Functional Gait Assessment - XML Representation - Smart Bear Implementation Guide v3.4.1

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
: Functional Gait Assessment - XML Representation

Draft as of 2024-09-17
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<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="FGAQuestionnaire"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Questionnaire FGAQuestionnaire</b></p><a name="FGAQuestionnaire"> </a><a name="hcFGAQuestionnaire"> </a><a name="FGAQuestionnaire-en-US"> </a><b>Structure</b><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description &amp; Constraints</a><span style="float: right"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> FGAQuestionnaire</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Functional Gait Assessment</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">https://smart-bear.eu/fhir/Questionnaire/FGAQuestionnaire#3.4.1</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.0" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> 0</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">GAIT 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.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.0">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.1" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> 1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">CHANGE 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.</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.1">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.2" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> 2</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">GAIT 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.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.2">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.3" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> 3</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">GAIT 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.</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.3">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.4" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> 4</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">GAIT 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.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.4">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.5" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> 5</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">STEP 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.</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.5">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.6" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> 6</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">GAIT 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.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.6">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.7" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> 7</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">GAIT 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.</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.7">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.8" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> 8</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">AMBULATING BACKWARDS. Instructions: Walk backwards until I tell you to stop. Grading: Mark the highest category that applies.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.8">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.9" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> 9</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">STEPS. 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.</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.9">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" id="item.score" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-integer.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="integer" class="hierarchy"/> score</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name="opt-item.0"> </a><p><b>Answer options for 0 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitLevelSurface#3 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitLevelSurface#2 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitLevelSurface#1 (&quot;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).&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitLevelSurface#0 (&quot;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.&quot;)</li></ul><a name="opt-item.1"> </a><p><b>Answer options for 1 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitSpeed#3 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitSpeed#2 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitSpeed#1 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitSpeed#0 (&quot;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. &quot;)</li></ul><a name="opt-item.2"> </a><p><b>Answer options for 2 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitHorizontalHeadTurns#3 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitHorizontalHeadTurns#2 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitHorizontalHeadTurns#1 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitHorizontalHeadTurns#0 (&quot;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).&quot;)</li></ul><a name="opt-item.3"> </a><p><b>Answer options for 3 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitVerticalHeadTurns#3 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitVerticalHeadTurns#2 (&quot;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. &quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitVerticalHeadTurns#1 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitVerticalHeadTurns#0 (&quot;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).&quot;)</li></ul><a name="opt-item.4"> </a><p><b>Answer options for 4 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitPivotTurns#3 (&quot;Normal—Pivot turns safely within 3 seconds and stops quickly with no loss of balance.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitPivotTurns#2 (&quot;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. &quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitPivotTurns#1 (&quot;Moderate impairment—Turns slowly, requires verbal cueing, or requires several small steps to catch balance following turn and stop.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitPivotTurns#0 (&quot;Severe impairment—Cannot turn safely, requires assistance to turn and stop.&quot;)</li></ul><a name="opt-item.5"> </a><p><b>Answer options for 5 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAStepsOverObstacle#3 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAStepsOverObstacle#2 (&quot;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. &quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAStepsOverObstacle#1 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAStepsOverObstacle#0 (&quot;Severe impairment—Cannot perform without assistance.&quot;)</li></ul><a name="opt-item.6"> </a><p><b>Answer options for 6 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitNarrowBase#3 (&quot;Normal—Is able to ambulate for 10 steps heel to toe with no staggering.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitNarrowBase#2 (&quot;Mild impairment—Ambulates 7–9 steps.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitNarrowBase#1 (&quot;Moderate impairment—Ambulates 4–7 steps.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitNarrowBase#0 (&quot;Severe impairment—Ambulates less than 4 steps heel to toe or cannot perform without assistance.&quot;)</li></ul><a name="opt-item.7"> </a><p><b>Answer options for 7 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitEyesClosed#3 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitEyesClosed#2 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitEyesClosed#1 (&quot;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).&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAGaitEyesClosed#0 (&quot;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.&quot;)</li></ul><a name="opt-item.8"> </a><p><b>Answer options for 8 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAAmbulatingBackwards#3 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAAmbulatingBackwards#2 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAAmbulatingBackwards#1 (&quot;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.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGAAmbulatingBackwards#0 (&quot;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.&quot;)</li></ul><a name="opt-item.9"> </a><p><b>Answer options for 9 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGASteps#3 (&quot;Normal—Alternating feet, no rail&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGASteps#2 (&quot;Mild impairment—Alternating feet, must use rail.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGASteps#1 (&quot;Moderate impairment—Two feet to a stair; must use rail.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FGASteps#0 (&quot;Severe impairment—Cannot do safely.&quot;)</li></ul></div>
  </text>
  <url value="https://smart-bear.eu/fhir/Questionnaire/FGAQuestionnaire"/>
  <version value="3.4.1"/>
  <name value="FGAQuestionnaire"/>
  <title value="Functional Gait Assessment"/>
  <status value="draft"/>
  <date value="2024-09-17T08:57:54+02:00"/>
  <description value="Functional Gait Assessment"/>
  <item>
    <linkId value="0"/>
    <text
          value="GAIT 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."/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitLevelSurface"/>
        <code value="3"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitLevelSurface"/>
        <code value="2"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitLevelSurface"/>
        <code value="1"/>
        <display
                 value="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)."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitLevelSurface"/>
        <code value="0"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="1"/>
    <text
          value="CHANGE 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."/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitSpeed"/>
        <code value="3"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitSpeed"/>
        <code value="2"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitSpeed"/>
        <code value="1"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitSpeed"/>
        <code value="0"/>
        <display
                 value="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. "/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="2"/>
    <text
          value="GAIT 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."/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitHorizontalHeadTurns"/>
        <code value="3"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitHorizontalHeadTurns"/>
        <code value="2"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitHorizontalHeadTurns"/>
        <code value="1"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitHorizontalHeadTurns"/>
        <code value="0"/>
        <display
                 value="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)."/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="3"/>
    <text
          value="GAIT 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."/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitVerticalHeadTurns"/>
        <code value="3"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitVerticalHeadTurns"/>
        <code value="2"/>
        <display
                 value="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. "/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitVerticalHeadTurns"/>
        <code value="1"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitVerticalHeadTurns"/>
        <code value="0"/>
        <display
                 value="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)."/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="4"/>
    <text
          value="GAIT 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."/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitPivotTurns"/>
        <code value="3"/>
        <display
                 value="Normal—Pivot turns safely within 3 seconds and stops quickly with no loss of balance."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitPivotTurns"/>
        <code value="2"/>
        <display
                 value="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. "/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitPivotTurns"/>
        <code value="1"/>
        <display
                 value="Moderate impairment—Turns slowly, requires verbal cueing, or requires several small steps to catch balance following turn and stop."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitPivotTurns"/>
        <code value="0"/>
        <display
                 value="Severe impairment—Cannot turn safely, requires assistance to turn and stop."/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="5"/>
    <text
          value="STEP 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."/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAStepsOverObstacle"/>
        <code value="3"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAStepsOverObstacle"/>
        <code value="2"/>
        <display
                 value="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. "/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAStepsOverObstacle"/>
        <code value="1"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAStepsOverObstacle"/>
        <code value="0"/>
        <display
                 value="Severe impairment—Cannot perform without assistance."/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="6"/>
    <text
          value="GAIT 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."/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitNarrowBase"/>
        <code value="3"/>
        <display
                 value="Normal—Is able to ambulate for 10 steps heel to toe with no staggering."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitNarrowBase"/>
        <code value="2"/>
        <display value="Mild impairment—Ambulates 7–9 steps."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitNarrowBase"/>
        <code value="1"/>
        <display value="Moderate impairment—Ambulates 4–7 steps."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitNarrowBase"/>
        <code value="0"/>
        <display
                 value="Severe impairment—Ambulates less than 4 steps heel to toe or cannot perform without assistance."/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="7"/>
    <text
          value="GAIT 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."/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitEyesClosed"/>
        <code value="3"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitEyesClosed"/>
        <code value="2"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitEyesClosed"/>
        <code value="1"/>
        <display
                 value="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)."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAGaitEyesClosed"/>
        <code value="0"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="8"/>
    <text
          value="AMBULATING BACKWARDS. Instructions: Walk backwards until I tell you to stop. Grading: Mark the highest category that applies."/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAAmbulatingBackwards"/>
        <code value="3"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAAmbulatingBackwards"/>
        <code value="2"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAAmbulatingBackwards"/>
        <code value="1"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/FGAAmbulatingBackwards"/>
        <code value="0"/>
        <display
                 value="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."/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="9"/>
    <text
          value="STEPS. 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."/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/FGASteps"/>
        <code value="3"/>
        <display value="Normal—Alternating feet, no rail"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/FGASteps"/>
        <code value="2"/>
        <display value="Mild impairment—Alternating feet, must use rail."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/FGASteps"/>
        <code value="1"/>
        <display
                 value="Moderate impairment—Two feet to a stair; must use rail."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/FGASteps"/>
        <code value="0"/>
        <display value="Severe impairment—Cannot do safely."/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="score"/>
    <type value="integer"/>
    <required value="true"/>
  </item>
</Questionnaire>