HiMAT Frequently Asked Questions

The HiMAT was specifically developed to be quick and easy to use in almost any clinical setting. It has minimal time, equipment and training requirements. If you experience any difficulty or require a point to be clarified, please do not hesitate to contact the developers of the HiMAT to discuss your questions.

There are four frequently asked questions in relation to the HiMAT;

1) Does the client have to perform the warm-up/practice trial?
The warm-up or practice trial is important before a performance is recorded. Retest reliability studies on high-level mobility performance following TBI show a practice effect is possible even in patients with chronic injuries.

2) Does the patient have to actually run for the running item or is a fast walk acceptable?
A ‘flight phase’ or ‘no-contact phase’ is essential for the running, skipping, hopping and bounding items. If a flight phase is not consistently performed between all foot contacts during the test, a fail is recorded for these items. Therefore a very fast walk is not acceptable as a run. Similarly, a very large step is not acceptable as a bound.

3) What happens if we don’t have a flight of 14 steps?
A full-flight of 14 steps needs to be used where-ever possible for the stair items because the performance quartiles for scoring are based on this number of steps. In the event that only a smaller number of steps are available, the time achieved by the patient has to be transformed before a score can be assigned. For example, if a time is recorded on a flight of 10 steps, this time needs to be multiplied by 14/10. The calculation is

Patient time x 14/number of steps = converted HiMAT time

To investigate if a reduced number of stairs was valid for HiMAT scoring, a sample of 20 people with extremely severe traumatic brain injuries were tested on flights of 6, 8, 11 and 14 stairs.

Subjects performed the four trials in a random order to control for the effect of ordering and fatigue. Performances were classified as ‘dependent’ or ‘independent’ and times were recorded and transformed so that a converted score could be calculated. To calculate the converted score for the flight of 6 stairs, the timed performance was multiplied by 14/6. This procedure was repeated for the flight of 8 stairs (14/8) and 11 stairs (14/11).

Converted scores were calculated for ‘Up Stairs’ and ‘Down Stairs’ separately (possible range 0-9) and compared to the score obtained on the full flight of 14 stairs.

The correlations between the scores obtained for the full flight of 14 stairs and the converted scores for 6, 8, and 11 stairs were generally very high, ranging from .80 to .98 for ‘Up Stairs’ and .92 to .95 for ‘Down Stairs’. Subjects did not change their method (reciprocal or rail use) of stair ascent or descent between the different flight trials.

When comparing the mean performances between the full flight of 14 stairs and the converted scores for 6, 8, and 11 stairs, no significant differences were identified for ‘Up Stairs’. There was a trend for the subjects to perform the flight of 6 stairs at a faster speed than the full flight of 14 stairs, but this difference was not significant.

When comparing the mean performances for ‘Down Stairs’, subjects performed at significantly faster speeds for flights of 6 and 8 stairs than the full set of 14 stairs.

On average, the subjects scored 0.5 points higher when performing on the flight of 6 stairs when compared to the full flight of 14 stairs for the ‘Up Stairs’ and ‘Down Stairs’ tasks. When considering the standard error of measurement, the upper 95% confidence interval for improvement was, at most, less than 1 point.

The clinical significance of these results are;

• Subjects may perform at a significantly faster speed when descending smaller flights of stairs.
• Scores converted from flights of 6 stairs may inflate ‘true’ HiMAT total scores, but scores converted from flights of 11 or more stairs seem to be valid.
• When converting a score from a flight of 6 stairs, the maximum a stair item score may inflate the total HiMAT score is 2 points (1 point for ‘Up Stairs’ and 1 point for ‘Down Stairs’).
• The impact of testing on a reduced number of stairs on total HiMAT scores is of minor importance for the majority of patients and clinicians as assessments are normally repeated in the same location. It is more important to acknowledge the potential impact on total scores when changing assessment location if patients are transferred between facilities.

4) What are the normative values for the HiMAT?
No normative values have been developed for the HiMAT yet. It is planned that normative values will be developed for younger and older adults and males and females.