Appendix V: Amputee Mobility Predictor (AMP) scoring …

1 Standard of Care: Lower Extremity Amputation Copyright 2011 The Brigham and Women s Hospital, Inc., Department of Rehabilitation Services. All Rights Reserved. 36 Appendix V: Amputee Mobility Predictor (AMP) scoring form19 Amputee Mobility Predictor QuestionnaireInitial instructions: Testee is seated in a hard chair with arms. The following maneuvers are tested with or without the use ofthe prosthesis. Advise the person of each task or group of tasks prior to performance. Please avoid unnecessary chatter throughout the test. Safety first, no task should be performed if either the tester or testee is uncertain of a safe outcome. The Right Limb is: - PF - TT - KD - TF - HD - intact. The Left Limb is: - PF - TT - KD - TF - HD Sitting balance: sitforward inachair with arms folded across chest for Sitting reach: reach forward and grasp the ruler. (Tester holds ruler 12in beyond extended arms midline to the sternum.)3. Chair to chair transfer: 2chairs at900.

2 Pt may choose direction and usetheir upper Arises from achair:ask pt to foldarms across chest and stand. Ifunable, use arms orassistive Attemptstoarise from achair (stopwatch ready): ifattemptin no. 4was without arms then ignore andallow another attempt without Immediate standing balance(first 5s): begin Standing balance (30s)(stopwatchready): Foritems nos. 7 & 8, firstattempt iswithout assistive device. Ifsupport isrequired, allow after first Single-limb standing balance(stopwatch ready): time the duration of singlelimb standing onboth thesound and prosthetic limb up to thequality, not the independently for 60s =0 Can sit upright independently for 60s =1 Does notattempt=0 Cannot grasp orrequires arm support =1 Reaches forward and successfully grasps item=2 Cannotdo or requires physical assistance =0 Performs independently, but appears unsteady=1 Performs independently, appears to be steady and safe =2 Unable without help (physical assistance) =0 Able, uses arms/assist device tohelp=1 Able, without using arms =2 Unable without help (physical assistance) =0 Able requires >1 attempt=1 Able to rise 1 attempt=2 Unsteady (staggers, moves foot, sways)

3 =0 Steady using walking aid or other support =1 Steady without walker orother support =2 Unsteady=0 Steady butuses walking aid or other support=1 Standing without support =2 Nonprosthetic sideUnsteady=0 Steady butuses walking aid or other support for 30s =1 Single-limb standing without support for 30s =2 Prosthetic SideSound side secondsUnsteady=0 Steady butuses walking aid or other support for 30s =1 Prosthetic side secondsSingle-limb standing without support for 30s =29. Standing reach: reach forward and grasp the ruler.(Tester holds ruler 12in beyond extended arm(s)midline to the sternum.)Does notattempt=0 Cannot grasp orrequires arm support onassistive=1deviceReaches forward and successfully grasps itemno=2support10. Nudge test (subject at maximum position #7):with feet as closetogether as possible, examiner pushes firmly on subject s sternum with palm ofhand3times (toesshould rise).Begins to fall =0 Staggers, grabs, catches self, or uses assistive device=1 Steady=2 Content has been exerpted from Gailey RS, Roach KE, Applegate EB, et al.

4 The Amputee Mobility Predictor : an instrument to assess determinants of the lower-limb Amputee 's ability to ambulate. Arch Phys Med ;83(5):613-627. Standard of Care: Lower Extremity Amputation Copyright 2011 The Brigham and Women s Hospital, Inc., Department of Rehabilitation Services. All Rights Reserved. 3711. Eyes closed (atmaximum position #7): if support isrequired grade Picking upobjects off the floor (pick up a pencil off the floor placedmidline 12in in front offoot).Unsteady orgrips assistive device=0 Steady without any use ofassistive device=1 Unable to pick up object and return tostanding=0 Performswithsome help (table, chair, walking aid, etc) =1 Performs independently (without helpfrom object orperson) =213. Sitting down: ask pt to fold arms across chest andsit. If unable, usearm orassistive (misjudged distance, falls into chair)=0 Uses arms, assistive device, or not a smooth motion=1 Safe,smoothmotion=214. Initiation of gait (immediately after told to go ).

5 Any hesitancy ormultiple attempts tostart=0 Nohesitancy=115. Step length and height: walk ameasured distance of 12ft twice (upandback). Four scoresare required or 2 scores (a & b) for each leg. Marked deviation is defined as extreme substitute movements to permitclearing the Foot footDoes notadvance aminimum of 12in = 0 Advancesaminimum of 12in =1 Prosthesis SoundFoot doesnotcompletely clear floorwithout deviation= 0 Footcompletelyclearsfloorwithout marked deviation=1 Prosthesis Sound16. Step ordiscontinuity between steps (stop & go =0gait)Steps appearcontinuous=117. Turning:1800 turn when returning toturn, requires intervention toprevent falling = 0 Greater than 3steps butcompletestask without intervention No more than 3continuous steps with or withoutassistive aid= 1=218. Variable cadence: walk a distance of 12ft fast assafely as possible 4 times. (Speeds may vary from slow to fast andfast to slow, varying cadence.)

6 19. Stepping over obstacle: place amovable box of4in. in heightin the walking Stairs (must have at least 2steps): try to go up and down these stairswithout holding on to the railing. Don t hesitatetopermit pt to holdontoUnableto vary cadence in a controlled manner= 0 Asymmetrical increase incadence controlled manner= 1 Symmetricalincreaseinspeedinacontrolledm anner=2 Cannot step over the box = 0 Catches foot, interrupts stride= 1 Steps over without interrupting stride=2 AscendingUnsteady, cannot do= 0 One stepat a time, ormust hold on to railing ordevice = 1rail. Safety first, if examiner feelsthat any r isk in involved omit andscore as over step, does nothold ontotherailing ordeviceDescending=2 Unsteady, cannot do= 0 One stepat a time,ormust hold on to railing ordevice = 1 Steps over step, does nothold ontotherailing ordevice=221. Assistive device selection: add points for the use of an assistive device ifusedfor 2 or more items.

7 Iftesting without prosthesis use ofappropriateassistive device is bound= 0 Wheelchair= 1 Walker= 2 Crutches (axillary orforearm)= 3 Cane (straight orquad)= 4 None=5 Total Score/47 Trial - no prosthesis - with prosthesisObserverDateAbbreviation: PF, partial foot; TT, transtibial; KD, knee disarticulation;TF,transfemoral; HD, hip disarticulation; Pt, has been exerpted from Gailey RS, Roach KE, Applegate EB, et al. The Amputee Mobility Predictor : an instrument to assess determinants of the lower-limb Amputee 's ability to ambulate. Arch Phys Med ;83(5):613-627.