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 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: DATE: TIME:
1.Sitting Balance Comments
Sit forward without backrest, with arms Cannot sit upright independently for 60s =0
folded across chest for 60s. Can sit upright independently for 60s =1
2.Sitting reach
Reach forwards and grasp the ruler using Does not attempt =0
preferred arm (Tester holds ruler 26cm Cannot grasp or required arm support =1
beyond extended arm midline to the sternum, Reaches forward and successfully grasps item =2
or against the wall, intact foot midline)
3.Chair to chair transfer 90° Cannot do or requires physical assistance =0
Chair height between 40-50cm , allowed to Performs task but unsteady or needs contact =1
use aid but no armrests guarding =2
Performs independently
4.Arises from chair–single effort
Chair height between 40-50cm, tester asks Unable without physical assistance =0
patient to cross arms over chest. If unable, Able, uses arms/assistive device to help =1
uses arms or assistive device Able without arms =2
5.Arises from chair-multiple Unable without physical assistance =0
Able but requires >1attempts =1
effort Able to rise in one attempt =2
Chair height between 40-50cm, multiple
efforts allowed without penalty
6. Immediate standing Balance(1st
Unable =0
5 secs) Able, but requires use of arms for support =1
Standing on one leg, timing commences at
Able without arm support =2
initial hip extension
7. Standing balance :30seconds Unable =0
1st attempt do not use arm support, if unable, Able, but requires use of arms for support =1
may use arm support on 2nd attempt Able without arm support =2
8. (Amypro only)
9. Standing balance: standing
Unable =0
reach Able, but requires use of arms for support =1
Reach forward and grasp the ruler 26cm
Able without arm support =2
beyond preferred arm midline to the sternum
or against a wall
10. Standing balance: nudge test
Standing on one leg, tester gently pushes on Begins to fall, needs catching =0
subjects sternum with palm of hand 3 times catches self using arms for support =1
(ONLY if safe to do so) Steady, toes come up for equilibrium reaction =2
11. Standing balance: eyes closed
Unsteady or uses arm support =0
30sec. Steady without arm support =1
12.Standing balance: picking
Unable =0
object off the floor Able, but requires use of arms for support =1
Object is placed 30cm in front of patient,
Able without arm support =2
midline
13. Stand to sit
Patient is asked to sit in chair with arms Unable, or falls into chair =0
crossed over chest. If unable, allow use of Able, but uses arms for support =1
hands Able, without use of arms =2
14. Initiation of gait
Patient is asked to hop with an aid and Any hesitancy or multiple attempts to start =0
observed for hesitancy No hesitancy =1
15. Hopping 8 meters a) Does not advances 30cm on each hop =0
a) Step length Advances minimum of 30cm each hop =1
b) Foot clearance (discourage b) Unable to clear foot without deviations =0
deviations incl. Circumduction, Clears foot on every step =1
foot sliding or shuffling
16. Step continuity Stopping or discontinuity between hops =0
Hops appear continuous =1
17. Turning Unable to turn without physical assistance =0
180° turn to sit in chair No assistance, 4 or more hops to turn =1
No assistance, 3 or less hops to turn =2
18. Variable cadence Unable to vary cadence =0
Patient is asked to hop 4 metres, and repeat a Able to vary cadence, but asymmetrical step
total of 4 times. Speeds are to vary from lengths used or balance compromised =1
slow, fast, fast and then slow (ONLY if safe Able without asymmetry or balance
to do so) compromise =2
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 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: DATE: TIME:
1.Sitting Balance Comments
Sit forward without backrest, with arms Cannot sit upright independently for 60s =0
folded across chest for 60s. Can sit upright independently for 60s =1
2.Sitting reach
Reach forwards and grasp the ruler using Does not attempt =0
preferred arm (Tester holds ruler 26cm Cannot grasp or required arm support =1
beyond extended arm midline to the sternum, Reaches forward and successfully grasps item =2
or against the wall, intact foot midline)
3.Chair to chair transfer 90° Cannot do or requires physical assistance =0
Chair height between 40-50cm , allowed to Performs task but unsteady or needs contact =1
use aid but no armrests guarding =2
Performs independently
4.Arises from chair–single effort
Chair height between 40-50cm, tester asks Unable without physical assistance =0
patient to cross arms over chest. If unable, Able, uses arms/assistive device to help =1
uses arms or assistive device Able without arms =2
5.Arises from chair-multiple Unable without physical assistance =0
Able but requires >1attempts =1
effort Able to rise in one attempt =2
Chair height between 40-50cm, multiple
efforts allowed without penalty
6. Immediate standing Balance(1st
Unable =0
5 secs) Able, but requires use of arms for support =1
Standing on one leg, timing commences at
Able without arm support =2
initial hip extension
7. Standing balance :30seconds Unable =0
1st attempt do not use arm support, if unable, Able, but requires use of arms for support =1
may use arm support on 2nd attempt Able without arm support =2
8. (Amypro only)
9. Standing balance: standing
Unable =0
reach Able, but requires use of arms for support =1
Reach forward and grasp the ruler 26cm
Able without arm support =2
beyond preferred arm midline to the sternum
or against a wall
10. Standing balance: nudge test
Standing on one leg, tester gently pushes on Begins to fall, needs catching =0
subjects sternum with palm of hand 3 times catches self using arms for support =1
(ONLY if safe to do so) Steady, toes come up for equilibrium reaction =2
11. Standing balance: eyes closed
Unsteady or uses arm support =0
30sec. Steady without arm support =1
12.Standing balance: picking
Unable =0
object off the floor Able, but requires use of arms for support =1
Object is placed 30cm in front of patient,
Able without arm support =2
midline
13. Stand to sit
Patient is asked to sit in chair with arms Unable, or falls into chair =0
crossed over chest. If unable, allow use of Able, but uses arms for support =1
hands Able, without use of arms =2
14. Initiation of gait
Patient is asked to hop with an aid and Any hesitancy or multiple attempts to start =0
observed for hesitancy No hesitancy =1
15. Hopping 8 meters a) Does not advances 30cm on each hop =0
a) Step length Advances minimum of 30cm each hop =1
b) Foot clearance (discourage b) Unable to clear foot without deviations =0
deviations incl. Circumduction, Clears foot on every step =1
foot sliding or shuffling
16. Step continuity Stopping or discontinuity between hops =0
Hops appear continuous =1
17. Turning Unable to turn without physical assistance =0
180° turn to sit in chair No assistance, 4 or more hops to turn =1
No assistance, 3 or less hops to turn =2
18. Variable cadence Unable to vary cadence =0
Patient is asked to hop 4 metres, and repeat a Able to vary cadence, but asymmetrical step
total of 4 times. Speeds are to vary from lengths used or balance compromised =1
slow, fast, fast and then slow (ONLY if safe Able without asymmetry or balance
to do so) compromise =2
