AMPUTEE MOBILITY PREDICTOR ASSESSMENT TOOL AMPnoPRO
Initial instructions: Testee is seated in a hard chair 40-50cm height with arms. The following maneuvers are tested 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 testee is uncertain of 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:
1.Sitting Balance
Sit forward without backrest, with arms
folded across chest for 60s.
2.Sitting reach
Reach forwards and grasp the ruler using
preferred arm (Tester holds ruler 26cm
beyond extended arm midline to the sternum,
or against the wall, intact foot midline)
3.Chair to chair transfer 90
Chair height between 40-50cm , allowed to
use aid but no armrests
4.Arises from chairsingle effort
Chair height between 40-50cm, tester asks
patient to cross arms over chest. If unable,
uses arms or assistive device
5.Arises from chair-multiple effort
Chair height between 40-50cm, multiple
efforts allowed without penalty
6. Immediate standing Balance(1st
5 secs)
Standing on one leg, timing commences at
initial hip extension
7. Standing balance :30seconds
1st attempt do not use arm support, if unable,
may use arm support on 2nd attempt
8. (Amypro only)
9. Standing balance: standing
reach
Reach forward and grasp the ruler 26cm
beyond preferred arm midline to the sternum
or against a wall
10. Standing balance: nudge test
Standing on one leg, tester gently pushes on
subjects sternum with palm of hand 3 times
(ONLY if safe to do so)
11. Standing balance: eyes closed
30sec.
Standing balance: picking
object off the floor
12.
Object is placed 30cm in front of patient,
midline
13. Stand to sit
Patient is asked to sit in chair with arms
crossed over chest. If unable, allow use of
hands
14. Initiation of gait
Patient is asked to hop with an aid and
observed for hesitancy
15. Hopping 8 meters
a)
Step length
b)
Foot clearance (discourage
deviations incl. Circumduction,
foot sliding or shuffling
16. Step continuity
17. Turning
180 turn to sit in chair
18. Variable cadence
Patient is asked to hop 4 metres, and repeat a
total of 4 times. Speeds are to vary from slow,
fast, fast and then slow (ONLY if safe to do
so)
DATE:
TIME:
COMMENTS
Cannot sit upright independently for 60s
Can sit upright independently for 60s
=0
=1
Does not attempt
Cannot grasp or required arm support
Reaches forward and successfully grasps item
=0
=1
=2
Cannot do or requires physical assistance
Performs task but unsteady or needs contact
guarding
Performs independently
=0
=1
=2
Unable without physical assistance
Able, uses arms/assistive device to help
Able without arms
Unable without physical assistance
Able but requires >1attempts
Able to rise in one attempt
=0
=1
=2
=0
=1
=2
Unable
Able, but requires use of arms for support
Able without arm support
=0
=1
=2
Unable
Able, but requires use of arms for support
Able without arm support
=0
=1
=2
Unable
Able, but requires use of arms for support
Able without arm support
=0
=1
=2
Begins to fall, needs catching
catches self using arms for support
Steady, toes come up for equilibrium reaction
=0
=1
=2
Unsteady or uses arm support
Steady without arm support
=0
=1
Unable
Able, but requires use of arms for support
Able without arm support
=0
=1
=2
Unable, or falls into chair
Able, but uses arms for support
Able, without use of arms
=0
=1
=2
Any hesitancy or multiple attempts to start
No hesitancy
a) Does not advances 30cm on each hop
Advances minimum of 30cm each hop
=0
=1
=0
=1
b) Unable to clear foot without deviations
Clears foot on every step
=0
=1
Stopping or discontinuity between hops
Hops appear continuous
Unable to turn without physical assistance
No assistance, 4 or more hops to turn
No assistance, 3 or less hops to turn
Unable to vary cadence
Able to vary cadence, but asymmetrical step
lengths used or balance compromised
Able without asymmetry or balance
compromise
=0
=1
=0
=1
=2
=0
=1
=2
The patient is asked to hop over an obstacle
10cm high
Unable
Able, but catches foot or appears unsafe
Able, safe and independant
=0
=1
=2
20. Stairs
Ascending;
Unable
Able using the rail
Able without the rail
=0
=1
=2
Descending; Unable
Able using the rail
Able without the rail
=0
=1
=2
Bed bound
Wheelchair
Frame
Crutches
=0
=1
=2
=3
19. Hopping over an obstacle
Patient is asked to ascend and descend at least
2 steps without holding the rail using
crutches. If unable, patient may use the rail.
21. Assistive device selection
Score ___/39
K Classification
AMPnoPRO score
Key AMP Tasks
K0
K1
Items 1,2,3,4,5,6,7
Ability to sit or stand without difficulty
Items 4,6,7,9,10,13,14
Able to sit to stand
Moderate standing balance
Cant displace COM over BOS
Initiates gait, possibly hesitant
Uses an assistive device
Probably low endurance
K2
K3
K4
Items 7,9,10,15,16,17
Able to maintain standing balance
Ability for limited displacement of COM over BOS
Able to maintain balance with assistance when nudged
Able to take a full stride with at least one foot
Maintains step continuity and can complete a 3 step
turn without intervention
Items 9,10,12,15,16,17,19,20
Ability to maintain single limb balance
Able to displace COM without difficulty
Able to maintain balance without assistance when
nudged
Able to alter COM and correct without difficulty
Gait demonstrates equal strides, good continuity,
varied cadence
Ability to turn independently with less than 3 steps
Able to step over obstacles and climb stairs
Items 9,15,16,17,18,19,20
Ability to maintain single limb balance with both legs
Able to perform most tasks at the highest level with
good balance
Gait is symmetrical with the ability to clearly vary
cadence and negotiate turns, obstacles and stairs
independently
