Smartnet & PNCR Hammersmith Functional Motor Scale for SMA (HFMS) 07/03/09

Name DOB
Date of assessment Time taken to complete
Date of spinal surgery Evaluator
Please circle highest current level of independent mobility LBC = Limited by contracture
None Rolls Bottom shuffles creeps /crawls Walks with crutches / frame /rollator Walks with KAFO’s / AFO’s Independent walking
Comment……………………………………………………………………………………………………………………………………………………......................................................
Test Instruction 2 1 0 L S Comments
B =
C S = score
1 Plinth /chair sitting Can you sit on the plinth Able to sit using no Needs one hand Needs two hand Item 1 Predominant
Can be over edge of /chair without using your hand support for a support to maintain support to maintain spinal posture
plinth or on plinth / hands for support for a count of 3 or more balance for a count of 3 balance
floor. Record best you count of 3?(Back
see unsupported /feet +/- Unable to sit
support) Predominant leg
posture
2 Long sitting Legs Can you sit on the Able to sit on Able to sit on Able to long sit using
straight = knees floor/plinth without floor/plinth with legs floor/plinth with legs two hands for a count
maybe flexed, knee using your hands for straight without hand straight propping with of 3
caps pointing support and with your support for a count of 3 one hand support for a
upwards, ankles legs straight for a count count of 3 Or unable to sit with
Circle predominant spinal
<10cm apart of 3? straight legs posture and leg position

3 One hand to head Can you get one hand to Able to bring one hand Can only bring hand to Unable to bring hand to R/L
in sitting Hand touch your head without to head. head by flexing head head even using head
head above level of bending your neck Head and trunk remain and trunk movement
ears stable
4 Two hands to head Can you lift both hands Able to place both Able to place hands on Unable to place both
in sitting up at the same time, to hands on head arms head but only using hands on head
your head, without free from side. Head head flexion or side tilt
Hands touch head bending your neck? and trunk remain stable or crawling hands up or
above level of ear one at a time
5 Supine to side- Can you roll onto your Able to ½ roll from Can ½ roll only one way Unable to half roll Shoulders perpendicular to
lying side in both directions? supine both ways R/L either way floor. Trunk and hips in line
Try not to use your with body
hands
6 Rolls prone to Can you roll from your Turns to supine with Turns to supine using Unable to turn into
supine over R tummy to your back in free arms to the right arms to push/ pull with supine
7 Rolls prone to both directions? Turns into supine with Turns to supine using Unable to turn into
supine over L free arms to the left arms to push/ pull with supine
8 Rolls supine to Can you roll from your Turns to prone with Turns to prone by Unable to turn into
prone over R back to your front in free arms to the right pulling/ pushing on prone
both directions? arms
9 Rolls supine to Turns to prone with Turns to prone by Unable to turn into
prone over L free arms to the left pulling/ pushing on prone
arms
10 Sitting to lying Can you lie down in a Able to lie down in a Able to lie down by Unable or falls over
controlled way from controlled fashion flopping forwards and
sitting? through side lying or rolling sideways
using clothes
11 Props on forearms Can you prop yourself on Able to achieve prop on Holds position when Unable
your forearms and hold elbows with head up for placed for a count of 3
for a count of 3? a count of 3
12 Lifts head from Can you lift you head up Able to lift head up in Lift head with arms in a Unable
prone keeping your arms by prone arms by side for a forward position for a
your side for a count of count of 3 count of 3
3?
13 Prop on extended Can you prop yourself up Able to prop on Can prop on extended Unable
arms with straight arms for a extended arms, head arms if placed for a
count of 3? up for a count of 3 count of 3
14 Lying to sitting Can you get from lying
Turns into prone or
to sitting without rolling Able by using side lying Unable
towards floor
to your tummy?
15 Four-point Can you get onto your Achieves four-point Holds position when Unable
kneeling hands and knees with kneeling – head up for a placed for a count of 3
your head up and hold count of 3
for a count of 3?

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Test Instruction 2 1 0 L S Comments
B =
C S = score
16 Crawling Can you crawl forwards? Able to crawl forwards Moves all four points Unable
– moves all four points only once
twice or more
17 Lifts head from Can you lift your head to In supine, head must be Head is lifted but Unable
supine look at your toes keeping lifted in mid-line. Chin through side flexion or
your arms folded for a moves towards chest. with no neck flexion
count of 3 Held for a count of 3 Held for a count of 3
18 Supported Can you stand using one Can stand using one Able to stand with Can stand with hand
standing hand for support for a hand support for a minimal trunk support support but needs
count of 3? count of 3 (not hip) for a count of 3 knee/hip support in
addition for a count of 3

Or unable
19 Stand Can you stand without Can stand Stands independently Stands only
unsupported holding onto anything independently for the for a count of 3 momentarily (less than
for a count of 3? more than a count of 3 a count of 3)

Or unable
20 Stepping Can you walk without Able to take more than Able to take 2 – 4 steps Unable
using any help or aids? 4 steps unaided unaided
Show me

SCORE No of 2’s = No of 1’s = No of 0’s = TOTAL = /40

Comments

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PNCR Expanded Hammersmith Functional Motor Scale for SMA (HFMSE) add-on module 07/03/09

Test Instruction 2 1 0 L S Comments

B = S = score
C
21 Right hip flexion Can you bring your Full hip flexion achieved Initiates right hip and Unable
in supine right knee to your knee flexion
chest? (more than 10% of
available range of
motion)
22 Left hip flexion in Can you bring your left Full hip flexion achieved Initiates left hip and Unable
supine knee to your chest? knee flexion
(more than 10% of
available range of
motion)
23 High kneeling to Can you bring your left Arms used for Maintains half kneel Unable
right half kneel leg up so that your transition, maintains with arm support for a
foot is flat on the arms free in half kneel count of 10
ground without using for a count of 10
your arms and hold for
a count of 10?
24 High kneeling to Can you bring your Arms used for Maintains half kneel Unable
left half kneel right leg up so that transition, maintains with arm support for a
your foot is flat on the arms free in half kneel count of 10
ground without using for a count of 10
your arms and hold for
a count of 10?
25 High kneeling to Can you stand up from Able with arms free Able to shift weight off Unable
stand leading with this position starting both knees (with or
left leg with your left leg without arm support)
without using your
hands? May need
demonstration
26 High keeling to Can you stand up from Able with arms free Able to shift weight off Unable
stand leading with this position starting both knees (with or
right leg with your right leg without arm support)
without using your
hands? May need
demonstration
27Stand to sit Can you sit on the Able to sit down with Sits on floor but uses Unable
floor, in a controlled arms free and no arms or crashes
way? Try not to use collapse
your arms.
28Squat Can you squat? Squats with arms free Initiates squat (more Unable to initiate
Pretend you are going (at least 90° of hip and than 10%) , uses arm
to sit in a very low knee flexion) support
seat.
29 Jump 12” forward Can you jump as far as Jumps at least 12”, both Jumps between 2-11”, Unable to initiate jump
you can, with both feet simultaneously both feet with both feet
feet, from this line all simultaneously simultaneously
of the way to the other
line?
30 Ascends stairs Can you walk up the Ascends 4 stairs with Ascends 2-4 stairs, one Unable to ascend 2
with rail steps? You can use railing, alternating feet rail, any pattern stairs one rail
one railing

31 Descends stairs Can you walk down Descends four stairs , Descends 2-4 stairs, one Unable to descend 2
with rail the steps? You can use with railing, alternating rail, any pattern stairs with one rail
one railing feet

32 Ascends stairs Can you walk up the Ascends four stairs, Ascends 2-4 stairs, arms Unable to ascend 2
without rail steps? This time try arms free, alternating free, any pattern stairs arms free
not to use the railing feet
33 Descends stairs Can you walk down Descends four stairs, Descends 2-4 stairs, Unable to descend 2
without rail the steps? This time arms free, alternating arms free, any pattern stairs arms free
try not to use the feet
railing

SCORE No of 2’s = No of 1’s = No of 0’s = TOTAL =

/66

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