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AMPUTEE MOBILITY PREDICTOR ASSESSMENT TOOL – AMPnoPRO Flipbook PDF
AMPUTEE MOBILITY PREDICTOR ASSESSMENT TOOL – AMPnoPRO NAME 1. Sitting Balance Sit forward without backrest, with arms fo
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AMPUTEE MOBILITY PREDICTOR ASSESSMENT TOOL – AMPnoPRO Instructions: Testee is seated in a hard chair 40-50cm height with arms. The following maneuvers are tested with or without the prosthesis. Advise the person of each task or group of tasks prior to performance. Please avoid unnecessary chatter throughout the test and no task should be performed if either the tester or tesee is uncertainof a safe outcome. One attempt only per item. Maximum of 2 days allowed to complete assessment. The right limb is:
PF
TT
KD
TF
HD
intact
The left limb is:
PF
TT
KD
TF
HD
intact
NAME
ASSESSOR
WITHOUT PROSTHESIS WITH PROSTHESIS DATE
TIME COMMENTS
1. Sitting Balance
Cannot sit upright independently for 60 sec.
0
Sit forward without backrest, with arms folded across chest for 60 sec.
Can sit upright independently for 60 sec.
1
2. Sitting reach
Does not attempt
0
Reach forward and grasp the ruler using preferred arm (Tester holds ruler 26 cm beyond extended arm midline to the sternum, or against the wall foot midline)
Cannot grasp or required arm support
1
Reaches forward and successfully grasps item
2
3. Chair to chair transfer 90 degrees
Cannot do or requires physical assistance Performs task but unsteady or needs contact Performs independently
0 1 2
Chair height between 40-50cm - ask patient to cross arms over chest. If unable, uses arms or assistive device
Unable without physical assistance Able, uses arms/assistive device to help Able without arms
0 1 2
5. Arises from chair-multiple effort
Unable without physical assistance
0
Able but requires >1 attempts
1
Able to rise in one attempt
2
Unable Able, but requires use of arms for support Able without arm support
0 1 2
1st attempt do not use arm support, if unable, may use arm support on 2nd attempt
Unable Able, but requires use of arms for support Able without arm support
0 1 2
8a. Single limb standing balance (Sound limb)
Unsteady
0
Steady, uses walking aid or otherr support for 30 sec.
1
Chair height between 40-50cm, tester asks
2
Unsteady
0
Steady, uses walking aid or otherr support for 30 sec.
1
Chair height between 40-50cm, tester asks
2
Reach forward and grasp the ruler 26cm beyond preferred arm midline to the sternum or against a wall
Unable Able, but requires use of arms for support Able without arm support
0 1 2
10. Standing balance: nudge test
Begins to fall, needs catching Catches self using arms for support
0 1
Steady, toes come up for equilibrium reaction
2
Unsteady or uses arm support
0
Steady without arm support
1
Unable Able, but requires use of arms for support Able without arm support
0 1 2
Patient is asked to sit in chair with arms crossed over chest - if unable, allow use of hands
Unable, or falls into chair Able, but uses arms for support Able, without use of arms
0 1 2
14. Initiation of gait
Any hesitancy or multiple attempts to start
0
No hesitancy
1
Chair height between 40-50cm , allowed to use aid but no armrests - either direction is allowed
4. Arises from chair–single effort
Chair height between 40-50cm - ask patient to rise from chair - if attempt from No. 4 was without arms, then ignore and allow another attempt without penalty
6. Immediate standing Balance (1st 5 secs.) Standing balance, timing commences at initial hip extension
7. Standing balance :30 seconds
Single limb stance balance (Stopwatch) - Time the duration of single limb standing on the sound limb up to 30 secs. - Grade quality not time
8b. Single limb standing balance (Prosthesis) Single limb stance balance (Stopwatch) - Time the duration of single limb standing on the prosthetic limb up to 30 secs. - Grade quality not time
9. Standing balance: standing reach
Standing on one leg, tester gently pushes on subject’s sternum with palm of hand 3 times (ONLY if safe to do) Patient at maximum position # 7
11. Standing balance: eyes closed 30 sec. Eyes closed - if support is required, grade as unsteady Patient at maximum position # 7
12. Standing balance: picking object off floor Picking up objects off the floor - pick up a pencil off the floor placed midline 26cm in front of foot
13. Stand to sit
Patient is asked to initiate gait - immediately after told to “go” - observed for hesitancy
AMPUTEE MOBILITY PREDICTOR ASSESSMENT TOOL – AMP Continued......................
COMMENTS
15a. Step length & height - sound limb
Does not advance 30cm on each hop.
0
Hop a distance of 8 meters as safely as possible - speeds may vary from slow to fast, fast to slow, varying cadence
Advances minimum of 30cm each hop
1
Does not advance 30cm on each hop.
0
Advances minimum of 30cm each hop
1
Unable to clear foot without deviations
0
Clears foot on every step
1
15d. Step length & height - prosthetic limb
Unable to clear foot without deviations
0
Hop a distance of 8 meters as safely as possible - speeds may vary from slow to fast, fast to slow, varying cadence
Clears foot on every step
1
16. Step continuity Hop a distance of 8 meters as safely as possible - speeds may vary from slow to fast, fast to slow, varying cadence
Stopping or discontinuity between hops
0
Hops appear continuous
1
17. Turning - 180 180 degree turn to sit in chair
Unable to turn without physical assistance No assistance, 4 or more hops to turn No assistance, 3 or less hops to turn
0 1 2
18. Variable cadence
Unable to vary cadence
0
Able to vary cadence, but asymmetrial step
1
Able without asymmetry or balance compromise
2
Unable Able, but catches foot or appears unsafe Able, safe and independent
0 1 2
Patient is asked to ascend and descend at least 2 steps with only crutches. If unable - use a handrail
Unable Able using the rail Able without the rail
0 1 2
20. Stairs - Descending
Unable
0
Patient is asked to ascend and descend at least 2 steps with only crutches. If unable - use a handrail
Able using the rail
1
Able without the rail
2
Bed bound Wheelchair Frame Crutches Cane (straight or quad) None
0 1 2 3 4 5
15b. Step length & height - prosthetic limb Hop a distance of 8 meters as safely as possible - speeds may vary from slow to fast, fast to slow, varying cadence
15c. Step length & height - sound limb Hop a distance of 8 meters as safely as possible - speeds may vary from slow to fast, fast to slow, varying cadence
Patient is asked to hop 4 meters and repeat a total of 4 times - speeds are to vary from slow to fast, fast to slow - only if safe to do so
19. Hopping over an obstacle Patient is asked to hop over an obstacle 10 cm high
20. Stairs - Ascending
21. Assistive device selection
Score without prosthesis
0
/43
K-0 K-1 K-2 K-3 K-4
0-8 9-20 21-28 29-36 37-43
Score with prosthesis
0
/47
K-0 K-1 K-2 K-3 K-4
N/A 15-26 27-36 37-42 43-47
Prosthetist
Additional Comments
Date RESET
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