GAITRite

Purpose

The GAITRite system was developed in response to the need for an objective way to quantify gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
and ambulatory status. The GAITRite System measures spatio-temporal parameters of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
such as cadence, step length and velocity, providing clinically relevant information that is useful in devising treatment plans and evaluating treatment outcomes. The system tracks parameters over time and can be used to generate progress and status reports.

In-Depth Review

Purpose of the measure

The GAITRite System was developed in response to the need for an objective way to quantify gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
and ambulatory status. Spatio-temporal parameters of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
, such as cadence, step length and velocity, are recorded and calculated using the GAITRite System and software. The GAITRite System tracks parameters over time and can be used to generate progress and status reports, providing clinically relevant information that is useful in devising treatment plans and evaluating treatment outcomes. While visual assessment of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
is more commonly used clinically, studies have demonstrated poor reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
.

According to producers of the GAITRite system (2010), the system can aid in the following tasks:

• Documentation of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
  patterns prior to any intervention
• Measurement of functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
  immediately following treatment/intervention
• Documentation of the effect of intervention
• Identification of the relationship between objective gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
  parameters and subjective findings
• Refinement of proper alignment and fit of prosthetics & orthotics
• Selection of appropriate assistive devicesAssistive devices are any piece of equipment that you use to make your daily activities easier to perform.
  
• Objective measurement to justify ongoing intervention

Available versions

There are no other available versions.

Features of the measure

Items:

An electronic walkway (61cm wide x 288cm long – additional custom sizes are available), containing a total of 18,432 sensors sensor pads, is connected to the USB port of Windows® XP/Vista/7 personal computer (CIR Systems, Inc., 2010).

What to consider before beginning:

• Assess patients’ balance and gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
  abilities prior to having them walk across the GAITRite walkway, to ensure adequate support is provided during assessment.
• Barefoot testing is not recommended.

Scoring and Score Interpretation:

The GAITRite System provides spatio-temporal parameters of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
; it does not provide a score.

Time:

The setup of the GAITRite System is reported to be time efficient. The GAITRite System administration time is dependent on patient ambulation speed and efficiency.

Training requirements:

The GAITRite System has been reported to yield highly accurate and reliable data regardless of the examiner. However, in order to ensure consistency in testing protocol, the manufacturers of GAITRite System, CIR Systems, offer an Examiner Accreditation course. Examiners who successfully complete the accreditation process are awarded an accreditation certificate valid for a period of 1 year. Do you know how long the course is?
Please contact CIR Systems for further details.

Equipment:

For further information regarding equipment and set-up, please refer to the GAITRite Electronic Walkway Technical Reference guide:
http://www.gaitrite.com/Downloads/GAITRite_Measurement_Definitions.pdf

Alternative Forms of GAITRite

There are no alternative forms of the GAITRite System reported, however there are different model numbers.

Client suitability

Can be used with:

• Patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
• Patients requiring assistive devicesAssistive devices are any piece of equipment that you use to make your daily activities easier to perform.
  and ambulatory aids such as crutches, walkers, or canes (GAITRite, 2010).
• Patients utilizing biped and quadruped locomotion (CIR Systems, Inc., 2012).

Should not be used in:

• None reported.

Languages of the measure

The GAITRite system is not a language based assessment tool.

Summary

What does the tool measure?	Spatio-temporal parameters of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. .
What types of clients can the tool be used for?	The GAITRite system can be used with, but is not limited to, clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Is this a screeningTesting for disease in people without symptoms. or assessment tool?	Assessment
Time to administer	The time to administer is dependent on familiarity of system set-up and use, and patient ambulatory status.
Versions	There are no alternative versions.
Other Languages	Not applicable.
Measurement Properties
ReliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .	Test-retest : One study found excellent test re-test reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest . of the GAITRite system among patients with (stage of) strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
ValidityThe degree to which an assessment measures what it is supposed to measure.	Concurrent: One study found moderate to excellent concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.” of the GAITRite system with the Clinical Stride Analyzer in a healthy population.
Floor/Ceiling Effects	No studies have examined the floor or ceiling effects of the GAITRite system in clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Does the tool detect change in patients?	No studies have examined the responsivenessThe ability of an instrument to detect clinically important change over time. of the GAITRite system in clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. However, the GAITRite system has the capacity to track parameters over time and can be used to generate progress and status reports.
Acceptability	There is no placement of devices on the patient allowing the patient to ambulate as close to their usual as possible.
Feasibility	The GAITRite system is portable and can be laid over any flat surface (CIR Systems, Inc., 2010).
How to obtain the tool?	For further information on the GAITRite system, please contact: CIR Systems, Inc 376 Lafayette Ave, Suite 202 Sparta, NJ 07871 Toll Free: (888) 482-2362 Phone: (973) 862-6151 Fax: (973) 862-6451 Email: sales@gaitrite.com

Psychometric Properties

Overview

A literature search was conducted to identify all relevant publications on the psychometric properties of the GAITRite System. One study involving patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., and another involving healthy adults were identified and reviewed for the purposes of this module.

Floor/Ceiling Effects

No studies have investigated the floor or ceiling effects of the GAITRite System in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

Reliability

Internal constancy:
No studies have investigated the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the GAITRite System in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Test-retest:
Kuys, Brauer and Ada (2011) examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the GAITRite System in measuring spatio-temporal parameters of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
(i.e gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
speed, cadence, step length (paretic and non-paretic limb), step time (paretic and non-paretic limb), stance phase as a percentage of the gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
cycle (paretic and non-paretic limb) in a group of 21 people following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. undergoing inpatient rehabilitation. Participants were asked to walk the distance of the GAITRIte walkway two separate times within 48 hours, at a self-selected speed. Test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
was found to be excellent for all spatio-temporal parameters in the overall group (ICC=0.72-0.94), as calculated using Intraclass CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
Coefficient. Patients were also categorized as ‘poor’ and ‘better’ ambulators, using the Motor Assessment Scale score (MAS) (poor: MAS Item 5 score 3 – 4, average gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
speed = 0.54 m/s; better: MAS Item 5 score 5 – 6, average gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
speed = 0.79 m/s). The test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
was found to be stronger for poorer ambulators compared to better ambulators (ICC ≥ 0.57 vs ICC ≥ 0.41). Results of this study indicate that test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the GAITRite System is slightly higher for individuals with more limited mobility.

Intra-rater:
No studies have investigated the intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings.
of the GAITRIte System in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Inter-rater:
No studies have investigated the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the GAITRite System in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

Validity

Content:

No studies have investigated the content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension.
of the GAITRIte System in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

Criterion:

Concurrent:
Bilney, Morris and Webster (2002) compared the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
of the GAITRite System with the Clinical Stride Analyzer (CSA) for quantification of the spatio-temporal gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters (gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
speed, cadence, stride length, single leg support time – right and left, double limb support as a percentage of the gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
cycle – right and left) in 25 healthy subjects. The CSA was selected as the criterion measure due to its wide clinical use in measuring spatiotemporal parameters of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
. Subjects were asked to walk the GAITRite walkway over three trials at three different speeds: self-selected speed, fast and slow speed. Excellent concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
was found between the two measures for speed, cadence and stride length (ICC=0.99) at self-selected, slow and fast speeds, as calculated using Intraclass Correlation Coefficient (ICC)Intraclass correlation (ICC) is used to measure inter-rater reliability for two or more raters. It may also be used to assess test-retest reliability. ICC may be conceptualized as the ratio of between-groups variance to total variance.. Concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
for quantification of single leg stance phase was found to be moderate to excellent (ICC = 0.52-0.86 across the three gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
speeds); and double limb support as a percentage of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
cycle was also found to have moderate to excellent concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
(ICC = 0.44-0.57) between the two measures.

Predictive:
No studies have investigated the predictive validityA form of criterion validity that examines a measure's ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
of the GAITRIte System in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

Construct:

Convergent/Discriminant:
No studies have investigated the convergent or discriminant validityMeasures that should not be related are not. Discriminant validity examines the extent to which a measure correlates with measures of attributes that are different from the attribute the measure is intended to assess.
of the GAITRite System in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Known Groups:
No studies have investigated the known groups validityKnown groups validity is a form of construct validation in which the validity is determined by the degree to which an instrument can demonstate different scores for groups know to vary on the variables being measured.
of the GAITRite System in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

SensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
/ SpecificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
:
No studies have investigated the sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
/specificity of the GAITRite System in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

Responsiveness:

No studies have investigated the responsivenessThe ability of an instrument to detect clinically important change over time.
of the GAITRite System in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

References

• Bilney, B., Morris, M. & Webster, K. (2003). Concurrent related validity of the GAITRite walkway system for quantification of the spatial and temporal parameters of gait. Gait and Posture, 17, 68-74.
• Kuys, S.S., Brauer, S.G. & Ada, L. (2011). Test-retest reliability of the GAITRite System in people with stroke undergoing rehabiliation. Disability and Rehabilitation, 33 (19-20), 1848. 1853.

See the measure

For further information regarding obtaining a GAITRite system, please contact CIR Systems, Inc.:

CIR Systems, Inc.
376 Lafayette Ave, Suite 202
Sparta, NJ 07871

Toll Free: (888) 482-2362
Phone: (973) 862-6151
Fax: (973) 862-6451
Email: sales@gaitrite.com