Amputee Mobility Predictor Flashcards by Jill Wilson

What are the important uses of the Amputee Mobility Predictor?

Determine Functional Level
Predict the distance walked
Determine the contribution of function ability
Determine what physical systems need to be addressed in rehab
Measure change over time

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Assessment Task #1 (sitting balance): Procedure and scoring?

** Have pt sit forward in a chair with their arms folded across chest for 60 sec
Cannot sit upright independently for 60 sec = 0
Can sit upright independently 60 sec = 1

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Assessment Task #1 (sitting balance): What systems are challenged?

trunk stability
sitting balance
sitting endurance

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Assessment Task #1 (sitting balance): Treatment Options?

Sitting supported w/ reaching
Pelvic tilts/plinth activities
Rhythmic stabilizations (Core glute med)
Physioball (balance pad/airex/disc)
Trunk rot – (iso walkout)
Resisted trunk flex/ext
Sitting endurance progression
Rest ball (against wall) behind pt head while sitting have the pt maintain the position

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Assessment Task #2 (sitting reach): Procedure and Scoring?

**Place ruler 12 inches in front of pt and have them reach out and grab ruler.
Does not attempt = 0
Cannot grasp or requires support = 1
Reaches forward and grasps item = 2

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Assessment Task #2 (sitting reach): What muscle groups are being challenged?

Challenge the trunk, back, and hip extensor strength, vestibular challenges

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Assessment Task #2 (sitting reach): Treatment?

juggling balloon/balloon batting
Cone reaching
PNF – reaching up/across/diagonal/lift
Cane trunk twists
Plyoball tosses with trunk reaching
Wand reaches
For reaching - have them reach to the same side their prosthetic is on

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Assessment Task #3 (chair to chair transfer): Procedure and Scoring?

** Have 2 chairs at 90 deg angles. pt can choose which direction to transfer and is allowed to use their UE.
Cannot do or requires assistance = 0
Performs independently, unsteady = 1
Performs independently, steady and safe = 2

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Assessment Task #3 (chair to chair transfer): Treatment?

Sit to stand
Arm strength (tricep dips, push-ups)
Glute squeezes
Bridges (single leg)
Eccentric knee (sound limb)
Scooting and pivoting on mat
Seated prostetic weight bearing
Sitting balance on unsteady surface
Planning for task is a problem for many of these patients b/c of preexisting conditions

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Are you allowed to push on prosthesis?

YES

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What is the biggest challenge with a prosthesis pt?

They do not utilize prosthesis (put weight thru prosthetic limb)!
- Fear of knee collapse, stump pain, etc

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What is the max score a pt can get on the AMP?

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What is the AMP?

21 Task Assessment designed to measure a patient’s physical and psychological potential for prosthetic rehab.

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True or False: The AMP score can NOT be linked to K levels?

FALSE - the AMP can be linked to K level

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AMP Test #4 Scoring (Arise from Chair)

Unable w/o help=0
Able, uses arms/AD=1
Able, w/o using arms=2

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What are treatment ideas for #4: Arise from Chair

Weight shift/rocking
Partial wall squats
Tricep Pushup
Stand against resistance on non-involved leg or trunk resistance
Step-by-step processing /organizational skills
Squat machine/Total Gym
Sit>Stand from a higher table (easier)

What will patients say about their prosthetic the first time they put it on?

Feel too long

What type of amputation do we see more often

Transfemoral more often than transtibial

Difference between #4 and #5 Sit>Stand? And Scoring

Monitoring the # of attempts it takes for them
0=Unable w/o help
1=able requires >1 attempt
2=able to rise one attempt

What are tested in #6 and #7 of AMP?

#6: immediate standing balance
#7: standing balance time (30 sec)

What is the scoring for 6 and 7 (score uses same scale for both)

0=unsteady (swagger, moves foot, sways)
1=steady using walking aid or other support
2=steady w/o walker or other support

Treatment ideas for 6 and 7

trunk rotation with ball
side to side/forward and back weight shifts
narrow BOS or unsteady surface
Diagonal weight shifts
Rhythmic stabilization
Perturbation in standing
Standing on 2x4, airex pad, tilt board

Scoring for #8: Single leg standing balance (30 sec)

Prosthetic and non-prosthetic are both tested
(same scoring, but score SEPARATELY)
0=unsteady (swaggers, moves foot, sways)
1=steady using walking aid or other support (30 sec)
2=steady w/o walker or other support (30 sec)

Treatment for Single leg sance

Patient stands on prosthesis

non-involved foot on step
foot on air ex pad
foot on foam roller
foot on mini basketball
Movement on non-involved leg while on any of above surfaces
Step up/down
Clock work
Parallel Bar work
Sideway/backward walk

What scores are linked to the K Levels

K1:15-26 K2: 27-36 K3: 3-42 K4: 43-47

Describe scoring criteria for #9 "Standing Reach" on AMP:

- Does not attempt = 0 - Cannot grasp/requires support = 1 - Reaches and grasps item = 2

List treatment ideas to improve score on #9, "Standing Reach" (4):

- Forward and backward shift - Arm swings up and back - Heavy ball swings - Standing ball throws

Describe scoring criteria and testing protocol for #10 "Nudge Test" on AMP:

Examiner pushes lightly on subjects sternum with palm of hands 3 times until toes rise - Begins to fall = 0 - Staggers or grabs support = 1 - Steady = 2

List treatment ideas to improve score on #10, "Nudge Test" (8):

- Ankle strategies - Hip strategies - Step strategies - Rhythmic stabilization - Shift arms up and back - Standing against wall - Heavy ball swings - Standing ball tosses

Describe scoring criteria for #11 "Eyes Closed" on AMP:

- Unsteady or grips assistive device = 0 | - Steady without any use of assistive device= 1

Describe scoring criteria for #12 "Picking up Objects off the floor" on AMP:

- Unable to pick up object = 0 - Performs with some help (chair, table, assistive device) = 1 - Performs Independently = 2

Treatment ideas to improve scores on #11 "Eyes Closed" and #12 "Picking up Objects off the floor" (5):

- Partial squats - Partial golfers lift - Lunges - Cones pick-up off the floor - Weighted ball pick-up off the floor

Describe scoring criteria for #20 "Stairs" on AMP

- Ascending and Descending - Unsteady or can't perform = 0 - One step at a time, support = 1 - Step over step, no support = 2

Treatment Ideas for #20 "Stairs"

- stool stepping - wall squats - lunges - squats - eccentric lowering - glut activities - spot the pt at the foot and with socket

Describe the scoring for #21 "Assistive Device"

- bed bound = 0 - Wheelchair = 1 - Walker = 2 - Crutches = 3 - Cane = 4 - None = 5

Ideas for advanced gait training for AK

- heel strikes on different surfaces | - power walk goals

How to: Running Gait Training STEP 1

- start w/prosthetic side behind you w/wt on ball of foot - push on front wall of socket to initiate start of start of swing phase - at same time, take a hop/strong push off of sound side - as soon as you hop, pull on the back wall of the socket to drive heel into the ground and land on the prosthetic side

How to: Running STEP 2

- once you have accomplished step one, continue by bringing sound leg forward through swing phase - press on front wall of socket to cause knee to break/bend - cont. to move till you finish in end position (sound side forward, prosthetic side knee bent and weight on ball of foot) - keep weight on prosthetic side (practice holding this position)