A. General Categories
1. Variability - a measure of inconsistency and arrhythmicity
in steps and arm movements
0 = Fluid and predictably paced limb
movements.
1 = Occasional interruptions (changes
in velocity) approximately < 25% of the time.
2 = Unpredictability of rhythm of
movement > 25% of the time.
3 = Random timing of limb movements.
2. Guardedness -- hesitancy, slowness, diminished propulsion
and lack of commitment stepping
and arm swing.
0 = Good forward momentum and lack of
apprehension in propulsion.
1 = Center of gravity of head, arms
and trunk (HAT) projects only slightly in front of push off, but still good arm - leg coordination.
2 = HAT held over anterior aspect of
foot, and some moderate loss of smooth reciprocation.
3 = HAT held over rear aspect of
stance phase foot, and great tentativeness in stepping.
3. Weaving -- an irregular line of progression.
0 = Straight line of progress on
frontal view.
1 = Single deviation from straight
line of progression.
2 = Two to three deviations from
straight line of progression.
3 = Four or more deviations from
straight line of progression.
4. Waddling -- A broad based gait characterized by excessive
truncal crossing of the midline and
bending.
0 = Narrow base of support and body
held nearly vertically over feet.
1 = Slight separation of medial
aspects of feet and just perceptible lateral movements of head
trunk.
2 = 3" to 4" separation of
feet and obvious bending of trunk to side so that cog of head lies well over
ipsilateral stance foot.
5. Staggering -- sudden and unexpected laterally directed
partial losses of balance.
0 = No losses of balance to side.
1 = A single lurch to the side.
2 = Two lurches to the side.
3 = Three or more lurches to the side.
B. Lower Extremity Categories
1. Percent of time in swing -- loss of percentage in the gait
cycle constituted by the swing phase.
0 = Approximately 3:2 ratio of
stance:swing.
1 = 1:1 or less ratio of stance:swing.
2 = Markedly prolonged stance phase
but with some obvious swing time remaining.
3 = Barely perceptible portion of
cycle spent in swing phase.
2. Foot Contact -- the degree to which the heel
strikes the ground before the forefoot.
0 = Very obvious angle of impact of
heel on ground.
1 = Barely visible contact of heel
before forefoot.
2 = Entire foot lands on ground.
3 = Anterior aspect of foot strikes
ground before heel.
3. Hip ROM -- the degree of loss of hip ROM seen during a
gait cycle.
0 = Obvious angulation of thigh
backwards during double support (~ 10 deg.)
1 = Just barely visible angulation of
thigh backwards from vertical.
2 = Thigh in line with vertical
projection from ground.
3 = Thigh angled forward from vertical
at maximum posterior excursion.
4. Knee ROM -- the degree of loss of knee ROM seen during the
gait cycle.
0 = Knee moves from complete extension
at heel strike (and late stance) to 70 or nearly 90 deg during swing.
1 = Slight bend in knee seen at
heel strike and late stance and maximal flexion at midswing is closer to 45 deg.
than 90 deg.
2 = Knee flexion at late stance more
obvious than at heel strike, very little clearance seen for toe during swing.
3 = Toe appears to touch ground during
swing, knee flexion appears constant durng stance, and knee angle during stance,
and knee angle during swing appears 45 deg or less.
C. Trunk, Head and Upper Extremity Categories
1. Elbow Extension -- a measure of the decrease in
elbow range of motion.
0 = large peak to peak excursion of
forearm (approximately 20 deg.), with distinct maximal flexion at end of
anterior trajectory.
1 = 25 deg. decrement of extension
during maximal posterior excursion of upper extremity.
2 = almost no change in elbow angle.
3 = no apparent change in elbow angle
(held in flexion).
2. Shoulder Extension -- a measure of the decrease in
shoulder range of motion.
0 = clearly seen movement of upper
arm anterior (15 deg) and posterior ( 20 deg) to vertical axis of trunk.
1 = shoulder flexes slightly anterior
to vertical axis.
2 = shoulder comes only to
vertical axis or slightly posterior to during flexion.
3 = shoulder stays well behind
vertical axis during entire excursion.
3. Shoulder Abduction -- a measure of pathological increase
in shoulder range of motion laterally.
0 = shoulders held almost parallel to
trunk.
1 = shoulders held 5 to 10 deg.
to side.
2 = shoulders held 10 to 20
deg. to side.
3 = shoulders held greater than
20 deg. to side.
4. Arm - Heel strike Snychrony -- the extent to which the
contralateral movements of an arm and leg are out of phase.
0 = good temporal conjunction of arm
and contralateral leg at apex of shoulder and hip excursions all of the time.
1 = arm and leg slightly out of
phase 25% of the time.
2 = arm and leg moderately out
phase 25 - 50% of the time.
3 = little or no temporal
cadence of arm and leg.
5. Head Held Forward -- a measure of the pathological forward
projection of the head relative to the trunk.
0 = earlobe vertically aligned with
shoulder tip.
1 = earlobe vertical projection
falls 1" anterior to shoulder tip.
2 = earlobe vertical projection
falls 2" anterior to shoulder tip.
3 = earlobe vertical projection
falls 3" anterior to shoulder tip.
6. Shoulders Held Elevated -- the degree to which the
scapular girdle is held higher than normal.
0 = tip of shoulder (acromion)
markedly below level of chin ( 1 - 2").
1 = tip of shoulder slightly
behind level of chin.
2 = tip of shoulder at level of chin.
3 = tip of shoulder above level
of chin.
7. Upper Trunk Flexed Forward -- a measure of kyphotic
involvement of the trunk.
0 = very gentle thoracic convexity,
cervical spine flat, or almost flat.
1 = emerging cervical curve,
more distant thoracic convexity.
2 = anterior concavity at
mid chest level apparent.
3 = anterior concavity at mid
chest level very obvious.
> 9 = at risk for falling.