Mobility Assessment Tool
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  2. High-level Mobility Assessment Tool

High-level Mobility Assessment Tool

Last Updated

Purpose

The HiMAT is an unidimensional scale designed to assess high-level motor performance in TBI patients.

Link to Instrument

Instrument Details

Acronym HiMAT

Area of Assessment

Functional Mobility
Vestibular

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Brain Injury Recovery
  • Parkinson's Disease & Neurologic Rehabilitation
  • Pediatric + Adolescent Rehabilitation
  • Sports & Musculoskeletal Injuries

Populations

Non-Specific Patient Population
Brain Injury

Key Descriptions

  • The HiMAT is designed to assesses patients who suffer from high-level balance and mobility problems.
  • Minimum mobility requirement is independent walking over 20 meters without gait aids (orthoses are permitted).
  • Patients are allowed a trial session prior to the scored assessment.
  • Thirteen items (Williams et al., 2005b) assess a wide range of high-level activities including:
    1) Walking and running
    2) Jumping and balance items
    3) Stairs
    4) Hopping
    5) Skipping
  • Patients perform each task at their maximum safe speed (except for bounding and stair items).
  • Thirteen scores are determined on 5-point scales (see the HiMAT scoring form).
  • Items are then summed for a total score.
  • An eight-item version, removing the stair items and the “bound-affected leg” item has been validated (Williams, 2010).

Number of Items

13

Equipment Required

  • Stopwatch
  • Tape Measure
  • House brick or similar sized obstacle
  • 20 m walkway
  • Flight of 14 stairs

Time to Administer

5-10 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team; Updated by Irene Ward, PT, DPT, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 2012; Updated by Eileen Tseng, PT, DPT, NCS, Rachel Tappan, PT, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 4/2012.

Body Part

Lower Extremity

ICF Domain

Body Function
Activity

Measurement Domain

Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

LS

LS

LS

StrokEDGE

UR

UR

UR

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

NR

UR

NR

UR

NR

StrokEDGE

UR

UR

UR

UR

UR

TBI EDGE

LS

LS

LS

HR

HR

Recommendations based on SCI AIS Classification: 

 

AIS A/B

AIS C/D

SCI EDGE

LS

LS

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

HR

HR

N/A

N/A

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

UR

UR

NR

NR

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

MS EDGE

No

No

No

Yes

SCI EDGE

No

No

No

Not reported

StrokEDGE

No

No

Yes

Not reported

TBI EDGE

Yes

Yes

Yes

Not reported

Considerations

  • The HiMAT is appropriate in the acute stages post TBI when the pt is able to ambulate unaided (Williams, et al., 2006)

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Brain Injury

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Standard Error of Measurement (SEM)

Chronic TBI: (Williams et al, 2006b; n = 103; mean age = 26.7 years; mean time post-TBI 2.7 months; test-retest subsample: n = 20; mean age = 31.0 years, mean time post-TBI = 54.6 months)

  • SEM = 1.36 

 

Chronic TBI: (Williams et al, 2010; n = 20 [test-retest reliability study]; mean age = 31.0 years; mean time post-TBI = 54.6 months)

  • SEM for revised eight-item version of HiMAT = 0.79

Minimal Detectable Change (MDC)

Chronic TBI: (Williams et al, 2006b)

  • MDC95 = increase of 4 points or decrease of 2 points on the total score of the HiMAT 

 

Chronic TBI: (Williams et al, 2010)

  • For the eight-item version the MDC95 was calculated as a deterioration of 1-point or an increase of 2-points

Test/Retest Reliability

Chronic TBI: (Williams et al, 2006; subset of n = 20, median age = 31 years, median time post injury = 54.6 months)

  • Excellent test-retest reliability (ICC = 0.99)

 

Chronic TBI: (Williams et al, 2010)

  • Excellent test-retest reliability for the eight-item version (ICC = 0.99)

Interrater/Intrarater Reliability

Chronic TBI: (Williams et al, 2006; subset of n = 17; median age = 26 years, median time post injury = 20.2 months)

  • Excellent Inter-rater Reliability (ICC = 0.99)

Internal Consistency

Chronic TBI: (Williams et al, 2006b)

  • Excellent internal consistency (Cronbach alpha = 0.97) 

 

Chronic TBI: (Williams et al, 2010) 

  • Excellent internal consistency of the eight-item version (Person Separation Index [PSI] = 0.96) 

 

Criterion Validity (Predictive/Concurrent)

TBI: (Williams et al, 2006; n = 103; median age = 27.0 years; median time of post-traumatic amnesia = 43.5 days; median time post-injury = 26.7 months)

  • Adequate concurrent validity: HiMAT and motor FIM (r = 0.53, p < .001)
  • Excellent Concurrent Validity: HiMAT and gross function Rivermead Motor Assessment (r = .87, p < .001)

Content Validity

Chronic TBI: (Williams et al, 2005; Williams et al, 2005b; n = 103; median age = 27 years, median time post-TBI = 801 days; median post-traumatic amnesia time = 43.5 days)

  • In the initial development of the HiMAT 28 potential test items were generated from pre-existing mobility scales that assessed high-level mobility and from expert consensus. 
  • 28 potential HiMAT test items were then tested for content validity and discriminability, resulting in excluding 17 items and adding 2 items with a total of 13 items in the final version of the HiMAT.

Floor/Ceiling Effects

Chronic TBI: (Williams et al, 2006)

  • The Gross Function Rivermead Motor Assessment and the Motor FIM were more susceptible to ceiling effects than the HiMAT 

 

Responsiveness

TBI : (Williams et al, 2006; n = 14; median age = 20.0 years; median time of post- traumatic amnesia= 43.5 days; median time postinjury = 3.0 [2.0-5.3] months) 

  • The HiMAT was found to be more responsive to change in high-level mobility than the Gross Function Rivermead Motor Assessment or the Motor FIM 
  • Mean improvement = 12.1 points (range, 3 to 25 points; max score = 54 points) with 13/14 subject showing change greater than the MDC95 over 3 months. 
  • Large effect size of HiMAT in subjects <12 months post-TBI who were retested after 3 months (Responsiveness Indices ranged 1.08-10.34) 

 

Chronic Acquired Brain Injury : (Williams and Morris, 2009; n = 16; mean age 30.2 (±15.4) years; median time post-injury = 25 (±7.5) months) 

The effect of chronicity on HiMAT scores:

 

 

 

 

 

Acute (n = 13)

Chronic (n = 15)

p

Mean initial HiMAT score; mean (SD)

27 (8.3)

14.5 (7.3)

<0.001*

Mean change score; mean (SD)

10.5 (4.4)

7.4 (3.3)

0.04*

*Significant difference between the acute and chronic sub-groups.

 

 

 

 

Non-Specific Patient Population

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Normative Data

Healthy 18-25 year olds: (Williams et al, 2009; n = 103; age range = 18-25)

  • 50-54 points for males (Median score of 54 points)
  • 44-54 points for females (Median score of 51 points)
  • Moderate effect size between males and females (r = 0.59)

Interrater/Intrarater Reliability

Healthy 18-25 year olds: (Williams et al, 2009)

  • Excellent inter-rater reliability (ICC = 0.88)

Internal Consistency

Neurologic conditions excluding TBI or congenital conditions: (Williams et al, 2011 n = 95, mean age = 41.3(±14.0) years )

  • Excellent internal consistency of the eight-item version (PSI = 0.91 and Cronback alpha = 0.95)

Floor/Ceiling Effects

Healthy Subjects: (Williams et al, 2009)

  • 52.1% of males reached ceiling effect
  • 5.5% of females reached ceiling effect

Bibliography

Williams, G., Hill, B., et al. (2012). "Internal validity of the revised HiMAT for people with neurological conditions." Clinical Rehabilitation 26(8): 741-747. 

Williams, G., Pallant, J., et al. (2010). "Further development of the high-level mobility assessment tool (HiMAT)." Brain Injury 24(7-8): 1027-1031. 

Williams, G., Robertson, V., et al. (2004). "Measuring high-level mobility after traumatic brain injury." Am J Phys Med Rehabil 83(12): 910-920. Find it on PubMed

Williams, G., Robertson, V., et al. (2005). "The high-level mobility assessment tool (HiMAT) for traumatic brain injury. Part 1: Item generation." Brain Inj 19(11): 925-932. Find it on PubMed

Williams, G., Robertson, V., et al. (2006). "The concurrent validity and responsiveness of the high-level mobility assessment tool for measuring the mobility limitations of people with traumatic brain injury." Arch Phys Med Rehabil 87(3): 437-442. Find it on PubMed  

Williams, G., Rosie, J., et al. (2009). "Normative values for the high-level mobility assessment tool (HiMAT)." International Journal of Therapy and Rehabilitation 16(7): 370-374. 

Williams, G. P., Greenwood, K. M., et al. (2006). "High-Level Mobility Assessment Tool (HiMAT): interrater reliability, retest reliability, and internal consistency." Phys Ther 86(3): 395-400. Find it on PubMed

Williams, G. P. and Morris, M. E. (2009). "High-level mobility outcomes following acquired brain injury: a preliminary evaluation." Brain Inj 23(4): 307-312. Find it on PubMed

Williams, G. P., Robertson, V., et al. (2005). "The high-level mobility assessment tool (HiMAT) for traumatic brain injury. Part 2: content validity and discriminability." Brain Inj 19(10): 833-843. Find it on PubMed

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