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Susan L. Whitney - One of the best experts on this subject based on the ideXlab platform.
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the usefulness of the video head impulse test in children and adults post concussion
Journal of Vestibular Research-equilibrium & Orientation, 2017Co-Authors: Mohammed M Alshehri, Joseph M Furman, Patrick J Sparto, Sheri Fedor, Anne Mucha, Luke C Henry, Susan L. WhitneyAbstract:OBJECTIVE Dizziness after concussion have been reported in both youths and adults. It is not clear if the dizziness experienced post-concussion is from peripheral or central etiology. New technology has been developed to quickly and easily quantify the magnitude of peripheral vestibular disorders that is non-invasive and acceptable to youths and adults. The purpose of this study was to determine if youths and adults' post-concussion have evidence of decreased horizontal semicircular canal vestibulo-ocular reflex (VOR) gains as measured with the video head impulse test (vHIT), which would indicate a peripheral vestibular disorder. An additional purpose was to determine if VOR gain scores correlate with functional performance measures. DESIGN Descriptive cross sectional. SETTING Large medical center out-patient concussion program. PARTICIPANTS Fifty-six subjects with concussion. MAIN OUTCOMES/MEASURES Subjects completed the vHIT testing, the Dizziness Handicap Inventory (DHI), the Vestibular Activities and Participation (VAP) scale, the Pediatric Vestibular Symptom Questionnaire, Gait speed assessment, the Dynamic Gait Index (DGI) and a verbal analog scale of symptom provocation before and after the vHIT testing. RESULTS There were no abnormal vHIT findings in any subject. Headaches, dizziness and nausea were significantly worse post vHIT testing (p < 0.05). Youths had better DGI and DHI scores than subjects older than 20 (p < 0.05). CONCLUSION The vHIT did not detect horizontal semicircular canal weakness in any of the subjects tested. In addition, older adults reported more activity and participation limitations than the younger subjects with concussion.
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responsiveness and minimal detectable change of the Dynamic Gait Index and functional Gait Index in persons with balance and vestibular disorders
Journal of Neurologic Physical Therapy, 2014Co-Authors: Gregory F Marchetti, Ahmad H Alghadir, Susan L. WhitneyAbstract:BACKGROUND AND PURPOSE: We performed a retrospective chart review to determine the responsiveness and minimal detectable change (MDC95) in persons with balance and vestibular disorders with the Dynamic Gait Index (DGI) and the functional Gait assessment (FGA). METHODS: The study cohort consisted of 326 patients with a mean age of 60 ± 18.3 years (range, 18-95 years; 69% female). The DGI, FGA, Activities-Specific Balance Confidence (ABC) scale, and the dizziness handicap inventory (DHI) were collected at intake and discharge. RESULTS: The standardized response mean as an Index of responsiveness was greater for the FGA (1.25) than for the DGI (0.72). Both measures demonstrated good internal consistency with baseline measures. The amount of pre- to posttreatment change that exceeds chance variation was estimated at 4 points for the DGI and 6 points for the FGA. In both the DGI and the FGA, a magnitude of change equivalent to the respective MDC95 was significantly associated with improvements in self-reported disability as measured by the ABC and DHI. DISCUSSION AND CONCLUSIONS: The DGI and the FGA are responsive to change over time in persons with balance and vestibular disorders. More complex Gait measures need to be developed, as close to 50% of the subjects received optimal scores at discharge from a physical therapy exercise program, indicating that these measures have a ceiling effect.
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responsiveness and minimal detectable change of the Dynamic Gait Index and functional Gait Index in persons with balance and vestibular disorders
Journal of Neurologic Physical Therapy, 2014Co-Authors: Gregory F Marchetti, Ahmad H Alghadir, Chiacheng Lin, Susan L. WhitneyAbstract:Background and Purpose:We performed a retrospective chart review to determine the responsiveness and minimal detectable change (MDC95) in persons with balance and vestibular disorders with the Dynamic Gait Index (DGI) and the functional Gait assessment (FGA).Methods:The study cohort consisted of 326
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factors associated with balance confidence in older adults with health conditions affecting the balance and vestibular system
Archives of Physical Medicine and Rehabilitation, 2011Co-Authors: Gregory F Marchetti, Susan L. Whitney, Mark S Redfern, Joseph M FurmanAbstract:Abstract Marchetti GF, Whitney SL, Redfern MS, Furman JM. Factors associated with balance confidence in older adults with health conditions affecting the balance and vestibular system. Objective To determine the functional, clinical, and comorbid health condition factors that contribute to balance confidence in persons with balance or vestibular disorders, or both. Design Cross-sectional descriptive. Setting Tertiary care center for balance disorders. Participants Older adults (N=95) with signs and symptoms of vestibular dysfunction. Interventions Not applicable. Main Outcome Measures Activity-specific Balance Confidence Scale (ABC) was administered on examination for complaints of balance, postural instability, or both. Results Balance confidence as measured by the ABC was associated with functional balance performance on the Timed Up & Go test and the Dynamic Gait Index. Duration of symptoms and general health-related quality of life (as measured by the Medical Outcomes Study 36-Item Short-Form Health Survey) were significant covariates of balance confidence. Self-reported treatment for anxiety, depression, or both, significantly reduced balance confidence. Conclusions Balance confidence is a complex construct in older adults with signs and symptoms of balance or vestibular dysfunction, or both. Decreased balance confidence in performing functional activities is associated with actual balance performance, duration of vestibular symptoms, general health-related quality of life, and the presence of comorbid psychological and visual impairments. Understanding these relationships can potentially improve management of older adults who present with balance or vestibular disease, or both.
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temporal and spatial characteristics of Gait during performance of the Dynamic Gait Index in people with and people without balance or vestibular disorders
Physical Therapy, 2008Co-Authors: Gregory F Marchetti, Susan L. Whitney, P J Blatt, Laura O Morris, Joan M VanceAbstract:Background and Purpose: Understanding underlying Gait characteristics during performance of the Dynamic Gait Index (DGI) could potentially guide interventions. The purpose of this study was to describe the characteristics and reliability of Gait performance during the level walking items of the DGI in people with balance or vestibular dysfunction. The study was a cross-sectional investigation with 2-group comparisons. Subjects and Methods: Forty-seven subjects (mean age=59.2 years, SD=8.5, range=24–90) participated in the study; 26 were control subjects, and 21 were subjects with balance or vestibular dysfunction. Three trials of each level Gait item were administered to subjects as they ambulated on an instrumented walkway. Test-retest reliability was determined by use of an intraclass correlation coefficient (3,1) 2-way random-effects model for Gait parameters associated with continuous walking and the item requiring turning and stopping quickly. Mean Gait parameter differences between control subjects and subjects with balance or vestibular disorders were compared by use of a multivariate analysis of variance for each Gait task. Results: The reliability of most Gait parameters during DGI performance were fair to excellent between trials. Subjects with balance or vestibular disorders demonstrated differences in Gait characteristics compared with control subjects. The heterogeneity of the group of subjects with balance or vestibular disorders does not permit inferences to be drawn regarding the relationship between Gait and any specific balance or vestibular diagnosis. The results are most pertinent to people with chronic balance or vestibular disorders. Discussion and Conclusion: Gait parameters underlying Dynamic walking appeared to be relatively reliable across multiple trials and distinguished subjects with balance or vestibular disorders. Evaluating a person's performance on items of the DGI may be useful in identifying Gait deviations and in evaluating Gait improvements as a result of interventions.
Gregory F Marchetti - One of the best experts on this subject based on the ideXlab platform.
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responsiveness and minimal detectable change of the Dynamic Gait Index and functional Gait Index in persons with balance and vestibular disorders
Journal of Neurologic Physical Therapy, 2014Co-Authors: Gregory F Marchetti, Ahmad H Alghadir, Susan L. WhitneyAbstract:BACKGROUND AND PURPOSE: We performed a retrospective chart review to determine the responsiveness and minimal detectable change (MDC95) in persons with balance and vestibular disorders with the Dynamic Gait Index (DGI) and the functional Gait assessment (FGA). METHODS: The study cohort consisted of 326 patients with a mean age of 60 ± 18.3 years (range, 18-95 years; 69% female). The DGI, FGA, Activities-Specific Balance Confidence (ABC) scale, and the dizziness handicap inventory (DHI) were collected at intake and discharge. RESULTS: The standardized response mean as an Index of responsiveness was greater for the FGA (1.25) than for the DGI (0.72). Both measures demonstrated good internal consistency with baseline measures. The amount of pre- to posttreatment change that exceeds chance variation was estimated at 4 points for the DGI and 6 points for the FGA. In both the DGI and the FGA, a magnitude of change equivalent to the respective MDC95 was significantly associated with improvements in self-reported disability as measured by the ABC and DHI. DISCUSSION AND CONCLUSIONS: The DGI and the FGA are responsive to change over time in persons with balance and vestibular disorders. More complex Gait measures need to be developed, as close to 50% of the subjects received optimal scores at discharge from a physical therapy exercise program, indicating that these measures have a ceiling effect.
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responsiveness and minimal detectable change of the Dynamic Gait Index and functional Gait Index in persons with balance and vestibular disorders
Journal of Neurologic Physical Therapy, 2014Co-Authors: Gregory F Marchetti, Ahmad H Alghadir, Chiacheng Lin, Susan L. WhitneyAbstract:Background and Purpose:We performed a retrospective chart review to determine the responsiveness and minimal detectable change (MDC95) in persons with balance and vestibular disorders with the Dynamic Gait Index (DGI) and the functional Gait assessment (FGA).Methods:The study cohort consisted of 326
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factors associated with balance confidence in older adults with health conditions affecting the balance and vestibular system
Archives of Physical Medicine and Rehabilitation, 2011Co-Authors: Gregory F Marchetti, Susan L. Whitney, Mark S Redfern, Joseph M FurmanAbstract:Abstract Marchetti GF, Whitney SL, Redfern MS, Furman JM. Factors associated with balance confidence in older adults with health conditions affecting the balance and vestibular system. Objective To determine the functional, clinical, and comorbid health condition factors that contribute to balance confidence in persons with balance or vestibular disorders, or both. Design Cross-sectional descriptive. Setting Tertiary care center for balance disorders. Participants Older adults (N=95) with signs and symptoms of vestibular dysfunction. Interventions Not applicable. Main Outcome Measures Activity-specific Balance Confidence Scale (ABC) was administered on examination for complaints of balance, postural instability, or both. Results Balance confidence as measured by the ABC was associated with functional balance performance on the Timed Up & Go test and the Dynamic Gait Index. Duration of symptoms and general health-related quality of life (as measured by the Medical Outcomes Study 36-Item Short-Form Health Survey) were significant covariates of balance confidence. Self-reported treatment for anxiety, depression, or both, significantly reduced balance confidence. Conclusions Balance confidence is a complex construct in older adults with signs and symptoms of balance or vestibular dysfunction, or both. Decreased balance confidence in performing functional activities is associated with actual balance performance, duration of vestibular symptoms, general health-related quality of life, and the presence of comorbid psychological and visual impairments. Understanding these relationships can potentially improve management of older adults who present with balance or vestibular disease, or both.
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temporal and spatial characteristics of Gait during performance of the Dynamic Gait Index in people with and people without balance or vestibular disorders
Physical Therapy, 2008Co-Authors: Gregory F Marchetti, Susan L. Whitney, P J Blatt, Laura O Morris, Joan M VanceAbstract:Background and Purpose: Understanding underlying Gait characteristics during performance of the Dynamic Gait Index (DGI) could potentially guide interventions. The purpose of this study was to describe the characteristics and reliability of Gait performance during the level walking items of the DGI in people with balance or vestibular dysfunction. The study was a cross-sectional investigation with 2-group comparisons. Subjects and Methods: Forty-seven subjects (mean age=59.2 years, SD=8.5, range=24–90) participated in the study; 26 were control subjects, and 21 were subjects with balance or vestibular dysfunction. Three trials of each level Gait item were administered to subjects as they ambulated on an instrumented walkway. Test-retest reliability was determined by use of an intraclass correlation coefficient (3,1) 2-way random-effects model for Gait parameters associated with continuous walking and the item requiring turning and stopping quickly. Mean Gait parameter differences between control subjects and subjects with balance or vestibular disorders were compared by use of a multivariate analysis of variance for each Gait task. Results: The reliability of most Gait parameters during DGI performance were fair to excellent between trials. Subjects with balance or vestibular disorders demonstrated differences in Gait characteristics compared with control subjects. The heterogeneity of the group of subjects with balance or vestibular disorders does not permit inferences to be drawn regarding the relationship between Gait and any specific balance or vestibular diagnosis. The results are most pertinent to people with chronic balance or vestibular disorders. Discussion and Conclusion: Gait parameters underlying Dynamic walking appeared to be relatively reliable across multiple trials and distinguished subjects with balance or vestibular disorders. Evaluating a person's performance on items of the DGI may be useful in identifying Gait deviations and in evaluating Gait improvements as a result of interventions.
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construction and validation of the 4 item Dynamic Gait Index
Physical Therapy, 2006Co-Authors: Gregory F Marchetti, Susan L. WhitneyAbstract:Background and Purpose. People with balance disorders often have difficulty walking. The purpose of this study was to develop and test the psychometric properties of a short form of the Dynamic Gait Index (DGI) for the clinical measurement of walking function in people with balance and vestibular disorders. Subjects. A total of 123 subjects with such disorders (test subjects) and 103 control subjects were included in this study. Methods. Rasch and factor analyses were used to create a short form of the DGI. Internal consistency and discriminative validity for test subjects versus control subjects and for falling versus nonfalling test subjects were evaluated. Results. Four items were selected for the shorter version of the test: Gait on level surfaces, changes in Gait speed, and horizontal and vertical head turns. Discussion and Conclusion. The clinical psychometric properties of the 4-item DGI were equivalent or superior to those of the 8-item test. The 4-item DGI can be used by clinicians to measure Gait in people with balance and vestibular disorders without compromising important clinical measurement characteristics.
Diane M Wrisley - One of the best experts on this subject based on the ideXlab platform.
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vibrotactile tilt feedback improves Dynamic Gait Index a fall risk indicator in older adults
Gait & Posture, 2009Co-Authors: Conrad Wall, Diane M Wrisley, Kennyn D StatlerAbstract:The purpose of this study was to determine the effectiveness of vibrotactile feedback of body tilt in improving Dynamic Gait Index (DGI) a fall risk indicator in community dwelling older adults. Twelve healthy elderly subjects (three males and nine females, age 79.7+/-5.4 yrs) were tested in an institutional balance rehabilitation laboratory to investigate changes between the feedback off and on conditions. Subjects were acutely exposed to a vibrotactile display that indicated the magnitude and direction of their body tilt from the vertical. DGI and mediolateral (ML) sway were determined during locomotion with, and without, vibrotactile tilt feedback (VTTF). All subjects were at risk for falls based on their initial DGI Score (range: 15-19, mean 17.4+/-1.56), which was taken with the vibratory stimulus turned off. Subjects learned to use the trunk tilt information from the vibrotactile feedback vest through 20-30min of Gait and balance training consisting of activities that challenged their balance. Subjects were then retested on the DGI. Statistically significant changes were demonstrated for the DGI total score while using the vibrotactile tilt feedback. DGI total scores improved from 17.1+/-0.4 to 20.8+/-0.3 (p Language: en
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clinical measurement of sit to stand performance in people with balance disorders validity of data for the five times sit to stand test
Physical Therapy, 2005Co-Authors: Susan L. Whitney, Gregory F Marchetti, Diane M Wrisley, Mark S Redfern, Michael A Gee, Joseph M FurmanAbstract:Background and Purpose. People with balance disorders are characterized as having difficulty with transitional movements, such as the sit-to-stand movement. A valid and feasible tool is needed to help clinicians quantify the ability of people with balance disorders to perform transitional movements. The purpose of this study was to describe the concurrent and discriminative validity of data obtained with the Five-Times-Sit-to-Stand Test (FTSST). The FTSST was compared with the Activities-specific Balance Confidence Scale (ABC) and the Dynamic Gait Index (DGI). Subjects and Methods. Eighty-one subjects without balance disorders and 93 subjects with balance disorders were recruited for the study. Each subject was asked to stand from a 43-cm-high chair 5 times as quickly as possible. The ABC and DGI scores were recorded. Results. Subjects with balance disorders performed the FTSST more slowly than subjects without balance disorders. Discriminant analysis demonstrated that the FTSST correctly identified 65% of subjects with balance dysfunction, the ABC identified 80%, and the DGI identified 78%. The ability of the FTSST to identify subjects with balance dysfunction was better for subjects younger than 60 years of age (81%). Discussion and Conclusion. The FTSST displays discriminative and concurrent validity properties that make this test potentially useful in clinical decision making, although overall the ABC and the DGI are better than the FTSST at discriminating between subjects with and subjects without balance disorders.
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reliability internal consistency and validity of data obtained with the functional Gait assessment
Physical Therapy, 2004Co-Authors: Diane M Wrisley, Gregory F Marchetti, Diane K Kuharsky, Susan L. WhitneyAbstract:Background and Purpose. The Functional Gait Assessment (FGA) is a 10-item Gait assessment based on the Dynamic Gait Index. The purpose of this study was to evaluate the reliability, internal consistency, and validity of data obtained with the FGA when used with people with vestibular disorders. Subjects. Seven physical therapists from various practice settings, 3 physical therapist students, and 6 patients with vestibular disorders volunteered to participate. Methods. All raters were given 10 minutes to review the instructions, the test items, and the grading criteria for the FGA. The 10 raters concurrently rated the performance of the 6 patients on the FGA. Patients completed the FGA twice, with an hour's rest between sessions. Reliability of total FGA scores was assessed using intraclass correlation coefficients (2,1). Internal consistency of the FGA was assessed using the Cronbach alpha and confirmatory factor analysis. Concurrent validity was assessed using the correlation of the FGA scores with balance and Gait measurements. Results. Intraclass correlation coefficients of .86 and .74 were found for interrater and intrarater reliability of the total FGA scores. Internal consistency of the FGA scores was .79. Spearman rank order correlation coefficients of the FGA scores with balance measurements ranged from .11 to .67. Discussion and Conclusion. The FGA demonstrates what we believe is acceptable reliability, internal consistency, and concurrent validity with other balance measures used for patients with vestibular disorders.
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the sensitivity and specificity of the timed up go and the Dynamic Gait Index for self reported falls in persons with vestibular disorders
Journal of Vestibular Research-equilibrium & Orientation, 2004Co-Authors: Susan L. Whitney, Gregory F Marchetti, Diane M Wrisley, Annika SchadeAbstract:The purpose of this study was to determine the sensitivity and specificity of the Timed "Up & Go" (TUG) and Dynamic Gait Index in identifying self-reported fallers among persons with vestibular dysfunction. One hundred three patient charts were included from a tertiary vestibular physical therapy practice. The patients ranged in age from 14-90 years and had vestibular diagnoses, falls reported in the patient chart, and completed the TUG and/or the Dynamic Gait Index (DGI). Thirty-one persons reported falling one or more times in the previous 6 months during their initial assessment. Persons who took longer than 13.5 seconds to perform the TUG test were 3.7 times more likely to have reported a fall in the previous 6 months. Those persons with scores less than or equal to 18 on the DGI were 2.7 times (p = 0.03) more likely to have reported a fall in the previous 6 months. The sensitivity of the DGI at 18 or less was 70% and the specificity was 51%. People who scored greater than 11.1 seconds on the TUG were 5 times (p = 0.001) more likely to have reported a fall in the previous 6 months. Sensitivity (80%) and specificity (56%) were calculated for TUG scores of greater than 11.1 seconds. The TUG and the DGI appear to be helpful in identifying fall risk in persons with vestibular dysfunction. Slower scores on the TUG (> 11.1 seconds) and lower scores on the DGI (18) correlated with reports of falls in persons with vestibular dysfunction.
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concurrent validity of the berg balance scale and the Dynamic Gait Index in people with vestibular dysfunction
Physiotherapy Research International, 2003Co-Authors: Susan L. Whitney, Diane M Wrisley, Joseph M FurmanAbstract:BACKGROUND AND PURPOSE: The Berg Balance Scale is a reliable and valid measure that is used to assess characteristics of balance. The Dynamic Gait Index is a relatively new measure that has been used to record Dynamic Gait tasks in people with vestibular dysfunction. The purpose of the present study was to determine the concurrent validity of the Dynamic Gait Index with the Berg Balance Scale in people with vestibular disorders. METHOD: A retrospective review of the charts of people who met the criteria of having completed both the Berg Balance Scale and the Dynamic Gait Index during their first physiotherapy visit. Seventy patients (19 male, 51 female) were identified through the retrospective review of the charts of people referred for vestibular rehabilitation with varying diagnoses of vestibular and balance dysfunction. All were seen at a tertiary medical centre in an outpatient physiotherapy setting. Their age range was from 14 to 88 years (mean 65 years). RESULTS: Correlation between the scores on the Dynamic Gait Index and the Berg Balance Scale was moderate but significant by use of the Spearman rank order correlation (r = 0.71; p < 01). No difference was found between scores on the Dynamic Gait Index or Berg Balance Scale based on gender or diagnosis. A significant difference was identified on the Berg Balance Scale between older and younger people with vestibular disorders. Using previously established criteria to determine increased risk of falling, the Berg Balance Scale and the Dynamic Gait Index agreed 63% of the time. CONCLUSIONS: The moderate correlation between the Dynamic Gait Index and the Berg Balance Scale establishes the concurrent validity of the Dynamic Gait Index in people with vestibular dysfunction. Both these measures provide valuable information to clinicians about patients' functional balance capabilities. However, the lack of perfect correlation indicates that the tests measure different aspects of balance. The Dynamic Gait Index appears to be a more sensitive assessment tool in identifying people with vestibular disorders who are at increased risk for falling, based on currently published criteria.
Joseph M Furman - One of the best experts on this subject based on the ideXlab platform.
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the usefulness of the video head impulse test in children and adults post concussion
Journal of Vestibular Research-equilibrium & Orientation, 2017Co-Authors: Mohammed M Alshehri, Joseph M Furman, Patrick J Sparto, Sheri Fedor, Anne Mucha, Luke C Henry, Susan L. WhitneyAbstract:OBJECTIVE Dizziness after concussion have been reported in both youths and adults. It is not clear if the dizziness experienced post-concussion is from peripheral or central etiology. New technology has been developed to quickly and easily quantify the magnitude of peripheral vestibular disorders that is non-invasive and acceptable to youths and adults. The purpose of this study was to determine if youths and adults' post-concussion have evidence of decreased horizontal semicircular canal vestibulo-ocular reflex (VOR) gains as measured with the video head impulse test (vHIT), which would indicate a peripheral vestibular disorder. An additional purpose was to determine if VOR gain scores correlate with functional performance measures. DESIGN Descriptive cross sectional. SETTING Large medical center out-patient concussion program. PARTICIPANTS Fifty-six subjects with concussion. MAIN OUTCOMES/MEASURES Subjects completed the vHIT testing, the Dizziness Handicap Inventory (DHI), the Vestibular Activities and Participation (VAP) scale, the Pediatric Vestibular Symptom Questionnaire, Gait speed assessment, the Dynamic Gait Index (DGI) and a verbal analog scale of symptom provocation before and after the vHIT testing. RESULTS There were no abnormal vHIT findings in any subject. Headaches, dizziness and nausea were significantly worse post vHIT testing (p < 0.05). Youths had better DGI and DHI scores than subjects older than 20 (p < 0.05). CONCLUSION The vHIT did not detect horizontal semicircular canal weakness in any of the subjects tested. In addition, older adults reported more activity and participation limitations than the younger subjects with concussion.
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factors associated with balance confidence in older adults with health conditions affecting the balance and vestibular system
Archives of Physical Medicine and Rehabilitation, 2011Co-Authors: Gregory F Marchetti, Susan L. Whitney, Mark S Redfern, Joseph M FurmanAbstract:Abstract Marchetti GF, Whitney SL, Redfern MS, Furman JM. Factors associated with balance confidence in older adults with health conditions affecting the balance and vestibular system. Objective To determine the functional, clinical, and comorbid health condition factors that contribute to balance confidence in persons with balance or vestibular disorders, or both. Design Cross-sectional descriptive. Setting Tertiary care center for balance disorders. Participants Older adults (N=95) with signs and symptoms of vestibular dysfunction. Interventions Not applicable. Main Outcome Measures Activity-specific Balance Confidence Scale (ABC) was administered on examination for complaints of balance, postural instability, or both. Results Balance confidence as measured by the ABC was associated with functional balance performance on the Timed Up & Go test and the Dynamic Gait Index. Duration of symptoms and general health-related quality of life (as measured by the Medical Outcomes Study 36-Item Short-Form Health Survey) were significant covariates of balance confidence. Self-reported treatment for anxiety, depression, or both, significantly reduced balance confidence. Conclusions Balance confidence is a complex construct in older adults with signs and symptoms of balance or vestibular dysfunction, or both. Decreased balance confidence in performing functional activities is associated with actual balance performance, duration of vestibular symptoms, general health-related quality of life, and the presence of comorbid psychological and visual impairments. Understanding these relationships can potentially improve management of older adults who present with balance or vestibular disease, or both.
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clinical measurement of sit to stand performance in people with balance disorders validity of data for the five times sit to stand test
Physical Therapy, 2005Co-Authors: Susan L. Whitney, Gregory F Marchetti, Diane M Wrisley, Mark S Redfern, Michael A Gee, Joseph M FurmanAbstract:Background and Purpose. People with balance disorders are characterized as having difficulty with transitional movements, such as the sit-to-stand movement. A valid and feasible tool is needed to help clinicians quantify the ability of people with balance disorders to perform transitional movements. The purpose of this study was to describe the concurrent and discriminative validity of data obtained with the Five-Times-Sit-to-Stand Test (FTSST). The FTSST was compared with the Activities-specific Balance Confidence Scale (ABC) and the Dynamic Gait Index (DGI). Subjects and Methods. Eighty-one subjects without balance disorders and 93 subjects with balance disorders were recruited for the study. Each subject was asked to stand from a 43-cm-high chair 5 times as quickly as possible. The ABC and DGI scores were recorded. Results. Subjects with balance disorders performed the FTSST more slowly than subjects without balance disorders. Discriminant analysis demonstrated that the FTSST correctly identified 65% of subjects with balance dysfunction, the ABC identified 80%, and the DGI identified 78%. The ability of the FTSST to identify subjects with balance dysfunction was better for subjects younger than 60 years of age (81%). Discussion and Conclusion. The FTSST displays discriminative and concurrent validity properties that make this test potentially useful in clinical decision making, although overall the ABC and the DGI are better than the FTSST at discriminating between subjects with and subjects without balance disorders.
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concurrent validity of the berg balance scale and the Dynamic Gait Index in people with vestibular dysfunction
Physiotherapy Research International, 2003Co-Authors: Susan L. Whitney, Diane M Wrisley, Joseph M FurmanAbstract:BACKGROUND AND PURPOSE: The Berg Balance Scale is a reliable and valid measure that is used to assess characteristics of balance. The Dynamic Gait Index is a relatively new measure that has been used to record Dynamic Gait tasks in people with vestibular dysfunction. The purpose of the present study was to determine the concurrent validity of the Dynamic Gait Index with the Berg Balance Scale in people with vestibular disorders. METHOD: A retrospective review of the charts of people who met the criteria of having completed both the Berg Balance Scale and the Dynamic Gait Index during their first physiotherapy visit. Seventy patients (19 male, 51 female) were identified through the retrospective review of the charts of people referred for vestibular rehabilitation with varying diagnoses of vestibular and balance dysfunction. All were seen at a tertiary medical centre in an outpatient physiotherapy setting. Their age range was from 14 to 88 years (mean 65 years). RESULTS: Correlation between the scores on the Dynamic Gait Index and the Berg Balance Scale was moderate but significant by use of the Spearman rank order correlation (r = 0.71; p < 01). No difference was found between scores on the Dynamic Gait Index or Berg Balance Scale based on gender or diagnosis. A significant difference was identified on the Berg Balance Scale between older and younger people with vestibular disorders. Using previously established criteria to determine increased risk of falling, the Berg Balance Scale and the Dynamic Gait Index agreed 63% of the time. CONCLUSIONS: The moderate correlation between the Dynamic Gait Index and the Berg Balance Scale establishes the concurrent validity of the Dynamic Gait Index in people with vestibular dysfunction. Both these measures provide valuable information to clinicians about patients' functional balance capabilities. However, the lack of perfect correlation indicates that the tests measure different aspects of balance. The Dynamic Gait Index appears to be a more sensitive assessment tool in identifying people with vestibular disorders who are at increased risk for falling, based on currently published criteria.
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concurrent validity of the berg balance scale and the Dynamic Gait Index in people with vestibular dysfunction
Physiotherapy Research International, 2003Co-Authors: Susan L. Whitney, Diane M Wrisley, Joseph M FurmanAbstract:Background and Purpose The Berg Balance Scale is a reliable and valid measure that is used to assess characteristics of balance. The Dynamic Gait Index is a relatively new measure that has been used to record Dynamic Gait tasks in people with vestibular dysfunction. The purpose of the present study was to determine the concurrent validity of the Dynamic Gait Index with the Berg Balance Scale in people with vestibular disorders. Method A retrospective review of the charts of people who met the criteria of having completed both the Berg Balance Scale and the Dynamic Gait Index during their first physiotherapy visit. Seventy patients (19 male, 51 female) were identified through the retrospective review of the charts of people referred for vestibular rehabilitation with varying diagnoses of vestibular and balance dysfunction. All were seen at a tertiary medical centre in an outpatient physiotherapy setting. Their age range was from 14 to 88 years (mean 65 years). Results Correlation between the scores on the Dynamic Gait Index and the Berg Balance Scale was moderate but significant by use of the Spearman rank order correlation (r = 0.71; p<01). No difference was found between scores on the Dynamic Gait Index or Berg Balance Scale based on gender or diagnosis. A significant difference was identified on the Berg Balance Scale between older and younger people with vestibular disorders. Using previously established criteria to determine increased risk of falling, the Berg Balance Scale and the Dynamic Gait Index agreed 63% of the time. Conclusions The moderate correlation between the Dynamic Gait Index and the Berg Balance Scale establishes the concurrent validity of the Dynamic Gait Index in people with vestibular dysfunction. Both these measures provide valuable information to clinicians about patients' functional balance capabilities. However, the lack of perfect correlation indicates that the tests measure different aspects of balance. The Dynamic Gait Index appears to be a more sensitive assessment tool in identifying people with vestibular disorders who are at increased risk for falling, based on currently published criteria. Copyright © 2003 Whurr Publishers Ltd.
Anne Shumwaycook - One of the best experts on this subject based on the ideXlab platform.
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investigating the validity of the environmental framework underlying the original and modified Dynamic Gait Index
Physical Therapy, 2015Co-Authors: Anne Shumwaycook, Patricia Noritake Matsuda, Catherine S TaylorAbstract:Background The modified Dynamic Gait Index (mDGI), developed from a person-environment model of mobility disability, measures mobility function relative to specific environmental demands. The framework for interpreting mDGI scores relative to specific environmental dimensions has not been investigated. Objective The aim of this study was to examine the person-environmental model underlying the development and interpretation of mDGI scores. Design This was a cross-sectional, descriptive study. Methods There were 794 participants in the study, including 140 controls. Out of the total study population, 239 had sustained a stroke, 140 had vestibular dysfunction, 100 had sustained a traumatic brain injury, 91 had Gait abnormality, and 84 had Parkinson disease. Exploratory factor analysis was used to investigate whether mDGI scores supported the 4 environmental dimensions. Results Factor analysis showed that, with some exceptions, tasks loaded on 4 underlying factors, partially supporting the underlying environmental model. Limitations Limitations of this study included the uneven sample sizes in the 6 groups. Conclusions Support for the environmental framework underlying the mDGI extends its usefulness as a clinical measure of functional mobility by providing a rationale for interpretation of scores that can be used to direct treatment and infer change in mobility function.
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examining the relationship between medical diagnoses and patterns of performance on the modified Dynamic Gait Index
Physical Therapy, 2015Co-Authors: Patricia Noritake Matsuda, Catherine S Taylor, Anne ShumwaycookAbstract:Background In the original and modified Dynamic Gait Index (mDGI), 8 tasks are used to measure mobility; however, disagreement exists regarding whether all tasks are necessary. The relationship between mDGI scores and Centers for Medicare & Medicaid Services (CMS) severity indicators in the mobility domain has not been explored. Objective The study objectives were to examine the relationship between medical diagnoses and mDGI scores, to determine whether administration of the mDGI can be shortened on the basis of expected diagnostic patterns of performance, and to create a model in which mDGI scores are mapped to CMS severity modifiers. Design This was a cross-sectional, descriptive study. Methods The 794 participants included 140 people without impairments (control cohort) and 239 people with stroke, 140 with vestibular dysfunction, 100 with traumatic brain injury, 91 with Gait abnormality, and 84 with Parkinson disease. Scores on the mDGI (total, performance facet, and task) for the control cohort were compared with those for the 5 diagnostic groups by use of an analysis of variance. For mapping mDGI scores to 7 CMS impairment categories, an underlying Rasch scale was used to convert raw scores to an interval scale. Results There was a main effect of mDGI total, time, and Gait pattern scores for the groups. Task-specific score patterns based on medical diagnosis were found, but the range of performance within each group was large. A framework for mapping mDGI total, performance facet, and task scores to 7 CMS impairment categories on the basis of Rasch analysis was created. Limitations Limitations included uneven sample sizes in the 6 groups. Conclusions Results supported retaining all 8 tasks for the assessment of mobility function in older people and people with neurologic conditions. Mapping mDGI scores to CMS severity indicators should assist clinicians in interpreting mobility performance, including changes in function over time.
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evidence for the validity of the modified Dynamic Gait Index across diagnostic groups
Physical Therapy, 2014Co-Authors: Patricia Noritake Matsuda, Catherine S Taylor, Anne ShumwaycookAbstract:Background The modified Dynamic Gait Index (mDGI) measures the capacity to adapt Gait to complex tasks utilizing 8 tasks and 3 facets of performance. The measurement stability of the mDGI in specific diagnostic groups is unknown. Objective This study examined the psychometric properties of the mDGI in 5 diagnostic groups. Design This was a cross-sectional, descriptive study. Methods A total of 794 participants were included in the study: 140 controls, 239 with stroke, 140 with vestibular dysfunction, 100 with traumatic brain injury, 91 with Gait abnormality, and 84 with Parkinson disease. Differential item functioning analysis was used to examine the comparability of scores across diagnoses. Internal consistency was computed using Cronbach alpha. Factor analysis was used to examine the factor loadings for the 3 performance facet scores. Minimal detectable change at the 95% confidence level (MDC95%) was calculated for each of the groups. Results Less than 5% of comparisons demonstrated moderate to large differential item functioning, suggesting that item scores had the same order of difficulty for individuals in all 5 diagnostic groups. For all 5 patient groups, 3 factors had eigenvalues >1.0 and explained 80% of the variability in scores, supporting the importance of characterizing mobility performance with respect to time, level of assistance, and Gait pattern. Limitations There were uneven sample sizes in the 6 groups. Conclusions The strength of the psychometric properties of the mDGI across the 5 diagnostic groups further supports the validity and usefulness of scores for clinical and research purposes. In addition, the meaning of a score from the mDGI, regardless of whether at the task, performance facet, or total score level, was comparable across the 5 diagnostic groups, suggesting that the mDGI measured mobility function independent of medical diagnosis.
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expanding the scoring system for the Dynamic Gait Index
Physical Therapy, 2013Co-Authors: Anne Shumwaycook, Patricia Noritake Matsuda, Catherine S Taylor, Michael T Studer, Brady K WhettenAbstract:Background. The Dynamic Gait Index (DGI) measures the capacity to adapt Gait to complex tasks. The current scoring system combining Gait pattern (GP) and level of assistance (LOA) lacks clarity, and the test has a limited range of measurement. Objective. This study developed a new scoring system based on 3 facets of performance (LOA, GP, and time) and examined the psychometric properties of the modified DGI (mDGI). Design. A cross-sectional, descriptive study was conducted. Methods. Nine hundred ninety-five participants (855 patients with neurologic pathology and mobility impairments [MI group] and 140 patients without neurological impairment [control group]) were tested. Interrater reliability was calculated using kappa coefficients. Internal consistency was computed using the Cronbach alpha coefficient. Factor analysis and Rasch analysis investigated unidimensionality and range of difficulty. Internal validity was determined by comparing groups using multiple t tests. Minimal detectable change (MDC) was calculated for total score and 3 facet scores using the reliability estimate for the alpha coefficients. Results. Interrater agreement was strong, with kappa coefficients ranging from 90% to 98% for time scores, 59% to 88% for GP scores, and 84% to 100% for LOA scores. Test-retest correlations (r) for time, GP, and LOA were .91, .91, and .87, respectively. Three factors (time, LOA, GP) had eigenvalues greater than 1.3 and explained 79% of the variance in scores. All group differences were significant, with moderate to large effect sizes. The 95% minimal detectable change (MDC95) was 4 for the mDGI total score, 2 for the time and GP total scores, and 1 for the LOA total score. Limitations. The limitations included uneven sample sizes in the 2 groups. The MI group were patients receiving physical therapy; therefore, they may not be representative of this population. Conclusions. The mDGI, with its expanded scoring system, improves the range, discrimination, and facets of measurement related to walking function. The strength of the psychometric properties of the mDGI warrants its adoption for both clinical and research purposes.
