Get Amputee Mobility Predictor Scoring Form

The Amputee Mobility Predictor scoring form is a valuable tool designed to assess the mobility of individuals with amputations. This guide provides a step-by-step approach on how to accurately complete the form online, ensuring clarity and precision in measurement.

Follow the steps to successfully fill out the form:

1. Click 'Get Form' button to obtain the Amputee Mobility Predictor scoring form and open it in the editing interface.
2. Begin by entering the client’s name and the date at the top of the form. Ensure all information is accurate as it will be important for records.
3. Proceed to the first section titled 'Sitting balance.' Observe the client’s ability to sit upright for 60 seconds. Mark the score accordingly (0, 1, or 2) based on their performance.
4. In the 'Sitting reach' section, have the client reach forward to grasp a ruler held 12 inches beyond their extended arms. Score based on their ability to grasp the item.
5. In the 'Chair to chair transfer' section, observe the client’s ability to transfer between chairs. Score them based on whether they need assistance or perform independently.
6. For 'Arises from a chair,' have the client attempt to stand with arms crossed. Note if they need assistance or can stand independently.
7. In 'Immediate standing balance,' time how long the client can maintain balance immediately after standing. Score them based on stability.
8. Next, complete the 'Standing reach' section using the same method as before, scoring their ability to grasp the ruler.
9. Conduct the 'Nudge test' to assess stability when an examiner applies gentle pressure to the client's sternum. Mark the score as indicated.
10. Proceed with the 'Picking up objects off the floor' section, instructing the client to pick up a pencil and return to a standing position while scoring appropriately.
11. Complete the 'Sitting down' section by asking the client to sit down safely, using the relevant scoring criteria.
12. For 'Initiation of gait,' observe the client’s response to the command 'go' and score any hesitancy if present.
13. In the 'Step length and height' section, perform a walking test over a measured distance, recording the performance for both legs.
14. Score the 'Step continuity' based on whether the client can walk continuously or needs to stop.
15. In 'Turning,' observe the manner in which the client turns 180 degrees and score their performance.
16. Assess the client’s ability for 'Variable cadence' walking over the distance of 12 feet and score accordingly.
17. For 'Stepping over obstacle,' ensure the client can successfully step over a box placed in their path without interruption.
18. Evaluate the client's ability to navigate stairs, with scores reflecting their independence and safety.
19. Determine the assistive device usage in the 'Assistive device selection' section and record any additional points as needed.
20. Finally, review all scores, calculate the total score, and assign the corresponding K level. Ensure all practitioner information is provided, including name, signature, and date.

Complete your Amputee Mobility Predictor scoring form online today to enhance patient care and treatment planning.