Understanding the Functional Gait Assessment (FGA)
The Functional Gait Assessment (FGA) is a standardized, 10-item clinical assessment used by physical therapists and other healthcare professionals to evaluate an individual's dynamic balance and ability to perform mobility tasks. Unlike simpler tests, the FGA assesses gait under more challenging, real-world conditions, including walking while turning your head, changing speeds, and navigating obstacles.
The test scores items on a 4-point scale from 0 to 3, where 0 indicates severe impairment and 3 indicates normal performance. The scores for all 10 items are then summed to get a total score out of 30, with higher scores representing better performance and lower fall risk.
The Common Cutoff Score: $\leq$ 22/30
For non-specific, community-dwelling older adults, a score of 22 or less on the FGA is widely accepted as indicating a higher risk of falls. This specific cutoff was identified in a landmark study that established the test's predictive validity. For individuals in this category, scoring at or below this threshold should prompt a more in-depth fall risk assessment and targeted interventions.
It is important to note that the specific cutoff may vary depending on the patient population and condition. For example, some studies suggest different thresholds for individuals with Parkinson's disease, highlighting the importance of a comprehensive evaluation. A lower score for a specific population reflects a more significant impairment in balance and mobility associated with their condition.
Interpreting Your FGA Score
Knowing the cutoff score is just the first step. The real value lies in understanding what your score means and what actions you should take.
- Score > 22: A score above 22 indicates relatively good balance and functional mobility, suggesting a lower risk of falls. However, it's not a guarantee against falling. It's an indicator of functional status at the time of the assessment.
- Score $\leq$ 22: A score at or below the cutoff indicates a higher risk of falling. This doesn't mean a fall is inevitable, but it signals the need for intervention. A physical therapist will use this information to create a targeted plan to improve strength, balance, and gait.
What the FGA Measures
The FGA is designed to measure how well a person can maintain balance while performing everyday tasks. The 10 items include:
- Gait on Level Surface: Normal walking.
- Change in Gait Speed: Walking at slow and fast speeds.
- Gait with Horizontal Head Turns: Walking while turning the head left and right.
- Gait with Vertical Head Turns: Walking while nodding the head up and down.
- Gait with Pivot Turn: Walking and making a quick 180-degree turn.
- Step Over Obstacle: Stepping over a shoebox-sized object.
- Gait with Narrow Base of Support: Walking heel-to-toe.
- Gait with Eyes Closed: Walking for 20 feet with eyes shut.
- Backwards Walking: Walking backward for 20 feet.
- Stairs: Walking up and down stairs (if available).
Comparison: FGA vs. Other Balance Tests
The FGA is one of several tools available to assess fall risk. It differs from other tests by including more challenging and dynamic tasks. The following table highlights some key differences.
| Feature | Functional Gait Assessment (FGA) | Timed Up and Go (TUG) Test | Tinetti Performance Oriented Mobility Assessment (POMA) |
|---|---|---|---|
| Focus | Dynamic balance, gait adaptability, postural control | Basic mobility, balance, and walking speed | Balance (sitting, standing, turning) and gait (initiation, step length, clearance) |
| Items | 10 tasks, including challenging conditions | Single task: Rise from chair, walk 10 ft, turn, return to chair, sit | 9 balance items, 7 gait items |
| Max Score | 30 | N/A (Timed) | 28 |
| Cutoff | $\leq$ 22/30 (older adults) | $\geq$ 12 seconds (older adults) | $\leq$ 18 (high risk), 19-23 (moderate risk) |
| Primary Use | Detailed assessment of mobility and balance deficits | Quick, screening tool | Comprehensive, but less focus on dynamic conditions |
How to Improve Your FGA Score and Reduce Fall Risk
If your FGA score indicates a higher risk of falling, there are effective strategies you can implement to improve your balance and gait:
- Physical Therapy: A physical therapist can provide targeted exercises to strengthen leg muscles, improve balance reactions, and retrain proper gait mechanics. The Otago Exercise Program, often delivered by a physical therapist, is proven to reduce fall risk.
- Home Safety Modifications: An occupational therapist can perform a home safety evaluation to identify and address hazards like poor lighting, loose rugs, and lack of grab bars.
- Balance Exercises: Regular practice of balance exercises, such as single-leg stands, heel-to-toe walking, and weight shifts, can significantly improve stability. Tai Chi is also highly recommended.
- Medication Review: Some medications can cause dizziness or drowsiness, increasing fall risk. A doctor or pharmacist can review your medications and adjust as needed.
- Address Vision and Footwear: Ensure regular eye exams and consider wearing single-lens glasses for outdoor activities. Wearing well-fitting, low-heeled shoes with good surface contact can also help.
For more detailed information and resources on fall prevention, you can visit the Centers for Disease Control and Prevention's STEADI program page.
Putting it all together
Understanding the Functional Gait Assessment cutoff score is an empowering first step in addressing fall risk. A score of $\leq$ 22/30 serves as a clear indicator for community-dwelling older adults that more attention is needed for balance and gait. By working with healthcare professionals, making necessary home modifications, and engaging in targeted exercises, you can effectively reduce your fall risk and maintain your independence. The FGA provides a clear starting point for a proactive approach to senior health and safety.
