Williams, PhD, Epworth Rehabilitation at
Citation Williams, G. (2006).
The High Level Mobility Assessment Tool. The Center for
Outcome Measurement in Brain Injury. http://www.tbims.org/
combi/himat ( accessed
to the High Level Mobility Assessment Tool
participation has been well documented following TBI. Existing scales
used in neurological rehabilitation are unable to quantify mobility
to the level required for participation in physically demanding
employment roles, leisure activities, social roles and sporting
activities. The HiMAT was developed to quantify high-level mobility
outcomes following traumatic brain injury (TBI). The HiMAT items
were generated from existing adult and paediatric neurological mobility
scales and the opinions of expert clinicians (Williams et al., 2005a),
before being tested on a cohort of people with TBI. The final HiMAT
items are unidimensional and can be used to quantify high-level
mobility on people with severe cognitive impairment. The HiMAT is
suitable for any TBI clients who have goals which require a level
of mobility beyond independent level walking.
HiMAT was developed as a unidimensional measure of motor performance
rather than a general measure of functional mobility. Functional
mobility for activities such as shopping or sport requires the integration
of motor, cognitive and behavioural control mechanisms. A unidimensional
scale of mobility, used in conjunction with other measures of cognitive,
behavioural and emotional status, could assist clinicians to identify
the reasons why participation in pre-morbid physically demanding
activities is restricted. In turn this could enable clinicians to
more easily quantify mobility restrictions.
scales used in TBI are able to quantify high-level mobility, even
though it is well recognized that people with TBI experience difficulty
in performing tasks such as running and jumping. Williams, Robertson
and Greenwood (2004a) identified 175 TBI outcome studies published
from 1990 through to May 2004 that reported on mobility outcome.
Their main findings can be summarized as follows:
measures of mobility are seldom used. Only 8 (4.6%) of the 175
outcome studies used a mobility measurement scale. These eight
studies used seven different mobility measures.
The mobility scales that are used have been developed in elderly
or stroke populations and have a substantial ceiling effect. The
Rivermead Mobility Index (RMI) was the only scale used, reported
in only one study in TBI, that extends mobility beyond walking
tasks and stair use.
measures designed for the inpatient phase of rehabilitation, such
as the FIM, Disability Rating Scale (DRS) and Barthel Index, were
used in 96 (54.9%) of the 175 outcome studies. These measures
were used to report outpatient or long-term outcomes, an application
for which they were not designed.
Twelve different measures of participation were used to report
physical outcome. When used on their own, measures of participation
are unable to identify the restriction leading to reduced participation
Robertson and Greenwood (2004a) showed that little is known about
the extent of high-level mobility limitations following TBI. Although
independent mobility is an important goal of rehabilitation, outcome
studies often fail to measure it. When mobility is measured, the
scales used suffer from a ceiling effect and fail to extend mobility
to age-appropriate levels for return to physically demanding employment
roles, leisure activities, social roles and sporting activities.
A new high-level mobility scale was needed to quantify motor performance
to the high-level required for such activities.
HiMAT was developed over several years of research (Williams et
al., 2005a; Williams et al., 2005b). In the initial stages, a literature
review was conducted to determine the range of existing high-level
items on adult and paediatric neurological mobility scales. To further
extend the pool of high-level mobility items, a consensus method
was used to survey the opinions of expert physiotherapists and physical
educators. This process resulted in a group of 20 high-level mobility
items that were prepared for testing on TBI clients.
hundred and three people with TBI were recruited from Epworth Hospital,
Melbourne, Australia. Inclusion criteria were; 1) the ability to
walk independently without a gait aid, 2) diagnosis of a TBI, 3)
willing and able to provide informed consent, 4) no diagnosis of
hypoxic brain damage, cerebrovascular accident, or a concurrent
pre-existing central nervous system disorder. Patients who were
unable to follow two-stage commands were excluded, as were those
with severe behavioural problems that restricted their ability to
participate in the testing procedures. Rasch analysis was used to
investigate the content validity and unidimensionality of the HiMAT.
HiMAT consists of 13 items that are measured using either a stopwatch
or tape-measure. Measures obtained on each item are scored and summed
for a total HiMAT score (maximum score 54). Higher scores indicate
better mobility performance. Depending on the ability of the client
and how many items they can perform, testing takes 5-15 minutes.
No formal training is required to administer the HiMAT. The HiMAT
has been developed and validated in TBI for clients who have high-level
mobility goals, or whose goals required advanced mobility. Although
clinically it is being used in CVA, Multiple Sclerosis, Spinal Cord
Injuries and Cerebral Palsy, it is yet to be validated in these
to use the HiMAT is not required but the principal investigator,
Gavin Williams PhD would appreciate prospective user’s of
the scale to contact him so the its application can be tracked for
location and population type.
For further information, please contact:
Gavin Williams, PhD
Senior Physiotherapist, Epworth Rehabilitation
89 Bridge Rd
Ph: 011 (613) 9426 8727
F: 011 (613) 9426 8734
regarding the HiMAT was contributed by Epworth
Rehabilitation. Please contact Gavin Williams, Ph.D., at
you find the information in the COMBI useful, please mention it
when citing sources of information. The information on the HiMAT
may be cited as:
Williams, G. (2006). The High Level Mobility Assessment Tool. The
Center for Outcome Measurement in Brain Injury. http://www.tbims.org/combi/himat