1. Amputee Mobility Predictors
Bethany Hightower, Lexi Okurily

2. Functional Ambulation Achieved
Hip disarticulation <10%
AKA (unilateral) %
Knee disarticulation %
BKA (unilateral) %
Less than 10% of people with a hip disarticulation can ambulate

3. What is it?
Assessment tool utilized to determine a lower limb amputee’s functional mobility status with or without a prosthesis
Helps determine amputee’s K Level for Medicare
Also helps estimate an amputee’s six minute walk test distance
Can be utilized for partial foot, transtibial, knee disarticulation, transfemoral, hip disarticulation

4. What is it?
Designed to measure hip extensor and abductor strength which both predict successful prosthetic ambulation
Helps maintain pelvic control during ambulation
Influences symmetrical step length
Age plays a role
Takes about 15 minutes to administer; Test is completed in a hard chair with arms

5. AMPPRO Vs. AMPnoPRO Scoring 0= Unable to perform task
1= Required minimal assistance or task was minimally performed
2= Independence of task
AMPPRO
Total score with prosthesis is out of 47
K Level…
K1= 15-26, K2= 27-36, K3= 37-42, K4= 43-47
AMPnoPRO
Total score without prosthesis is out of 43
K0= 0-8, K1= 9-20, K2= 21-28, K3= 29-36, K4= 37-43

6. It is a 20-item assessment tool designed to evaluate the skills required for successful prosthetic ambulation. Items 1 and 2 assess sitting balance; 3 through 7 assess simple mobility: transfers and coming from sit-to-stand; 8 through 13 assess standing balance activities: single-limb stance and pick up object from floor; and 14 through 20 assess components of gait: step length, transverse obstacle, and ascend and descend stairs. All subjects performed the AMP wearing their prostheses.

7. Components of AMP Sitting balance Sitting reach
Chair to chair transfer
Sit to stand
Attempts to sit to stand
Immediate standing balance
Standing balance
Single limb standing balance
Standing reach
Nudge test
Sitting balance- arms across chest; Sit reach- 12in beyond extended arms midline to sternum; Chair to chair- chairs at 90 degrees, patient can use UE; Sit to stand= arms across chest; Attempts to sit to stand= unable without assistance, 1 or more than 1 attempt; Single limb- time up to 30 seconds, both limbs (grade quality, not quantity); Standing reach- same as sitting; Nudge test- feet as close together as possible, examiner pushes lightly on pts sternum with palm of hand 3x (toes should rise)

8. Components of AMP Continued
11. Eyes closed
12. Pick up objects off the floor
13. Sitting down
14. Initiation of gait
15. Step length and height
16. Step continuity
17. Turning
18. Variable cadence
19. Stepping over an obstacle
20. Stairs
21. AD selection
AD Selection
0= Bed bound
1= Wheelchair/Parallel bars
2= Walker
3= Crutches (axillary or forearm)
4= Cane (straight or quad)
5= None

9. K Classifications K0= Ability to sit and stand without difficulty
K1= Able to sit to stand, moderate standing balance, initiates gait, uses an AD, low endurance
K2= Standing balance, maintain balance with assistance when nudged, able to take full stride with one foot, can complete 3 step turn without intervention
K3= Single limb balance, balance without assistance when nudged, “normal” gait (good stride length & continuity), turns independently with less than 3 steps, able to climb stairs and step over obstacles
K4= Single limb balance with both legs, able to perform most tasks with good balance, gait is symmetrical (able to vary cadence, navigate obstacles, and stairs independently)
AMPnoPRO
K0= 0-8
AMPnoPRO(out of 43) and AMPPRO (out of 47)= K1-K4

10. Evidence Measurement study with 191 lower limb amputees (18-100 y/o)
Gailey (2002) showed the validity and reliability of the tool (AMPPro & AMPnoPRO)
Interrater reliability was.99 for subjects tested with and without their prosthesis; intrarater reliability was.96 and.97.
AMP has a strong correlation with the 6MWT and amputee activity survey
AMP has a negative correlation with age and comorbidities
191 LE limb amputees aging
That decision is based on a subjective evaluation of the patient's past history (including prior prosthetic use, if applicable); the patient's current condition, including the status of the residual limb; concommitant medical problems; and the patient's desire to ambulate. To standardize this process would require an instrument that could classify the amputee subject by functional level and quantify function. The instrument would need to be applicable across a wide range of functional abilities.
The Amputee Mobility Predictor© (AMP), was designed to meet the following criteria: (1) to be administered before prosthetic fitting; (2) to be clinically feasible in terms of time, resources, and ease of use, and; (3) to assist in assigning an MFCL for prosthetic prescription of Medicare-eligible patients.

11. A model for evaluating mobility among seniors with lower-limb amputations of vascular origin
Observational and transversal study with 10 participants
Proposition of a new model to evaluate the mobility of older amputee population
Potential mobility indicators do not accurately predict effective mobility
In the population assessed, these factors reduced effective mobility:
living alone
no rehabilitation
Pain
limited social support
poor muscle strength
This model integrates the concepts of potential mobility (e.g. balance, speed of movement), effective mobility (e.g. life habits, movements in living areas) and factors that modulate these two types of mobility (e.g. strength, sensitivity, social support, depression).
The model generated 4 different profiles (categories) of participants ranging from reduced to excellent potential mobility and low to excellent effective mobility, and characterized the modulating factors.
participants who perform well on traditional measures done in the laboratory or clinic are not always those who perform well in the real world
Population ranging y/o, assessing 8-18 months post discharge of acute care.
Only 10 participants

12. What about Bilateral Lower Limb Amputees?
Cross-sectional study with 26 males
Does not effectively assess the mobility of BLLAs
Current AMP has unintentional bias for those with bilateral limb loss
Presence of at least one knee is necessary to achieve a maximum score
Required modifications to appropriately determine participation restrictions and abilities.
Without modifications, even the highest functioning BLLAs could not obtain a maximal score
Cross sectional study of 26 males- BLLAs (BTTA most common, then BTFA or combo )
example, for a person with two prosthetic knees, the ability to rise out of chair without the use of the upper limbs is regarded as impossible

13. Clinical Ramifications
Helps determine a lower limb amputee’s functional mobility status with or without a prosthesis
Aides in the justification of improving K Levels
Justification for different prosthetic
Medicare reimbursements

14. References
Amputee Mobility Predictor Questionnare Accessed at
Gailey RS, Roach KE, Applegate EB, Cho B, Cunniffe B, Licht S, Maguire M, Nash MS. The amputee mobility predictor: an instrument to assess determinants of the lower-limb amputee's ability to ambulate. Archives of physical medicine and rehabilitation May 31;83(5):
Raya MA, Gailey RS, Gaunaurd IA, Ganyard H, Knapp-Wood J, McDonough K, Palmisano T. Amputee Mobility Predictor-Bilateral: A performance-based measure of mobility for people with bilateral lower- limb loss. J Rehabil Res Dev Jul 1;50(7):961-8.
Vincent C, Demers É, Moffet H, Corriveau H, Nadeau S, Mercier C. Use of an innovative model to evaluate mobility in seniors with lower-limb amputations of vascular origin: a pilot study. BMC geriatrics Sep 20;10(1):1.