Smart Bear Implementation Guide
3.4.1 - ci-build

Smart Bear Implementation Guide - Local Development build (v3.4.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Questionnaire: Functional Gait Assessment

Official URL: https://smart-bear.eu/fhir/Questionnaire/FGAQuestionnaire Version: 3.4.1
Draft as of 2024-09-17 Computable Name: FGAQuestionnaire

Functional Gait Assessment

Generated Narrative: Questionnaire FGAQuestionnaire

Structure
LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. FGAQuestionnaireFunctional Gait AssessmentQuestionnairehttps://smart-bear.eu/fhir/Questionnaire/FGAQuestionnaire#3.4.1
... 0GAIT LEVEL SURFACE. Instructions: Walk at your normal speed from here to the next mark (6 m[20 ft]). Grading: Mark the highest category that applies.1..1choiceOptions: 4 options
... 1CHANGE IN GAIT SPEED. Instructions: 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]). Grading: Mark the highest category that applies.1..1choiceOptions: 4 options
... 2GAIT WITH HORIZONTAL HEAD TURNS. Instructions: 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. Grading: Mark the highest category that applies.1..1choiceOptions: 4 options
... 3GAIT WITH VERTICAL HEAD TURNS. Instructions: 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. Grading: Mark the highest category that applies.1..1choiceOptions: 4 options
... 4GAIT AND PIVOT TURN. Instructions: 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. Grading: Mark the highest category that applies.1..1choiceOptions: 4 options
... 5STEP OVER OBSTACLE. Instructions: Begin walking at your normal speed. When you come to the shoe box, step over it, not around it, and keep walking. Grading: Mark the highest category that applies.1..1choiceOptions: 4 options
... 6GAIT WITH NARROW BASE OF SUPPORT. Instructions: 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 are counted for a maximum of 10 steps. Grading: Mark the highest category that applies.1..1choiceOptions: 4 options
... 7GAIT WITH EYES CLOSED. Instructions: Walk at your normal speed from here to the next mark (6 m[20 ft]) with your eyes closed. Grading: Mark the highest category that applies.1..1choiceOptions: 4 options
... 8AMBULATING BACKWARDS. Instructions: Walk backwards until I tell you to stop. Grading: Mark the highest category that applies.1..1choiceOptions: 4 options
... 9STEPS. Instructions: Walk up these stairs as you would at home (ie, using the rail if necessary). At the top turn around and walk down. Grading: Mark the highest category that applies.1..1choiceOptions: 4 options
... scorenull1..1integer

doco Documentation for this format

Options Sets

Answer options for 0

  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitLevelSurface#3 ("Normal—Walks 6 m (20 ft) in less than 5.5 seconds, 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.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitLevelSurface#2 ("Mild impairment—Walks 6 m (20 ft) in less than 7 seconds but greater than 5.5 seconds, uses assistive device, slower speed, mild gait deviations, or deviates 15.24–25.4 cm (6–10 in) outside of the 30.48-cm (12-in) walkway width.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitLevelSurface#1 ("Moderate impairment—Walks 6 m (20 ft), slow speed, abnormal gait pattern, evidence for imbalance, or 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).")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitLevelSurface#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.")

Answer options for 1

  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitSpeed#3 ("Normal—Able to smoothly change walking speed without loss of balance or gait deviation. Shows a significant difference in walking speeds between normal, fast, and slow speeds. Deviates no more than 15.24 cm (6 in) outside of the 30.48-cm (12-in) walkway width.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitSpeed#2 ("Mild impairment—Is able to change speed but demonstrates mild gait deviations, 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 significant change in velocity, or uses an assistive device.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitSpeed#1 ("Moderate impairment—Makes only minor adjustments to walking speed, or accomplishes a change in speed with significant gait deviations, 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.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitSpeed#0 ("Severe impairment—Cannot change speeds, 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. ")

Answer options for 2

  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitHorizontalHeadTurns#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.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitHorizontalHeadTurns#2 ("Mild impairment—Performs head turns smoothly 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 an assistive device.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitHorizontalHeadTurns#1 ("Moderate impairment—Performs head turns with moderate change in gait velocity, 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.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitHorizontalHeadTurns#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).")

Answer options for 3

  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitVerticalHeadTurns#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.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitVerticalHeadTurns#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. ")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitVerticalHeadTurns#1 ("Moderate impairment—Performs task with moderate change in gait velocity, 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.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitVerticalHeadTurns#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).")

Answer options for 4

  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitPivotTurns#3 ("Normal—Pivot turns safely within 3 seconds and stops quickly with no loss of balance.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitPivotTurns#2 ("Mild impairment—Pivot turns safely in _3 seconds and stops with no loss of balance, or pivot turns safely within 3 seconds and stops with mild imbalance, requires small steps to catch balance. ")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitPivotTurns#1 ("Moderate impairment—Turns slowly, requires verbal cueing, or requires several small steps to catch balance following turn and stop.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitPivotTurns#0 ("Severe impairment—Cannot turn safely, requires assistance to turn and stop.")

Answer options for 5

  • https://smart-bear.eu/fhir/CodeSystem/FGAStepsOverObstacle#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.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAStepsOverObstacle#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. ")
  • https://smart-bear.eu/fhir/CodeSystem/FGAStepsOverObstacle#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.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAStepsOverObstacle#0 ("Severe impairment—Cannot perform without assistance.")

Answer options for 6

  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitNarrowBase#3 ("Normal—Is able to ambulate for 10 steps heel to toe with no staggering.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitNarrowBase#2 ("Mild impairment—Ambulates 7–9 steps.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitNarrowBase#1 ("Moderate impairment—Ambulates 4–7 steps.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitNarrowBase#0 ("Severe impairment—Ambulates less than 4 steps heel to toe or cannot perform without assistance.")

Answer options for 7

  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitEyesClosed#3 ("Normal—Walks 6 m (20 ft), no assistive devices, good speed,no evidence of imbalance, normal gait pattern, deviates no more than 15.24 cm (6 in) outside 30.48-cm (12-in) walkway width. Ambulates 6 m (20 ft) in less than 7 seconds.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitEyesClosed#2 ("Mild impairment—Walks 6 m (20 ft), uses assistive device, slower speed, mild gait deviations, deviates 15.24–25.4 cm (6–10 in) outside 30.48-cm (12-in) walkway width. Ambulates 6 m (20 ft) in less than 9 seconds but greater than 7 seconds.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitEyesClosed#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 30.48-cm (12-in) walkway width.Requires more than 9 seconds to ambulate 6 m (20 ft).")
  • https://smart-bear.eu/fhir/CodeSystem/FGAGaitEyesClosed#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 30.48-cm (12-in) walkway width or will not attempt task.")

Answer options for 8

  • https://smart-bear.eu/fhir/CodeSystem/FGAAmbulatingBackwards#3 ("Normal—Walks 6 m (20 ft), no assistive devices, good speed, no evidence for imbalance, normal gait pattern, deviates no more than 15.24 cm (6 in) outside 30.48-cm (12-in) walkway width.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAAmbulatingBackwards#2 ("Mild impairment—Walks 6 m (20 ft), uses assistive device, slower speed, mild gait deviations, deviates 15.24–25.4 cm (6–10 in) outside 30.48-cm (12-in) walkway width.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAAmbulatingBackwards#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 30.48-cm (12-in) walkway width.")
  • https://smart-bear.eu/fhir/CodeSystem/FGAAmbulatingBackwards#0 ("Severe impairment—Cannot walk 6 m (20 ft) without assistance,severe gait deviations or imbalance, deviates greater than 38.1cm (15 in) outside 30.48-cm (12-in) walkway width or will not attempt task.")

Answer options for 9

  • https://smart-bear.eu/fhir/CodeSystem/FGASteps#3 ("Normal—Alternating feet, no rail")
  • https://smart-bear.eu/fhir/CodeSystem/FGASteps#2 ("Mild impairment—Alternating feet, must use rail.")
  • https://smart-bear.eu/fhir/CodeSystem/FGASteps#1 ("Moderate impairment—Two feet to a stair; must use rail.")
  • https://smart-bear.eu/fhir/CodeSystem/FGASteps#0 ("Severe impairment—Cannot do safely.")