Amputee Mobility Predictors Bethany Hightower Lexi Okurily Functional

Amputee Mobility Predictors Bethany Hightower, Lexi Okurily

Functional Ambulation Achieved Hip disarticulation <10% AKA (unilateral) 10 -37% Knee disarticulation 36 -76% BKA (unilateral) 70 -100%

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

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

AMPPRO Vs. AMPno. PRO 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… K 1= 15 -26, K 2= 27 -36, K 3= 37 -42, K 4= 43 -47 AMPno. PRO Total score without prosthesis is out of 43

Components of AMP 1. Sitting balance 2. Sitting reach 3. Chair to chair transfer 4. Sit to stand 5. Attempts to sit to stand 6. Immediate standing balance 7. Standing balance

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

K Classifications K 0= Ability to sit and stand without difficulty K 1= Able to sit to stand, moderate standing balance, initiates gait, uses an AD, low endurance K 2= Standing balance, maintain balance with assistance when nudged, able to take full stride with one foot, can complete 3 step turn without intervention K 3= 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 K 4= 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)

Evidence Measurement study with 191 lower limb amputees (18 -100 y/o) Gailey (2002) showed the validity and reliability of the tool (AMPPro & AMPno. PRO) 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 6 MWT and amputee activity survey AMP has a negative correlation with age and comorbidities

A model for evaluating mobility among seniors with lowerlimb 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

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

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

References Amputee Mobility Predictor Questionnare Accessed at http: //www. oandp. com/opie/ampdownloads/assets/pdfs/amppro. pdf 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. 2002 May 31; 83(5): 613 -27. http: //www. austpar. com/portals/gait/tools. php Raya MA, Gailey RS, Gaunaurd IA, Ganyard H, Knapp-Wood J, Mc. Donough K, Palmisano T. Amputee Mobility Predictor-Bilateral: A performance-based measure of mobility for people with bilateral lowerlimb loss. J Rehabil Res Dev. 2013 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. 2010 Sep 20; 10(1): 1.