evaluating the activity level improvement for lower limbs amputees

1. K- Level Evaluation
HUDA ALFATAFTA, MSc. BY RESEARCH
UNIVERSITY OF SALFORD, UK
LECTURER AT UNIVERSITY OF JORDAN
ORTHOTICS AND PROSTHETICS DEPARTMENT
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2. Outlines
• Understanding K-level concept;
• Understanding the importance of K-level;
• Ability to identify the relation between K-level and prosthetics
components;
• Understanding K-level score;
• How to evaluate K- level before and after delivering prostheses for
unilateral and bilateral amputees.
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3. Activity Level Evaluation Tools
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questionnaires
Monitors
Phone app
smart watches
Gait analysis
Objective toolsSubjective tools

4. K- level
• It is also called Medicare Functional Classification Levels (MFCL).
• Established in 1995 as a means to quantify need and the potential benefit of
prosthetic devices for patients after lower limb amputation.
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5. Cont
• PTs and P&Os are often the most qualified member of the rehab team to
establish a patient's K level.
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6. K- levels
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Level 0 Does not have the ability or potential to ambulate or transfer safely with or without
assistance and a prosthesis does not enhance their quality of life or mobility.
Level 1 Has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at
fixed cadence. Typical of the limited and unlimited household ambulator.
Level 2 Has the ability or potential for ambulation with the ability to traverse low level environmental
barriers such as curbs, stairs or uneven surfaces. Typical of the limited community ambulator.
Level 3 Has the ability or potential for ambulation with variable cadence. Typical of the community
ambulator who has the ability to traverse most environmental barriers and may have vocational,
therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion.
Level 4 Has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills,
exhibiting high impact, stress, or energy levels. Typical of the prosthetic demands of the child,
active adult, or athlete.

7. K-levels
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8. Importance of K-level
Thus, it is important to document your patient’s K level and pass
that information along to their referring physician and their
Prosthetist. For:
 Follow up
 It is used as a guideline to prescribe the suitable prosthetics foot and knee
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9. K-level and prosthetics components
K-Level Foot/Ankle Assemblies Knee Units
K0 Not eligible for prosthesis Not eligible for prosthesis
K1 External keel, SACH feet or single axis ankle/feet Single-axis, constant friction knee
K2 Flexible-keel feet and multi-axial ankle/feet Single-axis, constant friction knee
K3 Flex foot and flex-walk systems, energy storing
feet, multi-axial ankle/feet, or dynamic response
feet
Fluid and pneumatic control knees
K4 Any ankle foot system appropriate Any ankle knee system appropriate
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10. Tools to evaluate K-level
• Amputee Mobility Predictor (AMP)
• Patient Assessment Validation Evaluation Test (PAVET)
• Prosthesis Evaluation Questionnaire (PEQ)
• Timed Up and Go (TUG)
• Timed Walk Tests
• Distance Walk Tests
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11. Amputee Mobility Predictor (AMP)
is a test used to assess functional ambulatory potential in persons with limb loss either with
(AMPPRO) or without (AMPnoPRO) a prosthesis for patinets with unilateral lower-limb
amputation.
It consists of 20 goal-oriented balance and ambulation tasks performed by the patient and rated by an
observer. The AMP has demonstrated the capability of discriminating K-levels
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Pre
Post
Lower limb prosthesis and training
Time in weeks

12. Notes
• Tasks
Each task has specific marking
criteria (0, 1, 2).
The total marks are calculated at
the end.

13. Scores
Amputee Mobility Predictor (AMP)
The total score before and after using prosthesis
No prostheses for level 0
level Pre (without
prostheses)
Post (with
prostheses)
Level 0 0-8 0-14
Level 1 9-20 15-26
Level 2 21-28 27-36
Level 3 29-36 37-42
Level 4 37-43 43-47

14. Time to practice
Unilateral form
Bilateral form
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15. References
• Kaluf, B. (2014). Evaluation of mobility in persons with limb loss using the Amputee Mobility Predictor
and the Prosthesis Evaluation Questionnaire–Mobility Subscale: A six-month retrospective chart
review. JPO: Journal of Prosthetics and Orthotics, 26(2), 70-76.
• Gailey, R. S., Roach, K. E., Applegate, E. B., Cho, B., Cunniffe, B., Licht, S., ... & Nash, M. S. (2002).
The amputee mobility predictor: an instrument to assess determinants of the lower-limb amputee's ability
to ambulate. Archives of physical medicine and rehabilitation, 83(5), 613-627.
• Raya, M. A., Gailey, R. S., Gaunaurd, I. A., Ganyard, H., Knapp-Wood, J., McDonough, K., & Palmisano,
T. (2013). Amputee mobility predictor-bilateral: a performance-based measure of mobility for people with
bilateral lower-limb loss. Journal of Rehabilitation Research & Development, 50(7).
• Ottobock catalogue
• https://www.youtube.com/watch?v=Y7V8nJraUYc
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