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BACKGROUND: Gait speed is often used to estimate the walking ability in daily life in people after stroke. While measuring gait with inertial measurement units (IMUs) during clinical assessment yields additional information, it remains unclear if this information can improve the estimation of the walking ability in daily life beyond gait speed. OBJECTIVE: We evaluated the additive value of IMU-based gait features over a simple gait-speed measurement in the estimation of walking ability in people after stroke. METHODS: Longitudinal data during clinical stroke rehabilitation were collected. The assessment consisted of two parts and was administered every three weeks. In the first part, participants walked for two minutes (2MWT) on a fourteen-meter path with three IMUs attached to low back and feet, from which multiple gait features, including gait speed, were calculated. The dimensionality of the corresponding gait features was reduced with a principal component analysis. In the second part, gait was measured for two consecutive days using one ankle-mounted IMU. Next, three measures of walking ability in daily life were calculated, including the number of steps per day, and the average and maximal gait speed. A gait-speed-only Linear Mixed Model was used to estimate the association between gait speed and each of the three measures of walking ability. Next, the principal components (PC), derived from the 2MWT, were added to the gait-speed-only model to evaluate if they were confounders or effect modifiers. RESULTS: Eighty-one participants were measured during rehabilitation, resulting in 198 2MWTs and 135 corresponding walking-performance measurements. 106 Gait features were reduced to nine PCs with 85.1% explained variance. The linear mixed models demonstrated that gait speed was weakly associated with the average and maximum gait speed in daily life and moderately associated with the number of steps per day. The PCs did not considerably improve the outcomes in comparison to the gait speed only models. CONCLUSIONS: Gait in people after stroke assessed in a clinical setting with IMUs differs from their walking ability in daily life. More research is needed to determine whether these discrepancies also occur in non-laboratory settings, and to identify additional non-gait factors that influence walking ability in daily life.

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BACKGROUND: A number of assessments exist that evaluate function in ambulatory adults. However, these assessments take for granted the cognitive abilities required for the participant to understand what is being asked of them in order to demonstrate their functional abilities. It has been shown that individuals with Down syndrome (DS) demonstrate lower functional levels when asked to perform additional tasks while walking. Therefore, measurements of function may not be reflective of actual function if the assessment requires additional tasks in those with DS. It is for these reasons the current investigation sought to evaluate four common functional assessments, two with [modified Berg balance test (mBERG) and Functional Gait Assessment (FGA)] and two without [Timed Up and Go (TUG) and Established Populations for Epidemiologic Study in the Elderly (EPESE)] complex tasks. METHODS: Adults with DS (n = 19) completed four functional assessments, which were later compared using bivariate Pearson correlation coefficients. RESULTS: There were large associations between simple assessments (TUG-EPESE: r = -0.525, P = 0.021) and complex assessments (FGA-mBERG: r = 0.612, P = 0.005), respectively. The TUG also inversely correlated with the FGA (r = -0.476, P = 0.039), and the EPESE had a large association with mBERG (r = 0.508, P = 0.027). CONCLUSIONS: The mBERG may be the best test to replicate real-world scenarios through its tasks, although it may also be confounded by the cognitive load required to perform the movements as asked. The TUG and EPESE may be more appropriate as mobility assessments because they require very little cognitive attention when completing the tasks. True assessments of mobility ought to err on the side of simple so to not confuse the outcomes with executive functionality.

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[This corrects the article DOI: 10.3389/fneur.2022.846429.].

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Background: Although the tap test for patients with suspected idiopathic normal pressure hydrocephalus (iNPH) is still often performed as part of the preoperative evaluation, it is true that some studies have reported the limitations of the tap test, claiming that it does not provide the additional information for appropriate patient selection for surgery. We aimed to determine whether a better method of pre- and post-tap test assessment could lead to appropriate patient selection for shunting. Methods: We performed the tap test as part of the preoperative evaluation in all 40 patients who underwent lumboperitoneal shunt surgery for iNPH from April 2021 to September 2021. We retrospectively analyzed the patient data. We examined whether a comprehensive evaluation of the effect of the tap test using the Functional Gait Assessment (FGA) and Global Rating of Change (GRC) scales would identify a wider range of patients who would benefit from shunt surgery than the 3-m Timed Up and Go test (TUG) alone. Results: Assuming a prevalence of 1% for iNPH, the TUG had a sensitivity of 0.23, specificity of 0.71, positive likelihood ratio of 0.79, and negative likelihood ratio of 1.09. When improvement in either the FGA or the GRC was used as a criterion for the validity of the tap test, the sensitivity was 0.88, specificity was 0.17, positive likelihood ratio was 1.06, and negative likelihood ratio was 0.71. Conclusion: Improvement in either the FGA or the GRC is a more sensitive criterion for the effectiveness of the tap test for the gait aspect than the TUG. Since the negative likelihood ratio is lower than that for the TUG alone, it is more appropriate to exclude patients with neither FGA nor GRC improvement from surgical indications than to exclude surgical indications based on a negative TUG.

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BACKGROUND: Vestibular Rehabilitation Therapists (VRT) utilize outcome measures to quantify gait and balance abilities in individuals with vestibular disorders (IVD). The minimal clinically important difference (MCID) in gait and balance outcome measures for IVD is unknown. OBJECTIVE: The purpose of this study is to estimate the MCID of the Activities-specific Balance Confidence Scale (ABC), Functional Gait Assessment (FGA), and Gait Speed (GS) using distribution and anchor-based methods relative to the Dizziness Handicap Inventory (DHI) in IVD. METHODS: Data were collected using a retrospective chart review from two outpatient Vestibular Rehabilitation (VR) clinics. Data included demographic characteristics, diagnosis, VR course, and pre and post outcome measures including DHI, ABC, FGA, and GS. The DHI was used to classify subjects as "responders" or "non-responders" in order to calculate MCID values. RESULTS: The total number of subjects analyzed for each outcome measure was 222 for the ABC, 220 for FGA, and 237 for GS. Subjects made statistically significant improvements in ABC, DHI, FGA, and GS (p < 0.001) from pre to post VR. The MCID calculated for ABC, FGA, and GS using the anchor-based approach was 18.1%, 4 points, and 0.09 m/s respectively. The MCIDs calculated using distribution-based approach for the ABC ranged between 7.5-23.5%, FGA ranged between 1.31-4.15 points, and GS ranged between 0.07 m/s-0.22 m/s. CONCLUSIONS: The anchor-based calculations of the MCID of 18.1%, 4 points, and 0.09 m/s for ABC, FGA, and GS respectively for IVD should be used over distribution-based calculations. This is due to strength of DHI as the anchor and statistical analysis. VRT and researches can use these values to indicate meaningful changes in gait and balance function in IVD.

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BACKGROUND: Gait is often impaired in people after stroke, restricting personal independence and affecting quality of life. During stroke rehabilitation, walking capacity is conventionally assessed by measuring walking distance and speed. Gait features, such as asymmetry and variability, are not routinely determined, but may provide more specific insights into the patient's walking capacity. Inertial measurement units offer a feasible and promising tool to determine these gait features. OBJECTIVE: We examined the test-retest reliability of inertial measurement units-based gait features measured in a two-minute walking assessment in people after stroke and while in clinical rehabilitation. METHOD: Thirty-one people after stroke performed two assessments with a test-retest interval of 24 h. Each assessment consisted of a two-minute walking test on a 14-m walking path. Participants were equipped with three inertial measurement units, placed at both feet and at the low back. In total, 166 gait features were calculated for each assessment, consisting of spatio-temporal (56), frequency (26), complexity (63), and asymmetry (14) features. The reliability was determined using the intraclass correlation coefficient. Additionally, the minimal detectable change and the relative minimal detectable change were computed. RESULTS: Overall, 107 gait features had good-excellent reliability, consisting of 50 spatio-temporal, 8 frequency, 36 complexity, and 13 symmetry features. The relative minimal detectable change of these features ranged between 0.5 and 1.5 standard deviations. CONCLUSION: Gait can reliably be assessed in people after stroke in clinical stroke rehabilitation using three inertial measurement units.

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BACKGROUND: The Functional Gait Assessment (FGA) evaluates postural stability in gait and predicts fall risk in older adults. Individual tasks within the FGA consider aspects of mobility assumed to require strength and/or balance to complete. Identifying how quantitative measures of strength and balance relate to FGA performance would allow for more targeted interventions based on one's pattern of performance on different tasks. RESEARCH QUESTION: Is performance on the FGA (total score and individual task scores) related to measures of strength and balance in healthy older adults? METHODS: In a cross-sectional study, healthy older adults (N = 46) were evaluated with the FGA, measures of knee extensor strength, and balance (static stance and weight shifting) (N = 46). Correlational analyses were performed between FGA scores (total and individual) and measures of strength and balance. RESULTS: Total FGA performance was positively correlated with knee extensor strength (maximum torque and rate of torque development). Individual FGA tasks of walking backwards (task 9) and stair climbing (task 10) had the highest correlations with strength measures. Total FGA performance was correlated with reduced postural sway in static balance tasks, but not with balance performance on the weight shifting tasks. The individual FGA task that challenged proprioceptive (task 7) inputs for balance was associated with static balance. SIGNIFICANCE: The total FGA score is related to domains of strength and static balance. The results indicate that the FGA can be influenced by reduced strength and balance. The pattern of performance on individual FGA tasks may indicate whether reduced postural stability in gait is related to deficits in strength or balance domains in this older population.

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BACKGROUND: Surgical treatment of vestibular schwannoma (VS) leads to acute ipsilateral vestibular loss if there is residual vestibular function before surgery. To overcome the sequelae of acute ipsilateral vestibular loss and to decrease postoperative recovery time, the concept of preemptive vestibular ablation with gentamicin and vestibular prehabilitation before surgery has been developed ("vestibular prehab"). OBJECTIVE: Studying postural stability during walking and handicap of dizziness over a 1-year follow-up period in VS patients undergoing vestibular prehab before surgical treatment of VS. METHODS: A retrospective review of consecutive patients with a diagnosis of a VS undergoing surgical therapy from June 2012 to March 2018 was performed. All patients were included with documentation of the length of hospital duration and the Dizziness Handicap Inventory (DHI) and the Functional Gait Assessment (FGA) assessed preoperatively as well as 6 weeks and 1 year postoperatively. RESULTS: A total 68 VS patients were included, of which 29 patients received preoperative vestibular ablation by intratympanic injection of gentamicin. Mean VS diameter was 20.2 mm (SD 9.4 mm) and mean age at surgery was 49.6 years (SD 11.5 years). Vestibular prehab had no effect on DHI and FGA at any time point studied. CONCLUSIONS: We found no effect of vestibular prehab on postural stability during walking and on the handicap of dizziness. These findings add to the body of knowledge consisting of conflicting results of vestibular prehab. Therefore, vestibular prehab should be applied only in selected cases in an experimental setting.

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OBJECTIVES: Obesity is a significant global health concern that involves motor impairment, including deficits in gait and balance. A simple tool would be useful to capture gait and balance impairment in obesity. We assessed whether the Functional Gait Assessment (FGA) captures impairment in individuals with obese BMI (≥30 kg/m2) and whether impairment was related to spatiotemporal gait parameters. METHODS: Fourteen individuals with obese BMI and twenty individuals of normal weight underwent the FGA. Spatiotemporal gait parameters were collected while participants walked on a pressure sensitive walkway under five conditions: pre-baseline (flat ground walking), crossing small, medium, and high obstacles, and final-baseline (flat ground walking). RESULTS: Individuals with obesity had lower scores on the FGA (p≤0.001) and showed less efficient spatiotemporal gait parameters than healthy controls, particularly when crossing over obstacles (all ps≤0.05). For participants with obesity, lower FGA scores were associated with decreased gait velocity, but only during obstacle crossing (p≤0.05). CONCLUSIONS: The FGA may be a useful tool to capture gait impairment in populations with obesity. Obstacles may help reveal meaningful gait impairments. To our knowledge, this is the first study to examine the FGA in individuals with obesity, and represents a proof-of-concept that motivates further validation studies.

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Oculomotor deficits, vestibular impairments, and persistent symptoms are common after a mild traumatic brain injury (mTBI); however, the relationship between visual-vestibular deficits, symptom severity, and dynamic mobility tasks is unclear. Twenty-three individuals (mean age 55.7 ± 9.3 years) with persistent symptoms after mTBI, who were between 3 months to 2 years post-injury were compared with 23 age and sex-matched controls. Oculomotor deficits [depth perception, near-point convergence, baseline visual acuity (BLVA), perception time], vestibular deficits (dynamic visual acuity in the pitch and yaw planes), dynamic mobility measured by the Functional Gait Assessment (FGA), and symptoms measured by the Post-Concussion Symptom Scale (PCSS) and Dizziness Handicap Inventory (DHI) were compared between groups. Participants with mTBI had poorer performance on the FGA (p < 0.001), higher symptom severity on the PCSS (p < 0.001), and higher DHI scores (p < 0.001) compared to controls. Significant differences were seen on specific items of the FGA between individuals with mTBI and controls during walking with horizontal head turns (p = 0.002), walking with vertical head tilts (p < 0.001), walking with eyes closed (p = 0.003), and stair climbing (p = 0.001). FGA performance was correlated with weeks since concussion (r = -0.67, p < 0.001), depth perception (r = -0.5348, p < 0.001), near point convergence (r = -0.4717, p = 0.001), baseline visual acuity (r = -0.4435, p = 0.002); as well as with symptoms on the PCSS (r = -0.668, p < 0.001), and DHI (r = -0.811, p < 0.001). Dynamic balance deficits persist in chronic mTBI and may be addressed using multifaceted rehabilitation strategies to address oculomotor dysfunction, post-concussion symptoms, and perception of handicap due to dizziness.

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BACKGROUND: There are limited psychometrically sound measures to assess higher level balance in individuals with incomplete spinal cord injury (iSCI). OBJECTIVES: To evaluate interrater and intrarater reliability and convergent validity of the Functional Gait Assessment (FGA) in individuals with iSCI. METHODS: Twelve participants (11 male, 1 female) 32 to 73 years old with chronic motor iSCI, American Spinal Injury Association Impairment Scale C (n = 2) or D (n = 10), were included. Participants completed five outcome measures during a single test session including lower extremity motor scores from the International Standards for the Neurological Classification of Spinal Cord Injury, FGA, 10-Meter Walk Test (10MWT), Walking Index for Spinal Cord Injury (WISCI-II), and the Spinal Cord Injury Functional Ambulation Profile (SCI-FAP). RESULTS: Inter- and intrarater reliability for the FGA were excellent. Interrater reliability was excellent with intraclass correlation coefficient (ICC) scores greater than 0.92 (p < .001). Interrater reliability against an expert was also excellent for all raters, with an ICC greater than or equal to 0.92 (p < .01). Intrarater reliability was excellent with an ICC score of greater than 0.91 (p < .002) for all raters. Validity of the FGA with 10MWT was -0.90 (p = .000), FGA with WISCI-II was 0.74 (p = .006), and FGA with SCI-FAP was -0.83 (p = .001). CONCLUSION: The FGA is a reliable and valid outcome measure to use when assessing gait and balance in individuals with motor iSCI. The FGA provides clinicians with a single tool to utilize across a variety of neurologic diagnoses.

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OBJECTIVE:: To evaluate construct validity and reproducibility of the Functional Gait Assessment (FGA) for measuring walking balance capacity in persons after stroke. DESIGN:: Cross-sectional study. SETTING:: Inpatient and outpatient rehabilitation center. SUBJECTS:: Fifty-two persons post-stroke (median (25% and 75% percentiles)) time post-stroke 6 (5-10) weeks) with independent walking ability (mean gait speed 1.1 ± .4 m/s). METHODS:: Subjects completed a standardized FGA twice within one to eight days by the same investigator. Validity was evaluated by testing hypotheses on the association with two timed walking tests, Berg Balance Scale, and the mobility domain of the Stroke Impact Scale using correlation coefficients ( r), and with Functional Ambulation Categories using the Kruskal-Wallis test. Reproducibility of FGA scores was assessed with intraclass correlation coefficient and standard error of measurement. RESULTS:: Subjects scored a median of 22 out of 30 points at the first FGA. Moderate to high significant correlations ( r .61-.83) and significant differences in FGA median scores between the Functional Ambulation Categories were found. Eight hypotheses (80%) could be confirmed. Inter-rater, intra-rater, and test-retest reliability of the total scores were excellent. The standard error of measurement and minimal detectable change were 2 and 6 points, respectively. No relevant ceiling effect was observed. CONCLUSION:: The FGA demonstrated good measurement properties in persons after stroke and yielded no ceiling effect in contrast to other capacity measures. In clinical practice, a measurement error of 6 points should be taken into account in interpreting changes in walking balance.

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OBJECTIVES: (1) To assess dynamic postural stability before and after cochlear implantation using a functional gait assessment (FGA). (2) To evaluate the correlation between loss of residual hearing and changes in dynamic postural stability after cochlear implantation. METHODS: Candidates for first-sided cochlear implantation were prospectively included. The FGAs and pure-tone audiograms were performed before and 4-6 weeks after cochlear implantation. RESULTS: Twenty-three subjects were included. Forty-eight percent (n = 11) showed FGA performance below the age-referenced norm before surgery. One subject had a clinically relevant decrease of the FGA score after cochlear implantation. No significant difference between the mean pre- and postoperative FGA scores was detectable (p = 0.4). Postoperative hearing loss showed no correlation with a change in FGA score after surgery (r = 0.3, p = 0.3, n = 16). CONCLUSION: Single-sided cochlear implantation does not adversely affect dynamic postural stability 5 weeks after surgery. Loss of functional residual hearing is not correlated with a decrease in dynamic postural stability.

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@#Objective To investigate the construct and concurrent validity of the Functional Gait Assessment (FGA) as the measure for balance and gait during walking in Parkinson's disease patients. Methods From March to December, 2011, 121 patients with Parkinson's disease (mean aged 61.9 years) were evaluated with FGA by one rater, as well as the other scales for balance and gait, such as Berg Balance Scale, Functional Ambulation Category, Timed Up and Go Test, Activities-specific Balance Confidence Scale, Movement Disorders Society revision of the Unified Parkinson's Disease Rating Scale part 3, modified Barthel Index, maximum walking speed and Modified Hoehn and Yahr Scale. Principal Component Analysis was used to determine construct validity. Spearman correlation coefficients between the FGA and other measures were used to determine concurrent validity. Results One common factor was extracted, which cumulatively explained 64.0% of the total variance. The FGA correlated moderately with the other measures (r = 0.57-0.85). Conclusion FGA is good in validity for Parkinson's disease patients.

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BACKGROUND: This study focussed on the effect of dual versus single tasking on balance, gait and cognition in veterans with mild traumatic brain injury (mTBI). We examined the correlation between these parameters, with responses to questions on community reintegration activities. METHOD: 22 male and female veterans (aged 19-65) walked along a narrow and 6.1-meter long path, both at their self-selected and fastest but safe pace under single and dual tasking conditions. For dual tasking, participants were required to recall and vocalize a 5-digit number at the end of the path. The outcome measures were the accuracy, velocity, cadence, stride length, and number of steps off the path. We calculated the reliability and correlation coefficient values for the walking time compared with the stride length, velocity, and percentage of swing and stance. RESULTS: Under dual task, the participants demonstrated slower gait, recalled shorter digit span and stepped off the path 12.6% more often than under single task. The stride length decreased by about 20% and the stride velocity increased by over 2% in dual compared with single tasking. CONCLUSIONS: Dual tasking slows down the gait and reduces the attention span in patients with mTBI, which can negatively impact their community reintegration, at least early after their hospital discharge, hence the need for exercising caution with their community reintegration activities. Dual tasking may have the potential to improve balance, gait and attention span of the patients in the long-term, thus leading to safer community integration, if incorporated in the rehabilitation plans.

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Objective To explore the relevance between gait speed and muscle strength of lower extremities, or several kinds of physical functional tests. Methods 341 community-dwelling individuals (160 males, 181 females) aged 65-94 years were selected. They were divid-ed into suspected sarcopenia group (n=137) and normal group (n=204) by their gait speed less or more than 0.8 m/s. It was compared be-tween both groups with the basic physical characteristics, strength of iliopsoas, quadriceps, hamstrings and tibialis anterior, and the scores of One Leg Standing Test, Berg Balance Scale, Functional Gait Assessment, Functional Stretch Test and Timed Up and Go Test. Results The subjects were older in the suspected sarcopenia group than in the normal group. The difference of body weight, height were not statistically significant between groups. The strength of the muscles in bilateral lower limbs was not significantly different between both groups (P>0.05), while the gait speed positively correlated with the strength of iliopsoas, quadriceps and hamstrings (r=0.121-0.227, P0.05). Gait speed positively correlated with the scores of One Leg Standing Test, Berg Balance Scale, Functional Gait Assessment, Functional Stretch Test (P<0.05), and negatively correlated with the score of Timed Up and Go Test (r=-0.502, P<0.001). The scores of all the tests were significantly different between 2 groups (P<0.05), except that of Functional Stretch Test (P=0.28). Conclu-sion Sarcopenia diagnosis is not only depended on the strength of muscle of lower extremity, but also their functions.