Functional Gait Assessment
Patient’s full name:
Date assessed: Age: Sex/gender:
Assessor’s full name: Assessor’s signature:
Gait level surface Instructions: Tell your patient
Walk at your normal speed from here to the next mark (20 ft/6 m)
Pick the category that applies to your patient.
Score Level of function Description
▢ 0 Severe impairment Cannot walk 6 m (20 ft) without assistance
Severe gait deviations or imbalance
Deviates greater than 38.1 cm (15 in) outside of the 30.48-cm (12-in) walkway width or
reaches and touches the wall.
▢ 1 Moderate impairment Walks 6 m (20 ft)
Slow speed
Abnormal gait pattern
Evidence for imbalance
Deviates 25.4 – 38.1 cm (10 –15 in) outside of the 30.48-cm (12-in) walkway width
Requires more than 7 seconds to ambulate 6 m (20 ft).
▢ 2 Mild impairment Walks 6 m (20 ft)
Slow speed
Abnormal gait pattern
Evidence for imbalance
Deviates 25.4 – 38.1 cm (10 –15 in) outside of the 30.48-cm (12-in) walkway width
Requires more than 7 seconds to ambulate 6 m (20 ft).
▢ 3 ormal Walks 6 m (20 ft) in less than 5.5 seconds
N
No assistive devices
Good speed
No evidence for imbalance
Normal gait pattern
Deviates no more than 15.24 cm (6 in) outside of the 30.48-cm (12-in) walkway width.
Ch ange in gait speed Instructions: Tell your patient
Begin walking at your normal pace (for 1.5 m / 5 ft)
When I tell you “go,” walk as fast as you can (for 1.5 m / 5 ft)
When I tell you “slow,” walk as slowly as you can (for 1.5 m / 5 ft).
Pick the category that applies to your patient.
Score Level of function Description
▢ 0 Severe impairment Cannot change speed
Deviates greater than 38.1 cm (15 in) outside 30.48-cm (12-in) walkway width or loses
,
balance and has to reach for wall or be caught
▢ 1 Moderate impairment Makes only minor ad ustments to walking speed or accomplishes a change in speed with
j ,
signi cant gait deviations
fi
Deviates 25.4 –38.1 cm (10 –15 in) outside the 30.48-cm (12-in) walkway width or ,
changes speed but loses balance but is able to recover and continue walking.
▢ 2 Mild impairment s able to change speed but demonstrates mild gait deviation
I
Deviates 15.24 –25.4 cm (6 –10 in) outside of the 30.48-cm (12-in) walkway width or no ,
gait deviations but unable to achieve a signi cant change in velocity or uses an assistive
fi ,
device.
▢ 3 ormal Able to smoothly change walking speed without loss of balance or gait deviation
N
Shows a signi cant difference in walking speeds between normal fast and slow speeds
fi , ,
Deviates no more than 15.24 cm (6 in) outside of the 30.48-cm (12-in) walkway width.
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Gait with horizontal Instructions: Tell your patient
head turns Walk from here to the next mark 6 m (20 ft) away
Begin walking at your normal pace
Keep walking straight; after 3 steps, turn your head to the right and keep walking straight while
looking to the right
After 3 more steps, turn your head to the left and keep walking straight while looking left
Continue alternating looking right and left every 3 steps until you have completed 2 repetitions
in each direction.
Pick the category that applies to your patient.
Score Level of function Description
▢ 0 Severe impairment
Performs task with severe disruption of gait (eg, staggers 38.1 cm / 15 in outside 30.48-
cm (12-in) walkway width, loses balance, stops, or reaches for wall).
Performs head turns with moderate change in gait velocity
▢ 1 Moderate impairment
Slows down
Deviates 25.4 –38.1 cm (10 –15 in) outside 30.48-cm (12-in) walkway width but recovers
Can continue to walk.
Performs head turns smoothly with slight change in gait velocity (eg, minor disruption to
▢ 2 Mild impairment
smooth gait path)
Deviates 15.24 –25.4 cm (6 –10 in) outside 30.48-cm (12-in) walkway width, or uses an
assistive device.
▢ 3 Normal
Performs head turns smoothly with no change in gait
Deviates no more than 15.24 cm (6 in) outside 30.48-cm (12-in) walkway width.
Gait with vertical head Instructions: Tell your patient
turns Walk from here to the next mark (6 m / 20 ft)
Begin walking at your normal pace
Keep walking straight; after 3 steps, tip your head up and keep walking straight while looking
up
After 3 more steps, tip your head down, keep walking straight while looking down
Continue alternating looking up and down every 3 steps until you have completed 2 repetitions
in each direction.
Pick the category that applies to your patient.
Score Level of function Description
▢ 0 Severe impairment
Performs task with severe disruption of gait (eg, staggers 38.1 cm / 15 in outside 30.48-
cm (12-in) walkway width, loses balance, stops, reaches for wall).
Performs task with moderate change in gait velocity
▢ 1 Moderate impairment
Slows down
Deviates 25.4 –38.1 cm (10 –15 in) outside 30.48-cm (12-in) walkway width but recovers
Can continue to walk.
▢ 2 Mild impairment Performs task with slight change in gait velocity (eg, minor disruption to smooth gait path)
Deviates 15.24 –25.4 cm (6 –10 in) outside 30.48-cm (12-in) walkway width or uses
assistive device.
▢ 3 Normal
Performs head turns with no change in gait
Deviates no more than 15.24 cm (6 in) outside 30.48-cm (12-in) walkway width.
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Gait and pivot turn Instructions: Tell your patient
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.
Pick the category that applies to your patient.
Score Level of function Description
▢ 0 Severe impairment Cannot turn safely, requires assistance to turn and stop.
Turns slowly, requires verbal cueing, or requires several small steps to catch balance
▢ 1 Moderate impairment
following turn and stop.
Pivot turns safely in 3 seconds and stops with no loss of balance, or pivot turns safely
▢ 2 Mild impairment
within 3 seconds and stops with mild imbalance, requires small steps to catch balance.
▢ 3 Normal Pivot turns safely within 3 seconds and stops quickly with no loss of balance.
Step over obstacle Instructions: Tell your patient
Begin walking at your normal speed
When you come to the shoe box, step over it, not around it, and keep walking.
Pick the category that applies to your patient.
Score Level of function Description
▢ 0 Severe impairment
Cannot perform without assistance.
▢ 1 Moderate impairment Is able to step over one shoe box (11.43 cm / 4.5 in total height) but must slow down and
adjust steps to clear box safely
May require verbal cueing.
▢ 2 Mild impairment Is able to step over one shoe box (11.43 cm [4.5 in] total height) without changing gait
speed
No evidence of imbalance.
▢ 3 Normal Is able to step over 2 stacked shoe boxes taped together (22.86 cm [9 in] total height)
without changing gait speed
No evidence of imbalance.
Gait with narrow base
Instructions: Tell your patient
of support Walk on the floor with arms folded across the chest, feet aligned heel to toe in tandem for a
distance of 3.6 m / 12 ft
The number of steps taken in a straight line is counted for a maximum of 10 steps.
Pick the category that applies to your patient.
Score Level of function Description
▢ 0 Severe impairment Ambulates less than 4 steps heel to toe or cannot perform without assistance.
▢ 1 Moderate impairment Ambulates 4 –7 steps.
▢ 2 Mild impairment Ambulates 7–9 steps.
▢ 3 Normal Is able to ambulate for 10 steps heel to toe with no staggering.
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Gait with eyes closed Instructions: Tell your patient
Walk at your normal speed
Pick the category that applies t
Score Level of function Description
Cannot walk 6 m (20 ft)
▢ 0 Severe impairment
Severe gait deviations o
Deviates greater than 38 ot
attempt task.
Walks 6 m (20 ft)
▢ 1 Moderate impairment
Slow speed
Abnormal gait pattern
Evidence for imbalance
Deviates 25.4 –38.1 cm
Requires more than 9 se
Walks 6 m (20 ft)
▢ 2 Mild impairment
Uses assistive device
Slower speed
Mild gait deviations
Deviates 15.24 –25.4 cm
Ambulates 6 m (20 ft) in
Walks 6 m (20 ft)
▢ 3 Normal
No assistive devices
Good speed
No evidence of imbalan
Normal gait pattern
Deviates no more than 1
Ambulates 6 m (20 ft) in
Ambulating backwards Instructions: Tell your patient
Walk backwards until I tell y
Pick the category that applies t
Score Level of function Description
▢ 0 Severe impairment
Cannot walk 6 m (20 ft)
Severe gait deviations o
Deviates greater than 38 ot
attempt task.
▢ 1 Moderate impairment Walks 6 m (20 ft)
Slow speed
Abnormal gait pattern
Evidence for imbalance
Deviates 25.4 –38.1 cm
▢ 2 Mild impairment Walks 6 m (20 ft)
Uses assistive device
Slower speed
Mild gait deviations
Deviates 15.24 –25.4 cm
Walks 6 m (20 ft)
▢ 3 Normal
No assistive devices
Good speed
No evidence for imbalan
Normal gait pattern
Deviates no more than 1
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Steps Instructions: Tell your patient
Walk up these stairs as you would at home (ie, using the rail if necessary)
At the top turn around and walk down.
Pick the category that applies to your patient.
Score Level of function Description
▢ 0 Severe impairment Cannot do safely.
▢ 1 Moderate impairment Two feet to a stair; must use rail.
▢ 2 Mild impairment Alternating feet, must use rail.
▢ 3 Normal Alternating feet, no rail.
Total score: / 30
Note: An FGA cutoff score of less than or equal to 22/30 is effective in classifying fall risk in older adults and predicting unexplained falls
in community-dwelling older adults.
Reference
W risley, 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. https://doi.org/10.2522/ptj.20090069
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