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. Author manuscript; available in PMC: 2017 Jan 4.
Published in final edited form as: Arch Phys Med Rehabil. 2014 May 24;95(11):2064–2070.e1. doi: 10.1016/j.apmr.2014.05.003
NM-Score D1: Standing position and transfers
0 No impairment: Walking ability, running and jumping are comparable to their peers.
1 Mild impairment: The individuals can walk (walking distance >500m) in town (sidewalks),
in supermarkets and on uneven ground. Many individuals may run and jump but with reduced
speed, impaired balance and/or compensatory strategies.
2 Moderate impairment: The individuals can walk over limited distances in the
neighborhood, within school or a workplace (walking distance <500m). Very few
individuals have the ability to run and jump.
3 Severe impairment: Upright mobility is very limited. Some individuals are able to take a few
steps inside the home with an assistive device or another person to assist, but upright mobility
is not the primary method of mobility.
4 Very severe impairment: Individuals cannot take any steps or stand up. No transfer of
weight to the feet can be achieved to move from seated to standing position.
NM-Score D2: Axial and proximal motor function
0 No impairment: Seated ability, proximal motor function of limbs, and head control are
comparable to their peers.
1 Mild impairment: Individuals can stay in an upright, seated position for an unlimited
amount of time (all day at school or at work) on a regular seat. Holding a seated position may
be qualitatively abnormal due to postural kyphosis or a level of fatigue requiring the support
of an upper limb or a chair back. Head control is normal for an unlimited amount of time.
2 Moderate impairment: Individuals can sit without support but for a limited amount of time.
Individuals able to sit for unlimited amount of time will be classified in this level of function
if:
→ the individual is unable to lift or carry objects above shoulder level and/or has difficulty
carrying and handling of heavy objects and/or
→ head control is compromised or only possible for short periods of time.
3 Severe impairment: The seated position without support is limited to a few important and
purely functional situations (dressing, positioning, donning/doffing a body jacket, sitting on
the toilet).
4 Very severe impairment: Individuals cannot sit up unassisted. The seated position is only
possible with the use of adaptive equipment.
NM-Score D3: Distal motor function
0 No impairment: Object manipulation and distal motor function are comparable to their peers.
1 Mild impairment: The majority of object manipulation and distal motor function in daily life
activities is preserved. Manual activities requiring greater strength are possible but with
difficulty, affecting speed, fatigue levels and the need for compensatory movements.
Intention tremors or a lack of precision can be the only impairment observed during the
activity.
2 Moderate impairment: Object manipulation and distal motor function are limited due to a
lack of strength and/or poor control of movement. The individuals cannot perform certain
manual activities requiring strength and significant dexterity. Easier manual activities are
possible, fully performed but with difficulty, slowness, fatigue or need to compensate. The
objects may be modified in order to facilitate their use (large pencil, adapted lids or covers).
3 Severe impairment: Individuals cannot perform manual activities requiring strength and
significant dexterity. Object manipulation and distal motor function during easy manual
activity may be partially accomplished. In order for these activities to be carried out in full,
adaptive equipment or assistance from another person is required.
□ 4 Very severe impairment: The great majority of object manipulation and distal motor
function in daily life activities is very difficult or unable to be accomplished.