Get Amputee Mobility Predictor - Amputee Prosthetic Clinic

The Amputee Mobility Predictor is a vital tool used to assess the mobility capabilities of individuals with limb loss. This guide will walk you through the process of filling out the Amputee Mobility Predictor form online, ensuring you have all the information you need to complete it accurately and efficiently.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to access the form and open it in the specified online platform.
2. Begin by providing basic information about the user, including their age, gender, and the type of amputation. This information is crucial for tailoring the assessment to individual needs.
3. Proceed to the sitting balance section. Assess and record whether the user can sit upright independently for 60 seconds or requires assistance.
4. In the sitting reach section, measure the user's ability to reach forward and grasp an object held by the tester. Document the user's success level.
5. Continue to the chair to chair transfer section. Observe how the user transfers between two chairs, noting any assistance required.
6. Evaluate the user's ability to arise from a chair. Record any assistance needed or if they can stand independently.
7. Measure immediate standing balance by timing how steady the user is while standing without assistance for the first five seconds.
8. Assess the standing balance for a full 30 seconds, recording whether the user requires support.
9. Conduct the single-limb standing balance test for both the prosthetic and non-prosthetic sides, timing the duration and grading the quality of balance.
10. Complete the standing reach test again, similar to the earlier task, documenting the user's reach abilities.
11. Perform the nudge test to evaluate the user's stability when pushed gently. Record their reaction.
12. Assess the user's ability to pick up an object from the ground and return to a standing position.
13. Document the user's ability to sit down safely, noting if assistance was needed.
14. Initiation of gait is next. Measure and note the user’s ability to start walking immediately after being instructed.
15. Evaluate the user's step length and height by requiring them to walk a measured distance and noting any deficiencies.
16. Assess step continuity, ensuring to record any interruptions during the user's stride.
17. Complete the turning test, assessing the user's ability to perform a 180-degree turn smoothly.
18. Determine variable cadence by having the user walk a distance repeatedly, monitoring their ability to change speeds.
19. Test the user's ability to step over an obstacle placed in their path, noting any difficulties.
20. If applicable, evaluate the user’s ability to navigate steps safely without holding on to a railing, recording the results.
21. Finally, record the appropriate assistive device selection, if any, that the user utilizes.
22. Once all sections are completed, save your changes. You can then download, print, or share the form as needed.

Start filling out the Amputee Mobility Predictor form online now to enhance your assessment process.