The Amputee Mobility Predictor is an outcome measure that assists in prescribing prosthetic
componentry by assigning a K-Level and assesses functional mobility in lower extremity amputees.
We recommend that you download our Amputee Mobility Predictor Toolkit at missiongait.org
for more information about K-Levels and how this outcome measure can support collaboration
between physical therapists and prosthetists.
This video will show you how to set up the Amputee Mobility Predictor, or AMP for short,
perform the tests with or without a prosthetic limb, and discuss how a patient’s score
can be used in a clinical setting.
For this video, we will be using the terms AMPPRO for the AMP with a prosthetic limb,
and AMPnoPRO for the AMP with no prosthesis.
Prior to starting this measure, make sure that you have all necessary materials prepared.
First, place two hard chairs with arm rests at 90 degrees to each other as shown.
Next, measure a walkway of 12 feet, or about 4 meters from one of the chairs.
Mark the endpoint of the runway with either tape or cones.
For one test item, you will need at least 2 stairs with a rail on both sides.
Other items needed include a stopwatch, a pencil, a 12-inch ruler, and a moveable box,
4 inches in height, such as a shoebox.
Finally, ensure that you have a copy of the AMP or AMPnoPRO clinical instrument.
At the top of the form you will see checkboxes to denote the physical status of each lower
extremity.
These include partial foot, trans-tibial, knee disarticulation, trans-femoral, hip disarticulation,
and intact (with no amputation).
Mark the appropriate boxes for each limb.
Note that each item is scored based on the initial attempt, unless otherwise noted.
Item 1: Sitting Balance Have the patient sit in a chair with arms
folded across the chest for 60 seconds, score as indicated.
Item 2: Sitting Reach While sitting, have the patient extend their
arms forward, and then hold a 12-inch ruler about 12 inches beyond their extended arms.
Have the patient reach forward and grasp the ruler.
Item 3: Chair to Chair Transfer With the two chairs at 90 degrees from each
other, have the patient transfer from chair to chair, using their arms as needed.
Item 4: Arises From a Chair Have the patient fold their arms across their
chest and stand, only using arms or assistive device as needed.
Item 5: Attempts to Arise From a Chair If the patient was able to rise in one attempt,
score full points.
If multiple attempts or assist is required, score as indicated.
Item 6: Immediate Standing Balance Once the patient has stood up, assess the
patient’s balance during the first 5 seconds.
For items 7 & 8, the first attempt is without an assistive device.
If support is required, allow after the initial attempt.
Item 7: Standing Balance Have the patient stand for 30 seconds, using
an assistive device only after the initial attempt.
Item 8: Single Limb Standing Balance If performing the AMPnoPRO, skip this item
assigning no score.
For the AMPPRO have the patient attempt to stand on one limb at a time, performing the
task on both sides.
Time the patient using your stopwatch up to 30 seconds, allowing the patient to use assistance
as necessary.
Allow only one trial on each side.
Item 9: Standing Reach While standing, have the patient extend their
arms forward, and then hold a 12 inch ruler about 12 inches beyond their extended arms.
Have the patient reach forward and grasp the ruler.
Item 10: Nudge Test With feet as close together as possible, push
on the patient’s sternum 3 times with the palm of your hand to the point where the patient’s
toes rise.
Item 11: Eyes Closed Have the patient stand with eyes closed for
30 seconds, using an assistive device as necessary.
Item 12: Picking Up Object Off the Floor Place a pencil on the ground at the patient’s
midline, 12 inches in front of the foot.
Have the patient pick up the pencil and return to standing.
Item 13: Stand to Sit Have the patient fold their arms across their
chest and sit, using arms or assistive device as necessary.
Items 14-20 utilize the 12 foot, or 4 meter, distance.
Have the patient sit in the chair at the start of your walkway.
For the AMPnoPRO, the patient will perform items 14-20 by hopping with an appropriate
assistance device.
Item 14: Initiation of Gait Have the patient walk or hop the distance
of the walkway, observe for any hesitation.
For the AMPnoPRO, Item 15: Hopping 12 Feet As the patient begins hopping, assess the
patient’s hop length, looking to achieve at least a 12 inch hop.
Secondly, assess the patient for clearing of the foot.
Score for both hop length and the foot clearance.
For the AMPPRO, Item 15: Step Length and Height As the patient begins walking, assess the
patient’s step length, looking for the swing limb to advance 12 inches.
Secondly, assess the patient for clearing of the foot.
Score for both step length and height for each limb.
Item 16: Step Continuity Have the patient walk or hop the distance
of the walkway, observe for continuity of their steps or hops once they have started
moving.
If there is any hesitancy between steps or hops, score as indicated.
Item 17: Turning As the patient turns 180 degrees at the end
of the walkway, assess the number of steps or hops and assistance required for the patient
to complete the transition.
Score as indicated.
With practice, using the AMPPRO or the AMPnoPRO, the clinician is capable of performing tasks
14 – 17 with the patient performing only one walk down the walkway.
While this is not a goal to strive for at first, it can be a significant time saving
strategy once you have gained experience with this tool.
Item 18: Variable Cadence Have the patient walk the 12 ft or 4-meter
walkway a total of 4 separate times.
Have the patient vary their speed as you instruct either slow or fast, for each walk as is safe
to do so.
It is recommended to perform this item with a pattern of slow, fast, fast, and slow for
each pass down the walkway respectively.
Observe for changes in cadence and asymmetries.
Item 19: Stepping Over an Obstacle Place the moveable box, 4 inches or 10 cm
in height, in the walkway.
Have the patient safely step over or hop over the obstacle.
Observe for clearance over the box and a consistent stride.
For the above knee amputee, have them lead with the prosthetic limb
Item 20: Stairs Have the patient ascend and descend at least
2 stairs using no hand assist if able.
Do not hesitate to allow the patient to use their hands if they perceive any risk.
Score as indicated, observing for step-over-step pattern or step-to pattern.
Above knee amputees should only perform step-to pattern unless they have been trained in the
step-over-step pattern.
Item 21: Assistive Device Selection For the final item, score for the assistive
device used by the patient for at least two of the test items.
Once all test items have been completed, add all scores up to receive the patient’s score
for the AMPPRO or AMPnoPRO.
While documenting, ensure that you have noted which test version was performed.
When compared with normative data, this score can be utilized for prosthetic prescription
through use of the patient’s K-level.
It can also be utilized for outcome measurement during rehabilitative care.
Thanks for watching this video, and we hope you can bring this great tool into your clinic.
If you want to learn more about K-Levels and how this test can be used, Mission Gait has
an ‘Amputee Mobility Predictor Toolkit’ available for free on missiongait.org.
It includes a ready-to-go in-service, quick setup sheet, and more.
Find the direct link in the description below.
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