Returning to walking or improving walking is one of the top priorities for many individuals with neurological conditions undergoing rehabilitation. As physical therapists, we frequently measure gait speed (via the 10 Meter Walk Test) and endurance (via the 6 Minute Walk Test), and while these tests can provide valuable objective data, these metrics may not fully capture how well someone can adapt their walking to the challenges encountered in daily life.
The Functional Gait Assessment (FGA) was developed to address this gap by evaluating walking under a variety of functional conditions. This post explores what the FGA is, how it is administered, and how clinicians can use the results to guide treatment and monitor progress.
What is the Functional Gait Assessment?
The Functional Gait Assessment (FGA) is a standardized outcome measure used to assess postural stability during walking. It evaluates a person’s ability to adapt their gait to changing task demands, making it particularly useful for individuals with neurological conditions, vestibular disorders, and balance impairments.
The FGA is a modified version of the Dynamic Gait Index (DGI), developed to improve reliability and reduce ceiling effects in higher-functioning individuals.
The assessment consists of 10 walking tasks, discussed below. Each task is generally scored as follows on a scale from 0 to 3:
- 0 = Severe impairment; patient cannot complete the task without assistance, or demonstrates severe gait deviations or loss of balance
- 1- Moderate impairment
- 2 = Mild impairment
- 3 = Normal performance; no gait deviations or imbalance and completes task in a timely manner
The ANPT has a detailed guide to administering the FGA, including the specific scoring criteria for each item. Patients are allowed to use orthoses and assistive devices, and the referenced guide details how scoring is impacted if an assistive device is required.
The maximum score is 30 points, with higher scores indicating better functional gait performance.
FGA Test Items
The FGA evaluates walking under a variety of conditions commonly encountered in everyday life. The test is conducted along a 20 foot long walkway with a width of at least 12 inches.
1. Gait on a Level Surface
The individual walks at their normal speed over a designated distance; scoring is based on time to walk the 20 ft as well as noted gait deviations or apparent imbalance.
2. Change in Gait Speed
The patient alternates between normal, fast, and slow walking speeds.
3. Gait with Horizontal Head Turns
The patient walks while turning their head side-to-side; be sure to assess active cervical rotation range prior to assessing during walking.
4. Gait with Vertical Head Turns
The patient walks while looking up and down; again, be sure to assess active cervical flexion/extension range prior to assessing during walking.
5. Gait and Pivot Turn
The patient walks, turns quickly, and stops.
6. Step Over Obstacle
The patient walks while stepping over an obstacle (9 inches high, or two stacked shoe boxes) placed in their path.
7. Gait with Narrow Base of Support
The patient performs tandem walking.
8. Gait with Eyes Closed
The patient walks while their visual input is removed.
9. Ambulating Backwards
The patient walks backward.
10. Steps
The patient ascends and descends stairs; stepping pattern and use of handrail guide scoring.
The FGA Matters Clinically because it:
1. Identifies Dynamic Balance Deficits
Often, patients may be able to walk independently on a flat surface but struggle when additional balance challenges are introduced.
The FGA helps identify deficits which may not be apparent during routine gait observation.
2. Assesses Fall Risk
Lower FGA scores have been associated with an increased risk of falls in several populations, including individuals with Parkinson’s disease, vestibular disorders, older adults and the post-stroke population.
While fall risk should never be determined by a single measure, the FGA can be a valuable component of a comprehensive fall-risk assessment.
3. Guides Treatment Planning
The individual test items can help clinicians identify specific impairments affecting mobility.
For example:
- Difficulty with head turns may suggest vestibular or sensory integration deficits.
- Difficulty with tandem walking may indicate impaired balance control.
- Difficulty stepping over obstacles may reflect reduced coordination, strength, or motor planning.
These findings can help direct treatment interventions and progression.
4. Tracks Change Over Time
Because the FGA challenges multiple aspects of gait and balance, it can be useful for monitoring progress throughout rehabilitation.
Improvements in FGA score may reflect meaningful gains in dynamic balance and community mobility.
Interpreting FGA Scores
The FGA should always be interpreted within the context of the individual’s diagnosis, functional abilities, and rehabilitation goals.
What are the age-matched norms for the FGA?
For community-dwelling adults, the following are considered normal FGA scores per age group (Walker et al., 2007; n = 200; aged 40 to 89; unimpaired adults, mean scores):
- 40s: 28.9
- 50s: 28.4
- 60s: 27.1
- 70s: 24.9
- 80s: 20.8
What is a meaningful change on the FGA?
While the minimal detectable change (MDC) and minimally clinically important difference (MCID) vary based on the patient’s condition (see a helpful breakdown here), a meaningful change on the FGA is typically around 4-6 points.
What scores reflect an increased fall risk?
Research has identified fall-risk cutoff scores for certain populations:
- Community-dwelling older adults: ≤22/30
- Parkinson’s disease: ≤15–18/30 (depending on the study)
- Stroke and other neurological populations: cutoff values may vary
How good is the FGA at measuring dynamic gait?
The FGA is generally seen as having excellent validity (actually measuring what it’s supposed to measure) as well as reliability (both inter and intra-rater reliability, or consistency of scoring between clinicians or from the same clinician).
However, a 2018 study determining the validity and reproducibility of the FGA in the post-stroke population suggested that the backward walking task could be improved by better quantifying the gait speed. Additionally, clinicians within the same practice should discuss how to standardize the test within their clinic (where the test is conducted, what to use as the obstacle, etc.) to ensure the greatest consistency possible.
Limitations of the Functional Gait Assessment
While the FGA is a valuable clinical tool, it has several limitations.
1. It Does Not Measure Endurance
The FGA evaluates walking adaptability and dynamic balance but does not assess how far an individual can walk or how quickly fatigue develops.
Measures such as the 6-Minute Walk Test may provide additional insight into endurance.
2. It Does Not Capture All Real-World Challenges
Although the test incorporates many functional tasks, it cannot fully replicate the complexity of community environments, including crowds, uneven terrain, and distractions.
3. It May Not Be Appropriate for All Patients
Individuals who require significant physical assistance for walking are likely not appropriate for the FGA; instead, the Berg Balance Scale may better capture deficits and fall risk.
4. It Represents a Snapshot in Time
Performance can be influenced by fatigue, pain, medications, and other factors that may vary from day to day.
As with any outcome measure, results should be interpreted alongside clinical judgment and other assessments.
Putting It All Together
The Functional Gait Assessment provides valuable insight into how well an individual can adapt their gait to everyday challenges. By evaluating dynamic balance under a variety of conditions, the FGA helps clinicians identify impairments, assess fall risk, guide treatment planning, and monitor progress over time.
When combined with other outcome measures and clinical reasoning, the FGA can help build a more complete picture of an individual’s walking ability and support informed rehabilitation decisions.
Frequently Asked Questions
References
- Wrisley, D. M., Marchetti, G. F., Kuharsky, D. K., & Whitney, S. L. (2004). Reliability, internal consistency, and validity of data obtained with the Functional Gait Assessment. Physical Therapy, 84(10), 906–918.
- Beninato, M., Fernandes, A., & Plummer, L. S. (2014). Minimal clinically important difference of the Functional Gait Assessment in older adults. Physical Therapy, 94(11), 1594–1603.
- Leddy, A. L., Crowner, B. E., & Earhart, G. M. (2011). Functional Gait Assessment and balance evaluation system test: Reliability, validity, sensitivity, and specificity for identifying individuals with Parkinson disease who fall. Physical Therapy, 91(1), 102–113.
- Rehabilitation Measures Database. Functional Gait Assessment (FGA). Available at: https://www.sralab.org/rehabilitation-measures/functional-gait-assessment
- Wrisley, D. M., & Kumar, N. A. (2010). Functional Gait Assessment: Concurrent, discriminative, and predictive validity in community-dwelling older adults. Physical Therapy, 90(5), 761–773.
