High-level Mobility Assessment Tool

Last Updated

July 10, 2025

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Purpose

The HiMAT is a unidimensional scale originally designed to assess high-level motor performance in TBI patients. It has also been used to evaluate people with multiple-trauma orthopedic injuries as well as normally developing children. The HiMAT is a thirteen item scale that assesses a wide range of high-level activities.

Link to Instrument

Instrument Details

Acronym HiMAT

Area of Assessment

Bodily Functions
Vestibular

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

CDE Status

Not a CDE--last searched 7/10/2025

Diagnosis/Conditions

Brain Injury Recovery
Parkinson's Disease & Movement Disorders
Pediatric + Adolescent Rehabilitation
Sports & Musculoskeletal Injuries

Brain Injury

Non-Patient

Musculoskeletal Conditions

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).
A hybrid tool has been developed that combines the Functional Gait Assessment and the Revised 8-item HiMAT (Fino, 2023)

Number of Items

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

5-10 minutes

Required Training

Reading an Article/Manual

Child

5 - 12

years

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. Updated in July, 2025 by Jakobi Johnson, Dartmouth University Medical School and SRALab Medical Extern, Summer 2025.

Body Structure

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:

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

StrokEDGE

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 �C 3.5	EDSS 4.0 �C 5.5	EDSS 6.0 �C 7.5	EDSS 8.0 �C 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	Yes
StrokEDGE	No	Yes	Yes	Not reported
TBI EDGE	Yes	No	Yes	Not reported

Considerations

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

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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

Children & Adolescents with TBI: (Kissane et al., 2015; n = 52, mean age = 13 (3.0), age range = 6-17, male = 36 (69%), time post-injury (median (IQR)) = 16.5 (1.9, 44.9) months, 13-item HiMAT)

MDC95 (n = 52): -4 to 2

Minimally Clinically Important Difference (MCID)

Adults with TBI: (Williams et al., 2010; n = 103 adults with TBI, Revised 8-item HiMAT)

MCID = 1-point decrease or 2-point increase over a 3-month period

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)

Children & Adolescents with TBI: (Kissane et al., 2015; n =12, mean age = 11.7 (3.3), mean time post-injury (mean (IQR)) = 57.4 (39.3, 103.2) months, mean test-retest interval = 5.6 days, 13-item HiMAT)

Excellent test-retest reliability (ICC = 0.98)

Children with Aquired Brain Injury (ABI): (Baque et al., 2016; n = 30, mean age = 11y, 11m (2y, 4m), at least 1 year post-ABI, 13-item HiMAT)

Excellent test-retest reliability (ICC = 0.98)

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)

Children & Adolescents with TBI: (Kissane et al., 2015; 13-item HiMAT)

Excellent inter-rater reliability (ICC = 0.93)

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)

Concurrent Validity:

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)

Children & Adolescents with TBI: (Kissane et al., 2015; 13-item HiMAT)

Excellent correlation between the HiMAT and Pediatric Evaluation of Disability Inventory (PEDI) Functional Skills Mobility Domain (Spearman��s r_s= 0.68)

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

Children & Adolescents with TBI: (Kissane et al., 2015; n = 52, 13-item HiMAT)

Adequate ceiling effect of 2% found for the HiMAT
Excellent: No floor effects

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)

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.

Children & Adolescents with TBI: (Kissane et al., 2015; n = 12, median interval between tests = 90 days, 13-item HiMAT)

Excellent responsiveness to change for the HiMAT

Responsiveness of the HiMAT and PEDI (n = 12)

Measure	Initial Assessment Median (IQR)	Mean Change in Score	p-value
HiMAT	31.5 (20.5, 40)	9.3	0.002
PEDI	100 (84.5, 100)	3.3	0.047

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)

Normally Developing Children: (Eldridge et al., 2020; n = 1,091, age range = 5-12 years, Revised 8-item HiMAT)

Estimated 2.5, 50, and 97.5 Percentiles of HiMAT Scores by Sex and Age Group (Median (2.5, 97.5))

Age Group, y	Boys (n = 537)	Girls (n = 554)
5-6	16.5 (9.0, 23.9)	17.4 (10.8, 24.0)
7-8	22.3 (14.9, 29.4)	21.5 (14.9, 28.1)
9-10	25.8 (18.6, 31.3)	24.8 (18.2, 30.7)
11-12	28.0 (21.2, 31.7)	26.8 (20.4, 31.5)

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)

Normally Developing Children: (Hill et. al., 2022; n = 1,091, male = 537, age range = 5-12, age groups: 5-6 (n = 296), 7-8 (n = 305), 9-10 (n = 294, 11-12 (n = 196), Revised 8-item HiMAT)

Excellent: Person Separation Index = 0.86

Content Validity

Normally Developing Children: (Hill et. al., 2022; Revised 8-item HiMAT)

Adequate overall fit to the Rasch Model (P = 0.01), with Bonferroni adjusted alpha = 0.05/8 = 0.006
Fit residual mean = 2.40, indicating most subjects found the tasks easy to complete
Differential Item Function = Uniform DIF observed for sex for walk backwards and skip items.
Local dependency (0.24) found between Item 1 (walk) and Item 4 (walk over an obstacle).

Floor/Ceiling Effects

Healthy Subjects: (Williams et al, 2009)

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

Standard Error of Measurement (SEM)

Multi-trauma Lower Limb Injuries: (Hill et al, 2014; n = 106, mean age = 37.3 (13.3), mean time post injury = 126.4 (92.7) days, Revised 8-item HiMAT)

Item fit statistics from Rasch analysis of the revised HiMAT

No.	Item	Location	SE	Fit residual	df	Chi sqaure	df	P-value
1	walk	-0.109	0.188	-0.595	89	1.792	1	0.181
2	Walk backward	-2.919	0.186	-.0826	89	0.895	1	0.344
3	Walk on toes	-1.352	0.156	-0.249	89	0.720	1	0.397
4	Walk over obstacle	-1.654	0.189	-0.808	89	0.167	1	0.683
5	Run	2.432	0.209	0.988	89	0.533	1	0.465
6	Skip	2.112	0.208	-0.583	89	1.111	1	0.291
7	Hop	2.478	0.198	0.226	89	1.724	1	0.189
8	Bound	-0.990	0.153	0.669	89	2.709	1	0.099

SE = Standard Error; df = Degrees of freedom

Minimal Detectable Change (MDC)

Multi-trauma Orthopedic Injuries: (Williams et al., 2014; n = 43, mean age = 39.4 (13.1) years, male = 28 (65%), mean time from date of injury to first test = 94.8 (51.4) days, inclusion criteria = allowed to fully weight bear on both lower extremities, Revised 8-item HiMAT)

MDC95 (calculated) for entire group (n = 43): -1.13 to 1.97

Normative Data

Multi-trauma Orthopedic Injuries: (Williams et al., 2014, Revised 8-item HiMAT)

Mean (SD) and score range for the Revised HiMAT at 0, 6, and 12 Weeks

Observation period	Mean (SD)	Range
Initial	1.7 �� 3.2	0-15
6 wk	8.4 �� 6.2	0-24
12 wk	11.5 ��7.8	0-27

Internal Consistency

Multi-trauma Lower Limb Injuries: (Hill et al., 2014, Revised 8-item HiMAT)

Excellent: Cronbach��s alpha = 0.93* (Person Separation Index = 0.91)

*Scores higher than 0.9 may indicate redundancy in the scale questions.

Criterion Validity (Predictive/Concurrent)

Multi-trauma Orthopedic Injuries: (Williams et al., 2014; Revised 8-item HiMAT)

Adequate correlation between the revised HiMAT and the motor Functional Independence Measure (FIM) (r = 0.49, P < 0.001)
Adequate correlation between the revised HiMAT and the Lower Extremity Functional Scale (LEFS) (r = 0.39, P = 0.012)

Content Validity

Multi-trauma Lower Limb Injuries: (Hill et al, 2014; Revised 8-item HiMAT)

Rasch analysis showed Adequate overall fit to the model for the Revised HiMAT (P = 0.29)

Face Validity

��The revised HiMAT appears to have better face validity than the LEFS and motor FIM for quantifying mobility limitations after lower-limb orthopedic trauma.�� (Williams et al., 2014)

Floor/Ceiling Effects

Multi-trauma Lower Limb Injuries: (Hill et al, 2014; Revised 8-item HiMAT)

Excellent: no ceiling or floor effects

Multi-trauma Orthopedic Injuries: (Williams et al., 2014; Revised 8-item HiMAT)

Excellent: no ceiling effects
Poor floor effects of 69.8% for participants who required the use of gait-assistive devices

Responsiveness

Multi-trauma Orthopedic Injuries: (Williams et al., 2014; Revised 8-item HiMAT)

The average change scores for the revised HiMAT were above the MDC score (2 points) from initial testing to 12 weeks (9.7 �� 7.2) and from 6 weeks to 12 weeks (3.1 �� 3.8)
At the individual participant level, 40 of the 43 participants (93%) significantly improved their HiMAT scores

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.

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.

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.

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.

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.

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.

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Purpose

Link to Instrument

Area of Assessment

Assessment Type

Administration Mode

Cost

CDE Status

Diagnosis/Conditions

Number of Items

Required Training

Instrument Reviewers

Body Structure

ICF Domain

Measurement Domain

Professional Association Recommendation

Considerations

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Minimally Clinically Important Difference (MCID)

Test/Retest Reliability

Interrater/Intrarater Reliability

Internal Consistency

Criterion Validity (Predictive/Concurrent)

Content Validity

Floor/Ceiling Effects

Responsiveness

Normative Data

Interrater/Intrarater Reliability

Internal Consistency

Content Validity

Floor/Ceiling Effects

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Normative Data

Internal Consistency

Criterion Validity (Predictive/Concurrent)

Content Validity

Face Validity

Floor/Ceiling Effects

Responsiveness

Bibliography

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