or uses an assistive device.;Moderate impairment: Performs head turns with moderate change in gait velocity, slows down, deviates 10-15 in outside 12-in walkway width but recovers, can continue to walk.;Severe impairment: Performs task with severe disruption of gait i.e., staggers 15 in outside the 12-in walkway width, loses balance, stops, or reaches for wall. Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Walk from here to the next mark 20 ft away, in a straight path marked by the lines. When I tell you look right, turn your head right and keep walking straight, when I tell you look left, turn your head left and keep walking straight.' Have subject turn head every 3 steps. ** Perform FGA instructions first. If they score a 3, go onto Gait with Vertical Head turns. If they score less than 3, perform again with the DGI instructions (i.e. omit last sentence about the head turn every 3 steps).

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 16:25:05.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54461 Functional Gait Assessment (FGA) - Gait task eye closed duration FGAGaitTskEyeClosedDur Time taken by the subject/particpant to complete the Gait With Eyes Closed task, as part of the Functional Gait Assessment (FGA) Time taken by the subject/particpant to complete the Gait With Eyes Closed task, as part of the Functional Gait Assessment (FGA) Time: Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Walk at your normal speed from here to the next mark [20 ft] with your eyes closed.'

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 17:34:28.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Free-Form Entry

Seconds
C54451 Dynamic Gait Index (DGI) - Gait head turn horizontal task score DGIGaitHeadTurnHrzntTskScore Score for the subject/participant's performance on the Gait with Horizontal Head Turns task, as part of the Dynamic Gait Index (DGI) Score for the subject/participant's performance on the Gait with Horizontal Head Turns task, as part of the Dynamic Gait Index (DGI) DGI: 3;2;1;0 Normal: Performs head turns smoothly with no change in gait.;Mild impairment: Performs head turns smoothly with slight change in gait velocity (e.g., minor disruption to smooth gait path), or uses an assistive device.;Moderate impairment: Performs head turns with moderate change in gait velocity, slows down, staggers but recovers, can continue to walk.;Severe impairment: Performs task with severe disruption of gait i.e., staggers outside 15 in path, loses balance, stops, or reaches for wall. Numeric Values

ctions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Walk from here to the next mark 20 ft away, in a straight path marked by the lines. When I tell you look right, turn your head right and keep walking straight, when I tell you look left, turn your head left and keep walking straight.'

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 16:25:05.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54462 Functional Gait Assessment (FGA) - Gait task support base narrow step count FGAGaitTskSpprtBasNrrwStpCt Count of steps taken by the subject/participant in performing the Gait With Narrow Base of Support task, as part of the Functional Gait Assessment (FGA) Count of steps taken by the subject/participant in performing the Gait With Narrow Base of Support task, as part of the Functional Gait Assessment (FGA) # steps: Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Walk on the floor with arms folded across the chest, feet aligned heel to toe in tandem.' The number of steps taken in a straight line is counted for a maximum of 10 steps.

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 17:29:03.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Free-Form Entry

0 10 Steps
C54452 Functional Gait Assessment (FGA) - Gait head turn vertical task score FGAGaitHeadTurnVrtclTskScore Score for the subject/participant's performance on the Gait With Vertical Head Turns task, as part of the Functional Gait Assessment (FGA) Score for the subject/participant's performance on the Gait With Vertical Head Turns task, as part of the Functional Gait Assessment (FGA) FGA: 3;2;1;0 Normal: Performs head turns with no change in gait. Deviates no more than 6 in outside 12-in walkway width.;Mild impairment: Performs task with slight change in gait velocity (e.g., minor disruption to smooth gait path), deviates 6–10 in outside 12-in walkway width or uses assistive device.;Moderate impairment: Performs task with moderate change in gait velocity, slows down, deviates 10–15 in outside 12-in walkway width but recovers, can continue to walk.;Severe impairment: Performs task with severe disruption of gait (e.g., staggers 15 in outside 12-in walkway width, loses balance, stops, reaches for wall). Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Walk from here to the next mark 20 ft away, in a straight path marked by the lines. When I tell you look up, tip your head up and keep walking straight, when I tell you look down, tip your head down and keep walking straight. Have subject turn head every 3 steps.' ** Perform FGA instructions first. If they score a 3, go onto Gait and Pivot Turn. If they score less than 3, perform again with the DGI instructions (i.e. omit last sentence about the head turn every 3 steps).

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 16:39:33.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54463 Functional Gait Assessment (FGA) - Gait task ambulate backward score FGAGaitTskAmbltBckwdScore Score for the subject/participant's performance on the Ambulating Backwards task, as part of the Functional Gait Assessment (FGA) Score for the subject/participant's performance on the Ambulating Backwards task, as part of the Functional Gait Assessment (FGA) FGA: 1;0;2;3 Moderate impairment—Walks 20 ft, slow speed, abnor?mal gait pattern, evidence for imbalance, deviates 10–15 in outside 12-in walkway width.;Severe impairment—Cannot walk 20 ft without assistance, severe gait deviations or imbalance, deviates greater than 15 in outside 12-in walkway width or will not attempt task.;Mild impairment—Walks 20 ft, uses assistive device, slower speed, mild gait deviations, deviates 6–10 in outside 12-in walkway width.;Normal: Walks 20 ft, no assistive devices, good speed, no evidence for imbalance, normal gait pattern, deviates no more than 6 in outside 12-in walkway width. Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Walk backwards until I tell you to stop.'

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 17:44:38.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54453 Dynamic Gait Index (DGI) - Gait head turn vertical task score DGIGaitHeadTurnVrtclTskScore Score for the subject/participant's performance on the Gait With Vertical Head Turns task, as part of the Dynamic Gait Index (DGI) Score for the subject/participant's performance on the Gait With Vertical Head Turns task, as part of the Dynamic Gait Index (DGI) DGI: 3;2;1;0 Normal: Performs head turns smoothly with no change in gait.;Mild impairment: Performs head turns smoothly with slight change in gait velocity (e.g., minor disruption to smooth gait path), or uses an assistive device.;Moderate impairment: Performs head turns with moderate change in gait velocity, slows down, staggers but recovers, can continue to walk.;Severe impairment: Performs task with severe disruption of gait i.e., staggers outside 15 in path, loses balance, stops, or reaches for wall. Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Walk from here to the next mark 20 ft away, in a straight path marked by the lines. When I tell you look up, tip your head up and keep walking straight, when I tell you look down, tip your head down and keep walking straight.'

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 16:39:33.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54464 Functional Gait Assessment (FGA) - Gait task ambulate backward duration FGAGaitTskAmbltBckwdDur Time take for the subject/participant to complete the Ambulating Backwards task, as part of the Functional Gait Assessment (FGA) Time take for the subject/participant to complete the Ambulating Backwards task, as part of the Functional Gait Assessment (FGA) Time: Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Walk backwards until I tell you to stop.'

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 17:44:38.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Free-Form Entry

Seconds
C54454 Functional Gait Assessment (FGA) - Gait turn pivot task score FGAGaitTurnPivotTaskScore Score for the subject/participant's performance on the Gait And Pivot Turn task, as part of the Functional Gait Assessment (FGA) Score for the subject/participant's performance on the Gait And Pivot Turn task, as part of the Functional Gait Assessment (FGA) FGA: 3;1;0;2 Normal: Pivot turns safely within 3 seconds and stops quickly with no loss of balance.;Moderate impairment: Turns slowly, requires verbal cueing, or requires several small steps to catch balance following turn and stop.;Severe impairment: Cannot turn safely, requires assistance to turn and stop.;Mild impairment: Pivot turns safely in >3 seconds and stops with no loss of balance, or pivot turns safely within 3 seconds and stops with mild imbalance, requires small steps to catch balance. Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Begin with walking at your normal pace. When I tell you, 'turn and stop,' turn as quickly as you can to face the opposite direction and stop.'

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 16:51:44.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54465 Functional Gait Assessment (FGA) - Gait task stair score FGAGaitTskStairScore Score for the subject/participant's performance walking up stairs for the Steps task, as part of the Functional Gait Assessment (FGA) Score for the subject/participant's performance walking up stairs for the Steps task, as part of the Functional Gait Assessment (FGA) FGA: 3;2;1;0 Normal: Alternating feet, no rail.;Mild impairment: Alternating feet, must use rail.;Moderate impairment: Two feet to a stair, must use rail.;Severe impairment: Cannot do safely. Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Walk up these stairs as you would at home (i.e., using the rail if necessary). At the top turn around and walk down.'

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 17:52:09.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54455 Dynamic Gait Index (DGI) - Gait turn pivot task score DGIGaitTurnPivotTaskScore Score for the subject/participant's performance on the Gait And Pivot Turn task, as part of the Dynamic Gait Index (DGI) Score for the subject/participant's performance on the Gait And Pivot Turn task, as part of the Dynamic Gait Index (DGI) DGI: 3;2;1;0 Normal: Pivot turns safely within 3 seconds and stops quickly with no loss of balance.;Mild impairment: Pivot turns safely in >3 seconds and stops with no loss of balance.;Moderate impairment: Turns slowly, requires verbal cueing, or requires several small steps to catch balance following turn and stop.;Severe impairment: Cannot turn safely, requires assistance to turn and stop. Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Begin with walking at your normal pace. When I tell you, 'turn and stop,' turn as quickly as you can to face the opposite direction and stop.'

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 16:51:44.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54466 Dynamic Gait Index (DGI) - Gait task stair score DGIGaitTskStairScore Score for the subject/participant's performance walking up stairs for the Steps task, as part of the Dynamic Gait Index (DGI) Score for the subject/participant's performance walking up stairs for the Steps task, as part of the Dynamic Gait Index (DGI) DGI: 3;2;1;0 Normal: Alternating feet, no rail.;Mild impairment: Alternating feet, must use rail.;Moderate impairment: Two feet to a stair, must use rail.;Severe impairment: Cannot do safely. Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Walk up these stairs as you would at home (i.e., using the rail if necessary). At the top turn around and walk down.'

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 17:52:09.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54445 Functional Gait Assessment (FGA) - Gait level surface task score FGAGailLevlSrfcTskScore Score for the level-surface gait task, as part of the Functional Gait Assessment (FGA) Score for the level-surface gait test, as part of the Functional Gait Assessment (FGA) FGA: 0;1;2;3 Severe impairment: Cannot walk 20 ft without assistance, severe gait deviations or imbalance, deviates greater than 15 in ouside of the 12-in walkway width or reaches and touches the wall.;Moderate impairment: Walks 20 ft, slow speed, abnormal gait pattern, evidence for impalance, or deviates 10-15 in outside of the 12-in walkway. Requires more than 7 seconds to ambulate 20 ft.;Mild impairment: Walks 20 ft in less than 7 seconds but greater than 5.5 seconds, uses assistive device, slower speed, mild gait deviations, or deviates 6-10 in outside of the 12-in walkway width.;Normal: Walks 20 ft in less than 5.5 seconds, no assistive devices, good speed, no evidence for imbalance, normal gait pattern, deviates no more than 6 in outside of the 12-in walkway. Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Walk from here to the wall at your normal speed.'

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 15:44:54.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54456 Functional Gait Assessment (FGA) - Step over obstacle task score FGAStepOverObstclScore Score for the subject/participant's performance on the Step Over Obstacles task, as part of the Functional Gait Assessment (FGA) Score for the subject/participant's performance on the Step Over Obstacles task, as part of the Functional Gait Assessment (FGA) FGA: 3;2;1;0 Normal: Is able to step over 2 stacked shoe boxes taped together (9 in total height) without changing gait speed throughout entire path, no evidence of imbalance.;Mild impairment: Is able to step over one shoe box (4.5 in total height) without changing gait speed, no evidence of imbalance.;Moderate impairment: Is able to step over one shoe box (4.5 in total height) but must slow down and adjust steps to clear box safely. May require verbal cueing.;Severe impairment: Cannot perform without assistance. Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Begin walking at your normal speed. When you come to the shoe box, step over it, not around it, and keep walking.'

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 17:00:30.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54467 Functional Gait Assessment (FGA) - Total score FGATotalScore Total score for the subject/participant's performance on all tasks, as part of the Functional Gait Assessment (FGA) Total score for the subject/participant's performance on all tasks, as part of the Functional Gait Assessment (FGA) FGA Total Score: __/30 Numeric Values Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 18:00:21.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Free-Form Entry

0 30
C54446 Dynamic Gait Index (DGI) - Gait level surface task score DGIGailLevlSrfcTskScore Score for the level-surface gait task, as part of the Dynamic Gait Index (DGI) Score for the level-surface gait task, as part of the Dynamic Gait Index (DGI) DGI: 3;2;1;0 Normal: walks 20 ft, no assistive devices, good speed, no evidence for imbalance, normal gait pattern.;Mild impairment: Walks 20 ft, uses assistive device, slower speed, mild gait deviations.;Moderate impairment: Walks 20 ft, slow speed, abnormal gait pattern, evidence for imbalance.;Severe impairment: Cannot walk 20 ft without assistance, severe gait deviations or imbalance. Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Walk from here to the wall at your normal speed.' ** Use FGA score to determine scores based on time.

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 15:44:54.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54457 Dynamic Gait Index (DGI) - Step over obstacle task score DGIStepOverObstclScore Score for the subject/participant's performance on the Step Over Obstacles task, as part of the Dynamic Gait Index (DGI) Score for the subject/participant's performance on the Step Over Obstacles task, as part of the Dynamic Gait Index (DGI) DGI: 3;2;1;0 Normal: Is able to step over box without changing gait speed, no evidence of imbalance.;Mild impairment: Is able to step over box but must slow down and adjust steps to clear box safely.;Moderate impairment: Is able to step over box but must stop, then step over. May require verbal cueing.;Severe impairment: Cannot perform without assistance. Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Begin walking at your normal speed. When you come to the shoe box, step over it, not around it, and keep walking.'

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 17:00:30.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54468 Dynamic Gait Index (DGI) - Total score DGITotalScore Total score for the subject/participant's performance on all tasks, as part of the Dynamic Gait Index (DGI) Total score for the subject/participant's performance on all tasks, as part of the Dynamic Gait Index (DGI) DGI Total Score: __/24 Numeric Values Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 18:00:21.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Free-Form Entry

0 24
C54447 Functional Gait Assessment (FGA) - Gait level surface task duration FGAGailLevlSrfcTskDur Time taken by the subject/participant to ambulate 20 feet for the level-surface gait task, as part of the Functional Gait Assessment (FGA) Time taken by the subject/participant to ambulate 20 feet for the level-surface gait task, as part of the Functional Gait Assessment (FGA) Time: Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Walk from here to the wall at your normal speed' (time for 20')

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 15:44:54.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Free-Form Entry

0 Seconds
C54458 Dynamic Gait Index (DGI) - Step around obstacle task score DGIStepAroundObstclScore Score for the subject/participant's performance on the Step Around Obstacles task, as part of the Dynamic Gait Index (DGI) Score for the subject/participant's performance on the Step Around Obstacles task, as part of the Dynamic Gait Index (DGI) DGI: 3;2;1;0 Normal: Is able to walk around cones safely without changing gait speed, no evidence of imbalance.;Mild impairment: Is able to step around both cones, but must slow down and adjust steps to clear cones.;Moderate impairment: Is able to clear cones but must significantly slow speed to accomplish task or requires verbal cueing.;Severe impairment: Cannot perform without assistance. Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Begin walking at your normal speed. When you come to the first cone walk around the right side, when you come to the second cone walk around it to the left.'

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 17:00:30.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54448 Functional Gait Assessment (FGA) - Gait speed change task score FGAGaitSpedChangTskScore Score for the change in gait speed task, as part of the Functional Gait Assessment (FGA) Score for the change in gait speed task, as part of the Functional Gait Assessment (FGA) FGA: 3;2;1;0 Normal: Able to smoothly change walking speed without loss of balance or gait deviation. Shows a significant difference in walking speeds between normal, fast, and slow speeds. Deviates no more than 6 in outside of the 12-in walkway width.;Mild impairment: Is able to change speed but demonstrates mild gait deviations, deviates 6-10 in outside of the 12-in walkway width, or no gait deviations but unable to achieve a significant change in velocity, or uses an assistive device.;Moderate impairment: Makes only minor adjustments to walking speed, or accomplishes a change in speed with significant gait deviations, deviates 10-15 in outside the 12-in walkway width, or changes speed but loses balance but is able to recover and continue walking.;Severe impairment: Cannot change speeds, deviates greater than 15 in outside the 12-in walkway width, or loses balance and has to reach for wall or be caught. Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Begin walking at your normal pace [5 ft]. When I tell you 'go,' walk as fast as you can [5 ft]. When I tell you 'slow,' walk as slowly as you can [5 ft].'

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 15:44:54.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54459 Functional Gait Assessment (FGA) - Gait task support base narrow score FGAGaitTskSpprtBasNrrwScore Score for the subject/participant's performance on the Gait With Narrow Base of Support task, as part of the Functional Gait Assessment (FGA) Score for the subject/participant's performance on the Gait With Narrow Base of Support task, as part of the Functional Gait Assessment (FGA) FGA: 3;2;1;0 Normal: Is able to ambulate for 10 steps heel to toe with no staggering.;Mild impairment: Ambulates 7–9 steps.;Moderate impairment: Ambulates 4–7 steps.;Severe impairment: Ambulates less than 4 steps heel to toe or cannot perform without assistance. Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Walk on the floor with arms folded across the chest, feet aligned heel to toe in tandem.' The number of steps taken in a straight line is counted for a maximum of 10 steps.

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 17:29:03.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54449 Dynamic Gait Index (DGI) - Gait speed change task score DGIGaitSpedChangTskScore Score for the change in gait speed task, as part of the Dynamic Gait Index (DGI) Score for the change in gait speed task, as part of the Dynamic Gait Index (DGI) DGI: 3;2;1;0 Normal: Able to smoothly change walking speed without loss of balance or gait deviation. Shows a significant difference in walking speeds between normal, fast, and slow speeds.;Mild impairment: Is able to change speed but demonstrates mild gait deviations, or no gait deviations but unable to achieve a significant change in velocity, or uses an assistive device.;Moderate impairment: Makes only minor adjustments to walking speed, or accomplishes a change in speed with significant gait deviations, or changes speed but loses balance but is able to recover and continue walking.;Severe impairment: Cannot change speeds, or loses balance and has to reach for wall or be caught. Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria).'Begin walking at your normal pace [5 ft]. When I tell you 'go,' walk as fast as you can [5 ft]. When I tell you 'slow,' walk as slowly as you can [5 ft].'

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 15:44:54.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C54460 Functional Gait Assessment (FGA) - Gait task eye closed score FGAGaitTskEyeClosedScore Score for the subject/particpant's performance on the Gait With Eyes Closed task, as part of the Functional Gait Assessment (FGA) Score for the subject/particpant's performance on the Gait With Eyes Closed task, as part of the Functional Gait Assessment (FGA) FGA: 3;2;1;0 Normal: Walks 20 ft, no assistive devices, good speed, no evidence of imbalance, normal gait pattern, deviates no more than 6 in outside 12-in walkway width. Ambulates 20 ft in less than 7 seconds.;Mild impairment: Walks 20 ft, uses assistive device, slower speed, mild gait deviations, deviates 6–10 in outside 12-in walkway width. Ambulates 20 ft in less than 9 seconds but greater than 7 seconds.;Moderate impairment: Walks 20 ft, slow speed, abnor?mal gait pattern, evidence for imbalance, deviates 10–15 in outside 12-in walkway width. Requires more than 9 seconds to ambulate 20 ft.;Severe impairment: Cannot walk 20 ft without assistance, severe gait deviations or imbalance, deviates greater than 15 in outside 12-in walkway width or will not attempt task. Numeric Values

General Instructions to subject: 'I want you to give your best effort as you perform these walking tasks.' Repeat the task if the subjects was interrupted or acted goofy. No high heels, flip flops and open back shoes. For ambulating tasks, instruct them NOT to run. Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria). 'Walk at your normal speed from here to the next mark [20 ft] with your eyes closed.'

Shumway-cook A, Woolacott MH. Control of posture and balance. In: Shumway-Cook A, Woolacott MH. Motor Control Theory and Practical Applications. Maryland: Williams & Wilkins; 1995: 12 Adult;Pediatric Supplemental 1.00 2017-03-10 17:34:28.0 Dynamic Gait Index (DGI) Functional Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

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