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| | Item instructions and descriptions | Scoring | |
|
| 1 | †Head elevation endurance: “Raise your head off of the table.” Patient in supine; patient flexes head and neck forward and attempts to maintain self-selected position; test ends when occiput touches table. | 0 <5 seconds or unable
1 5–30 seconds
2 31–60 seconds
3 61–90 seconds
4 >90 seconds |  |
|
| 2 | Supine to prone: “Roll onto your stomach without stopping and place your arms at your side.” Patient begins in supine with arms at side; test ends when patient is prone with arms at side. | 0 >10 seconds to attempt transfer or unable
1 completion in >6 seconds <10 seconds or rolls without freeing dependent arm
2 completion in >3 seconds ≤6 seconds
3 completion in ≤3 seconds |  |
|
| 3 | Modified push-up: “Perform a push-up, ending with your elbows as straight as possible; your knees will touch the table during the movement.” Patient begins with hands facing forward on table with arm in 0 degrees abduction. | 0 unable to do
1 partial elbow extension; sternum in partial
contact with table
2 partial elbow extension; sternum NOT in
contact with table
3 full elbow extension achieved |  |
|
| 4 | †Repeated modified push-up: “Perform as many push-ups as you can, ending with arms straight, in 2 minutes; your upper chest should touch the table with each repetition.” Patient begins with hands on table and shoulders in 0 degrees abduction; self-selected pace; test ends if cueing for faulty technique occurs on 2 consecutive attempts; faulty attempts are not counted. | 0 unable to do
1 1–10 repetitions
2 11–20 repetitions
3 21–30 repetitions
4 31–40 repetitions |  |
|
| 5 | Sit-up: “Perform a sit-up.” Patient begins from supine position with knees fully extended and with hands on thighs or across abdomen; tester applies counter balance at distal lower extremities for grades 0–2. | 0 unable to do
1 scapulae and T7 vertebra not in contact with table (rectus phase) with counter balance
2 L1 vertebra not in contact with table: completion of full sit-up (hip flexor phase) with counter balance
3 completion of full sit-up without
counter balance |  |
|
| 6 | Supine to sit: “Move to a sitting position at the edge of the table as quickly as you can.” Patient begins from supine position, legs straight, and arms at side. Test ends when feet touch the floor and torso is vertical. | 0 ≥12 seconds to attempt transfer or unable
1 completion in >7 and <12 seconds
2 completion in >4 and ≤7 seconds
3 completion in ≤4 seconds |  |
|
| 7 | Arm raise: “Raise both hands as high as you can above your head with the elbows straight.” Complete within available PROM; apply grade to weakest upper extremity if asymmetry is present. | 0 unable to raise arms to level of acromioclavicular joint
1 hands raised between acromioclavicular joint and top of head
2 hands raised above top of head without full
elbow extension
3 hands raised above top of head with full
elbow extension |  |
|
| 8 | †Arm raise endurance: “Raise both hands forward (shoulder flexion) to eye level with elbows straight.” Trunk upright without hyperextension and both feet flat on floor; end test if shoulder flexion drops below 90 degrees; apply grade to weakest upper extremity if asymmetry is present. | 0 unable to do or <5 seconds
1 5–30 seconds
2 31–60 seconds
3 61–90 seconds
4 >90 seconds |  |
|
| 9 | Sit to stand: “Stand up with as little arm support as possible.” Patient seated on exam table with edge bisecting thigh length, trunk erect, lower legs vertical, and knees at 90 degrees measured via goniometer; contact between posterior aspect of the legs and the table is not allowed. | 0 unable to do
1 completes transfer with two or more
extremities in contact with the exam table or thigh
2 completes transfer with one extremity
in contact with the exam table or thigh
3 completes transfer without contact
of any extremity with the exam table or thigh |  |
|
| 10 | †Hip flexion endurance: “Raise and hold your knee in the air on your dominant side.” Seated with hips and knees at ninety degrees; no shoes; nondominant foot on floor; trunk upright with edge of table bisecting thigh length; upper extremity support on table allowed; knee height is based on the mid-PROM; test ends when foot contacts the floor. | 0 unable to do or <5 seconds
1 5–30 seconds
2 31–60 seconds
3 61–90 seconds
4 >90 seconds |  |
|
| 11 | †Knee extension endurance: “Hold your knee as straight as possible on your dominant side.” No shoes; nondominant foot on floor; trunk upright with thigh fully supported on table; test ends when the foot contacts the floor; full available PROM. | 0 unable to do or <5 seconds
1 5–30 seconds
2 31–60 seconds
3 61–90 seconds
4 >90 seconds |  |
|
| 12 | †Repeated heel rise: “While standing on your dominant leg only, raise your heel off of the ground.” No shoes; self-selected pace; test ends when 5th metatarsal base or midfoot does not fully rise from the floor; test ends if cueing for faulty technique occurs on 2 consecutive attempts; faulty attempts are not counted; knees remain as straight as possible with no additional flexion during attempts; minimal external support may be provided by a wall; 2 min or 30 repetition limit. | 0 unable to do
1 1–7 repetitions
2 8–15 repetitions
3 16–23 repetitions
4 24–30 repetitions |  |
|
| 13 | Step-up: “Place your dominant leg onto the 7-inch step, step forward with as little arm support as possible, and bring the opposite foot onto the step.” Stable upper extremity support should be available for both arms. | 0 unable to do
1 uses two upper extremities
2 uses one upper extremity
3 completes without upper extremity use |  |
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