Edinburgh Visual Gait Score for Use in Cerebral Palsy

ExplanatoryNotes
The P&O Clinical Movement DATA software can assist you in calculating the Edinburgh Visual Gait Score
(EVGS).Usetheonscreenmeasurementanddrawingtoolstohelpyoutoevaluateeachitemofthescoreand
entertheresultsintheEVGSpaneonthelefthandsideofthescreen.ThesoftwarewillthengenerateaEVGS
report,withillustrativeimagesfromthevideoifdesired,inPDFformat.

Foot
1. InitialContactinStance
Theheelnormallycontactsfirst.Thetoedescribesthatportionofthefootdistaltothemetatarsophalangeal
joints.Simultaneouscontactwiththeheelandtoecomprisesflatfootcontact.
Observation

Score

Heelcontact

Flatfootcontact

Toecontact

2. HeelLiftinStance
Ifthereisnoheelcontactduringstance,therecanbenoheellift(i.e.,"Noheelcontact").Heelliftnormally
occursbetweenoppositefootlevelandoppositefootcontact("Normal")."Early"heelliftindicatesthatheel
liftprecedestheoppositefootbeinglevelwiththestancefoot."Delayed"heelliftispresentifheelliftoccurs
withorafteroppositefootcontact."Noforefootcontact"describestherareoccasionofacalcaneousfoot
whentheforefootdoesnotcontactduringstance.
Observation

Score

Noforefootcontact

Delayed

Normal

Early

Noheelcontact

3. MaximumAnkleDorsiflexioninStance
Thereisnormalforwardprogressionofthetibialovertheplantedhindfootfromslightplantarflexionatinitial
contacttodorsiflexionatterminalstance.
Describethemaximumangleofdorsiflexionbetweenhindfootandshaftofthetibiaduringstance.
In pathological gait, lack of heel contact may be caused by either excessive plantarflexion of the foot or
excessivekneeflexion.Thetibialhindfootangleisthereforeanalysedirrespectiveofthepositionofthefoot
onthefloor.
Observation

Score

Excessivedorsiflxn(>40df)

Increaseddorsiflxn(2640df)

Normaldorsiflxn(525df)

Reduceddorsiflxn(10pl4df)

Markedplantarflxn(>10pl)

4. HindfootVarus/ValgusinStance
Inthecoronalplane,thenormalhindfootisinneutralorveryslightvalgus.
Observation

Score

Severevalgus(morethan15valgus)

Modvalgus(6to15valgus)

Neutral/slightvalgus(0to5valgus)

Mildvarus(1to10varus)

Severevarus(morethan10varus)

5. FootRotationinStance
ThenormalfootisslightlyexternallyrotatedrelativetotheKneeProgressionAngle(KPA,i.e.,thedirectionin
whichthekneepointsduringgait).
Observation

Score

Markedext>KPA(by>40)

Modext>KPA(by2140)

SImoreextthanKPA(by020extn)

Modint>KPA(by125)

Markedint>KPA(by>25)

6. ClearanceinSwing
Thewholefootincludingthetoeshouldclearthefootandnotmakecontactduringswingphase.
"None" should be recorded if there is continuous contact between some part of the foot and the floor
throughoutswingphase.
"Reduced"indicatesthatthereisashortenedbutdefiniteperiodofclearanceduringsomepartoftheswing
phasebetweenthewholefootandthefloor.
"Full"ornormalclearanceiswhenthefootdoesnottouchatallinswing;however,normalclearanceisavery
smallamount.
"Highsteps"describesexcessiveliftingofthefootfromthefloor.Whenthereisreducedclearancefollowed
byhighstepping,circleboth,givingascoreof2forthiscombinationoffeatures.
Observation

Score

HighSteps

Full

Reduced

None

7. MaximumAnkleDorsiflexioninSwing
Theankleisnormallyapproximatelyneutralinswing,butveryslightplantarflexion(5)isacceptable.
Observation

Score

Excessivedorsiflxn(>30df)

Increaseddorsiflxn(1630df)

Normaldorsiflxn(15df5pl)

Modplantarflxn(620pl)

Markedplantarflxn(>20pl)

Knee
8. KneeProgressionAngleinMidStance
Thekneenormallypointsforwardduringgait.Recordthepositioninwhichthekneeappearstopointduring
most of the stance phase. When either internal or external rotation is present but the whole knee cap is
visible,score1.Whenrotationispresenttosuchanextentthatthekneecapispartiallyoutofview(external
orinternal,partcapvisible),score2.
Observation

Score

External,partkneecapvisible

External,allkneecapvisible

Neutral,kneecapmidline

Internal,allkneecapvisible

Internal,partkneecapvisible

9. PeakExtensionStance
Thekneeapproachesfullextensioninterminalstance.Inpathologicalgait,thekneemayremainmoreflexed
throughoutstance.Alternatively,hypertensioncanoccurasfemoralprogressionproceedsoveranarrested
tibia.
Observation

Score

Severeflexn(>25)

Modflexn(1625)

Normal(015flexn)

Modhyperextn(110)

Severehyperextn(<10)

10.TerminalSwingPosition
Thekneeisnormallyinslightflexionimmediatelybeforeheelstrike.
Observation

Score

Severeflexn(>30)

Modflexn(1630)

Normal(515flxn)

Modoverextn(4flx10xtn)

Severehyperextn(>10xtn)

11.PeakKneeFlexioninSwing
Thenormalrangeis50to70.
Observation

Score

Severelyincreased(>85flxn)

Modincreased(7185flxn)

Normal(5070flxn)

Modreduced(3549flxn)

Severelyreduced(<35flxn)

Hip
12.PeakHipExtensioninStance
Thehipnormallyextendsinstancetobetweenneutraland20ofextension.
Observation

Score

Modflexn(115flxn)

Modflexn(115flxn)

Normal(020extn)

Modhyperextn(2135extn)

Markedhyperextn(>35)

13.PeakHipFlexionduringSwing
Normalflexionisbetween25and45.
Observation

Score

Markedincrease(>60flxn)

Increasedflexn(4660flxn)

Normalflexn(2545flxn)

Reducedflexn(1024flxn)

Severelyreduced(<10flxn)

Pelvis
14.ObliquityatMidStance
The pelvis normally drops slightly on the opposite side during loading, becoming level by terminal stance.
Estimatethepositioninmidstance."Up"and"down"refertotheposition oftheASISonthestanceside,
relativetotheoppositesideASIS.
Observation

Score

Markeddown(>10)

Moddown(110)

Normalobliquity(05up)

Modup(615)

Markedup(>15)

15.PelvicRotationatMidStance
In mid stance, the pelvis should be at approximately neutral rotation, between 5 backward rotation
(retraction)ofthestanceleg,and10forwardrotation(protraction).
Observation

Score

Markedretraction(>15)

Modretraction(615)

Normal(5retr10pro)

Modprotraction(1120)

Severeprotraction(>20)

Trunk
16.PeakSagittalPositioninStance
Thetrunkiserectduringstanceandswingphases.Suggestedvalueshereare:
0

=Ver calto5forwardorbackward
1

=morethan5backwardsorbetween6and15forward
2

=morethan15forward
Observation

Score

Marked

Moderate

Normal

Reduced

17.MaximumLateralShift
Normallythetrunkdisplaceslaterallyapproximately25mmduringstance,towardsthestanceleg.
"Excessive"thoracicshiftlaterallyorlateralflexionshouldbeconsideredwhenrecordingobservations.
"Reduced"describesthosecasesinwhichthetrunkremainsleaningovertheswingingleg.
Observation

Score

Excessive

Normal

Reduced

Summary
Totalallthecores:
?Initialcontact
?Heellift
?Maxankledorsiinstance
?Hindfootvarus/valgus
?Footrotation
?Clearanceinswing
?Maxankledorsiinswing
?Kneeprogressionangle
?Peakkneeextninstance
?Kneeextninterminalswing
?Peakkneeflexninswing
?Peakhipextninstance
?Peakhipflexninswing
?Maxpelvicobliquityinmidstance
?Pelvicrotationinmidstance
?Peaksagittaltrunkposition
?Maxlateralshiftoftrunk

??TOTAL