Development and testing of the Gait Assessment and Intervention Tool (G.A.I.T.): A measure of coordinated gait components

Abstract

Recent neuroscience methods have provided the basis upon which to develop effective gait training methods for recovery of the coordinated components of gait after neural injury. We determined that there was not an existing observational measure that was, at once, adequately comprehensive, scored in an objectively-based manner, and capable of assessing incremental improvements in the coordinated components of gait. Therefore, the purpose of this work was to use content valid procedures in order to develop a relatively inexpensive, more comprehensive measure, scored with an objectively-based system, capable of incrementally scoring improvements in given items, and that was both reliable and capable of discriminating treatment response for those who had a stroke. Eight neurorehabilitation specialists developed criteria for the gait measure, item content, and scoring method. In subjects following stroke (>12 months), the new measure was tested for intra- and inter-rater reliability using the Intraclass Correlation Coefficient; capability to detect treatment response using Wilcoxon Signed Ranks Test; and discrimination between treatment groups, using the Plum Ordinal Regression. The Gait Assessment and Intervention Tool (G.A.I.T.) is a 31-item measure of the coordinated movement components of gait and associated gait deficits. It exhibited the following advantages: comprehensive, objective-based scoring method, incremental measurement of improvement within given items. The G.A.I.T. had good intra- and inter-rater reliability (ICC=.98, p=.0001, 95% CI=.95, .99; ICC=.83, p=.007, 95% CI=.32, .96, respectively. The inexperienced clinician who had training, had an inter-rater reliability with an experienced rater of ICC=.99 (p=.0001, CI=.97, .999). The G.A.I.T. detected improvement in response to gait training for two types of interventions: comprehensive gait training (z=-2.93, p=.003); and comprehensive gait training plus functional electrical stimulation (FES; z=-3.3, p=.001). The G.A.I.T. was capable of discriminating between two gait training interventions, showing an additive advantage of FES to otherwise comparable comprehensive gait training (parameter estimate=1.72, p=.021; CI, .25, 3.1).

Spanish Cross‐cultural Adaptation of the Gait Assessment and Intervention Tool

“…have been analyzed in a sample of 29 people with stroke. The scale showed excellent intra‐ and interrater reliability for the total score, moderate correlation of knee flexion at toe‐off (item 26), and peak swing knee flexion (item 27), with data obtained with a tridimensional motion‐capture system proving its validity; and sensitivity to changes after a gait‐training program …”

Developing the Supporting Choice Observational Tool (SCOT): A Formative Assessment Tool to Assist Nursing Home Staff in Realizing Resident Choice

“…Researchers conducted ethnographic observation at CLC1’s site visit and CLC2’s first site visit, using the resulting data to iteratively derive and develop a preliminary draft of the tool. This tool went through developmental testing in CLC2’s second site visit and CLC3’s site visit—a process that has been performed in others’ observational tool development (Daly et al, 2009). Modified Delphi panel consultation helped refine the tool and shed light on the instrument’s face and content validity.…”

Construction and pilot assessment of the Lower Limb Function Assessment Scale

“…Next, the "Upright standing" parts of the Q and T were evaluated against other postural assessments (the PASS (Benaim et al, 1999) and the "transfer" item of the Barthel Index (BI) (Mahoney & Barthel, 1965). For the "Walking" parts of the Q and T, the kinematic scores were evaluated against the Gait Assessment and Intervention Tool (GAIT) by using a two-dimensional video recording system (Daly et al, 2009). The "Walking" activity scores were evaluated against the 10-Meter Walk Test (10-MWT) (Bohannon, 1992), the New Functional Ambulation Classification (NFAC) (Brun et al, 2000) and the RMI (Collen et al, 1991).…”

“…Most assessment tools evaluate the patient in a clinical or laboratory-based examination. Various groups of tools can be identified, with the assessment of (i) kinematics, using visual or instrumental analyses of troubles of each joint or segment of the lower limb during upright standing and walking (Daly et al, 2009;Lord, Halligan, & Wade, 1998;Read, Hazlewood, Hillman, Prescott, & Robb, 2003;Sutherland, 2002), (ii) global performance (e.g. the Functional Reach Test (Smith, Hembree, & Thompson, 2004), the Timed Up and Go Test (Flansbjer, Holmbäck, Downham, Patten, & Lexell, 2005), and walking speed (Kollen, Kwakkel, & Lindeman, 2006) or endurance measurements (Kosak & Smith, 2005)), (iii) abilities (e.g.…”