Q&A: Gait Assessment for Falls Risk
Question: I work in home care and have been asked to begin using two falls risk assessment tools, the DGI-Dynamic Gait Index and the Tinetti Performance Oriented Mobility Assessment.
These assessments have gait components: is gait assessment/training and the use of these tools within the occupational therapy scope of practice?
Answer: The foundations of a profession's scope of practice are inclusion in the educational curriculum, a history of application in practice, and language in the legally defined scope of practice in the state licensure law. As a first step, I suggest you check your state licensure law to see if there is any language related to gait assessment/training in that document. Language in practice acts tends to be quite broad, however, so you may not see anything that specific. You can also check with the licensure board to get their interpretation: ultimately, the board has authority about what is/is not in a profession's scope of practice.
While OTs do work with patients on functional mobility, specific gait assessment and training is primarily in the realm of PT. The educational programs in OT do not generally cover this topic in any depth. That said, falls risk assessment is an increasingly common reportable performance measure, and the Centers for Medicare & Medicaid Services does allow OTs to screen for this and report. These particular assessments appear to be fairly generic and may be done by other health professionals. In fact, OTs do use the Tinetti and some other assessments with some frequency because they allow for reporting on the balance component in an objective way. They measure static and dynamic balance and are not discipline specific. The focus of reporting should be on the balance component. OTs would likely prefer functional assessments, but these falls risk tools are widely used. However, competence to administer them, as with any assessment or intervention, is an ethical imperative. You should seek appropriate continuing education and/or training to ensure competency and a comfort level before administering them.
If, in your observations, the patient appears to truly have gait issues, refer him or her to PT. From an OT perspective, functional mobility is incorporated into interventions as it relates to occupational performance of activities that are necessary or meaningful to the patient (e.g., ambulating to the bathroom for ADLS with whatever gait aids are appropriate/necessary; mobility around the kitchen for IADLs related to preparing a meal; working on balance, standing endurance, etc.).
Additional information and AOTA resources related to falls prevention are available here.