Amputee Mobility Predictor Flashcards
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
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
Assessment Task #1 (sitting balance): What systems are challenged?
- trunk stability
- sitting balance
- sitting endurance
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
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
Assessment Task #2 (sitting reach): What muscle groups are being challenged?
Challenge the trunk, back, and hip extensor strength, vestibular challenges
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
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
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
Are you allowed to push on prosthesis?
YES
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
What is the max score a pt can get on the AMP?
47
What is the AMP?
21 Task Assessment designed to measure a patient’s physical and psychological potential for prosthetic rehab.
True or False: The AMP score can NOT be linked to K levels?
FALSE - the AMP can be linked to K level
AMP Test #4 Scoring (Arise from Chair)
Unable w/o help=0
Able, uses arms/AD=1
Able, w/o using arms=2
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)
