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North Star Ambulatory Assessment - score sheet

Name: Date:

Date of Birth: Examiner name and signature:

Test Item 2 1 0 Comments

Stands upright, still and Stands still but with some degree of
symmetrically, without compensation (e.g. on toes or with Cannot stand still or
1. Stand compensation (with heels flat and legs abducted or with bottom stuck independently, needs support
legs in neutral) for minimum count out) for minimum count of 3 (even minimal)
of 3 seconds seconds
Loss of independent
Walks with heel-toe or flat-footed Persistent or habitual toe walker, ambulation. May use KAFOs
2. Walk
gait pattern unable to heel-toe consistently or walk short distances with
assistance
Keeping arms folded. Starting With help from thighs / push on
3. Stand up from chair position 90º hips and knees, feet on chair / prone turn or alters starting Unable
floor/supported on a box step. position by widening base.
Stands but either momentarily or
Able to stand upright in a relaxed
with trunk side-flexion or needs
4. Stand on one leg - right manner (no fixation) for count of 3 Unable
fixation e.g. by thighs adducted or
seconds
other trick
Stands but either momentarily or
Able to stand upright in a relaxed
with trunk side-flexion or needs
5. Stand on one leg - left manner (no fixation) for count of 3 Unable
fixation e.g. by thighs adducted or
seconds
other trick
Goes up sideways / rotates trunk /
6. Climb box step - right Faces step – no support needed Unable
circumducts hip or needs support
Goes up sideways / rotates trunk /
7. Climb box step - left Faces step – no support needed Unable
circumducts hip or needs support
Faces forward, steps down
Sideways, skips down or needs
8. Descend box step -right controlling weight bearing leg. No Unable
support
support needed
Faces forward, steps down
Sideways, skips down or needs
9. Descend box step -left controlling weight bearing leg. No Unable
support
support needed
Starts in supine – may use one Uses two arms / pulls on legs or
10. Gets to sitting Unable
hand / arm to push up turns towards floor.
Exhibits at least one of the
(a) NEEDS external support of
No evidence of Gowers’ components described on page 2 – Time (seconds)
11. Rise from floor object e.g. chair OR (b)
manoeuvre. in particular rolls towards floor, __._
Unable
and/or use hand(s) on legs
Head is lifted but through side
In supine, head must be lifted in
12. Lifts head flexion or with no neck flexion Unable
mid-line. Chin moves towards chest
(protracts)
Both feet at the same time, clearly
standing on heels only (acceptable Only raises forefeet or only
13. Stands on heels Unable
to move a few steps to keep manages to dorsiflex one foot.
balance) for count of 3
One foot after the other (skip) or
Both feet at the same time, clear the
14. Jump does not fully clear both feet at the Unable
ground simultaneously
same time.
Able to bend knee and raise heel,
15. Hop right leg Clears forefoot and heel off floor Unable
no floor clearance
Able to bend knee and raise heel,
16. Hop left leg Clears forefoot and heel off floor Unable
no floor clearance
Both feet off the ground (no double Time (seconds)
17. Run (10m) ‘Duchenne jog’. Walk
stance phase during running) _ _. _
TOTAL= /34