Fugl-Meyer Assessment of Motor Recovery after Stroke: Difference between revisions

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== Objective<br>  ==
== Objective<br>  ==


The&nbsp;'''Fugl-Meyer Assessment of Motor Recovery after Stroke''' is used to evaluate and measure recovery in post-stroke hemiplegic patients.  
The&nbsp;'''Fugl-Meyer Assessment of Motor Recovery after Stroke''' is used to evaluate and measure recovery in post-stroke hemiplegic patients.  
[[Category:Outcome_Measures]]


== Intended Population<br>  ==
== Intended Population<br>  ==


The FMA was designed to be used for patients with post-stroke hemiplegic patients of all ages
The FMA was designed to be used for patients with post-stroke hemiplegic patients of all ages  


== Method of Use  ==
== Method of Use  ==


'''Equipment Required:'''
'''Equipment Required:'''  
 
Tennis ball


Tennis ball
*A small spherical container  
*A small spherical container
*Reflex hammer  
*Reflex hammer
*Quiet, private space with little distraction
*Quiet, private space with little distraction


'''Description:'''
'''Description:'''  


Items are scored on a 3-point ordinal scale
Items are scored on a 3-point ordinal scale  


0 = cannot perform<br>1 = performs partially<br>2 = performs fully
0 = cannot perform<br>1 = performs partially<br>2 = performs fully  


*Maximum Score = 226 points
*Maximum Score = 226 points  
*The Five domains assessed include:
*The Five domains assessed include:


Motor function (UE maximum score = 66; LE maximum score = 34)<br>Sensory function (maximum score = 24)<br>Balance (maximum score = 14)<br>Joint range of motion (maximum score = 44)<br>Joint pain (maximum score = 44)
Motor function (UE maximum score = 66; LE maximum score = 34)<br>Sensory function (maximum score = 24)<br>Balance (maximum score = 14)<br>Joint range of motion (maximum score = 44)<br>Joint pain (maximum score = 44)  


*Subscales can be administered without the using the full test
*Subscales can be administered without the using the full test


<br>


 
Links to scoring sheet found below  
Links to scoring sheet found below


== Reference<br>  ==
== Reference<br>  ==
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=== Reliability  ===
=== Reliability  ===


<u>Test-retest Reliability:</u>
<u>Test-retest Reliability:</u>  


<u></u>General Rehab Sample:  
<u></u>General Rehab Sample:  


(Platz et al, 2005; n = 37 stroke, 14 MS, and 5 TBI patients; assessed twice within a 7 day interval, General Rehab Sample)&nbsp;<ref name="Platz et al">Platz, T., Pinkowski, C., et al. "Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study." Clin Rehabil 2005 19: 404-411</ref>
(Platz et al, 2005; n = 37 stroke, 14 MS, and 5 TBI patients; assessed twice within a 7 day interval, General Rehab Sample)&nbsp;<ref name="Platz et al">Platz, T., Pinkowski, C., et al. "Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study." Clin Rehabil 2005 19: 404-411</ref>  


*Excellent Total Motor Score (ICC = 0.97)
*Excellent Total Motor Score (ICC = 0.97)  
*Excellent Sensation (ICC = 0.81)
*Excellent Sensation (ICC = 0.81)  
*Excellent Passive Joint motion (ICC = 0.95)
*Excellent Passive Joint motion (ICC = 0.95)


<u>Interrater/Intrarater Reliability:</u>
<u>Interrater/Intrarater Reliability:</u>  


<u></u>Stroke:<br>(Duncan et al, 1983; n = 19; mean age = 56 (13) years; same PT rating on 3 occasions each 3 weeks apart; VA sample, Chronic Stroke)&nbsp;<ref name="Duncan et al">Duncan, P. W., Propst, M., et al. "Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident." Phys Ther 1983 63: 1606-1610</ref><br>'''Interrater Reliability'''
<u></u>Stroke:<br>(Duncan et al, 1983; n = 19; mean age = 56 (13) years; same PT rating on 3 occasions each 3 weeks apart; VA sample, Chronic Stroke)&nbsp;<ref name="Duncan et al">Duncan, P. W., Propst, M., et al. "Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident." Phys Ther 1983 63: 1606-1610</ref><br>'''Interrater Reliability'''  


{| width="200" border="1" cellpadding="1" cellspacing="1"
{| width="200" border="1" cellpadding="1" cellspacing="1"
|-
|-
| '''Rating'''
| '''Rating'''  
| '''Domain'''
| '''Domain'''  
| '''Pearson's r'''
| '''Pearson's r'''
|-
|-
| ''Excellent''
| ''Excellent''  
| FMA total score
| FMA total score  
| r = 0.98-0.99
| r = 0.98-0.99
|-
|-
| ''Excellent''
| ''Excellent''  
| Upper Extremity
| Upper Extremity  
| r = 0.995 - 0.996
| r = 0.995 - 0.996
|-
|-
| ''Excellent''
| ''Excellent''  
| Lower Extremity
| Lower Extremity  
| r = 0.96
| r = 0.96
|-
|-
| ''Excellent''
| ''Excellent''  
| Sensation
| Sensation  
| r = 0.95 - 0.96
| r = 0.95 - 0.96
|-
|-
| ''Excellent''
| ''Excellent''  
| Joint Range / Pain
| Joint Range / Pain  
| r = 0.86 - 0.996
| r = 0.86 - 0.996
|-
|-
| ''Excellent''
| ''Excellent''  
| Balance
| Balance  
| r = 0.89 - 0.98
| r = 0.89 - 0.98
|}
|}


<br>
<br>  


=== Validity  ===
=== Validity  ===
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<u>Criterion Validity:</u>  
<u>Criterion Validity:</u>  


<u></u>Stroke:
<u></u>Stroke:  


(Malouin et al, 1994; n = 32; mean age = 60; mean time since stroke = 64.5 days, Acute Stroke)&nbsp;<ref name="Malouin et al">Malouin, F., Pichard, L., et al. "Evaluating motor recovery early after stroke: comparison of the Fugl-Meyer Assessment and the Motor Assessment Scale." Arch Phys Med Rehabil 1994 75: 1206-1212</ref>
(Malouin et al, 1994; n = 32; mean age = 60; mean time since stroke = 64.5 days, Acute Stroke)&nbsp;<ref name="Malouin et al">Malouin, F., Pichard, L., et al. "Evaluating motor recovery early after stroke: comparison of the Fugl-Meyer Assessment and the Motor Assessment Scale." Arch Phys Med Rehabil 1994 75: 1206-1212</ref>  


*Excellent FMA &amp; Motor Assessment Scale (MAS) total score correlations (r = 0.96)  
*Excellent FMA &amp; Motor Assessment Scale (MAS) total score correlations (r = 0.96)  
*Poor FMA &amp; MAS sitting balance item correlations (r = -0.10)
*Poor FMA &amp; MAS sitting balance item correlations (r = -0.10)  
*Motor and sensory FMA scores 5 days post-stroke were the strongest predictor of motor recovery 6 months post-stroke (Duncan et al, 1992)&nbsp;<ref name="Duncan et al">Duncan, P. W., Goldstein, L. B., et al. "Measurement of motor recovery after stroke. Outcome assessment and sample size requirements." Stroke 1992 23(8): 1084-1089</ref>
*Motor and sensory FMA scores 5 days post-stroke were the strongest predictor of motor recovery 6 months post-stroke (Duncan et al, 1992)&nbsp;<ref name="Duncan et al">Duncan, P. W., Goldstein, L. B., et al. "Measurement of motor recovery after stroke. Outcome assessment and sample size requirements." Stroke 1992 23(8): 1084-1089</ref>


<u>Construct Validity:</u>  
<u>Construct Validity:</u>  


<u></u>Stroke:<br>Acute Stroke:
<u></u>Stroke:<br>Acute Stroke:  


*Excellent correlation: modified Balance Subscale on FMA and the Barthel Index; r = 0.86 - 0.89 (Mao et al, 2002)&nbsp;<ref name="Mao et al">Mao, H.-F., Hsueh, I. P., et al. "Analysis and comparison of the psychometric properties of three balance measures for stroke patients." Stroke 2002 33: 1022-1027</ref>
*Excellent correlation: modified Balance Subscale on FMA and the Barthel Index; r = 0.86 - 0.89 (Mao et al, 2002)&nbsp;<ref name="Mao et al">Mao, H.-F., Hsueh, I. P., et al. "Analysis and comparison of the psychometric properties of three balance measures for stroke patients." Stroke 2002 33: 1022-1027</ref>  
*Excellent correlation: FMA and Functional Independence Measures (FIM) administered to 172 inpatients who had recently had a stoke; r = 0.63 (Shelton et al, 2000)&nbsp;<ref name="Shelton et al">Shelton, F. D., Volpe, B. T., et al. "Motor impairment as a predictor of functional recovery and guide to rehabilitation treatment after stroke." Neurorehabil Neural Repair 2001 15(3): 229-237</ref>
*Excellent correlation: FMA and Functional Independence Measures (FIM) administered to 172 inpatients who had recently had a stoke; r = 0.63 (Shelton et al, 2000)&nbsp;<ref name="Shelton et al">Shelton, F. D., Volpe, B. T., et al. "Motor impairment as a predictor of functional recovery and guide to rehabilitation treatment after stroke." Neurorehabil Neural Repair 2001 15(3): 229-237</ref>  
*FMA effectively distinguished between three levels of self care (Independent, Partly Dependant, and Dependant) in a sample of 109 recent (&lt; 90 days) stroke survivors (Bernspang et al, 1987).&nbsp;<ref name="Bernspang et al">Bernspang, B., Asplund, K., et al. (1987). "Motor and perceptual impairments in acute stroke patients: effects on self-care ability." Stroke 1987 18: 1081-1086</ref>
*FMA effectively distinguished between three levels of self care (Independent, Partly Dependant, and Dependant) in a sample of 109 recent (&lt; 90 days) stroke survivors (Bernspang et al, 1987).&nbsp;<ref name="Bernspang et al">Bernspang, B., Asplund, K., et al. (1987). "Motor and perceptual impairments in acute stroke patients: effects on self-care ability." Stroke 1987 18: 1081-1086</ref>  
*FMA was a better measure of higher-level recovery than the MAS (Malouin, et al, 1994)&nbsp;<ref name="Malouin et al">Malouin, F., Pichard, L., et al. "Evaluating motor recovery early after stroke: comparison of the Fugl-Meyer Assessment and the Motor Assessment Scale." Arch Phys Med Rehabil 1994 75: 1206-1212</ref>
*FMA was a better measure of higher-level recovery than the MAS (Malouin, et al, 1994)&nbsp;<ref name="Malouin et al">Malouin, F., Pichard, L., et al. "Evaluating motor recovery early after stroke: comparison of the Fugl-Meyer Assessment and the Motor Assessment Scale." Arch Phys Med Rehabil 1994 75: 1206-1212</ref>


Chronic Stroke<br> (Dettmann et al, 1987; n = 15; mean age = 64 years; mean time since stroke, 2 years, Chronic Stroke)&nbsp;<ref name="Dettmann et al">Dettmann, M. A., Linder, M. T., et al. "Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient." Am J Phys Med 1987 66: 77-90</ref>
Chronic Stroke<br> (Dettmann et al, 1987; n = 15; mean age = 64 years; mean time since stroke, 2 years, Chronic Stroke)&nbsp;<ref name="Dettmann et al">Dettmann, M. A., Linder, M. T., et al. "Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient." Am J Phys Med 1987 66: 77-90</ref>  


*The FMA and the Barthel Index were used to assess a group of 15 participants at an average of 2 years post stroke. Correlations between the measures were excellent (r = 0.67). The strongest correlations were observed in the Balance subscore (r = 0.76) the Upper Extremity subscore of the motor domain (r = 0.75) and FMA Motor total score (r = 0.74)
*The FMA and the Barthel Index were used to assess a group of 15 participants at an average of 2 years post stroke. Correlations between the measures were excellent (r = 0.67). The strongest correlations were observed in the Balance subscore (r = 0.76) the Upper Extremity subscore of the motor domain (r = 0.75) and FMA Motor total score (r = 0.74)
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=== Responsiveness  ===
=== Responsiveness  ===


Stroke:
Stroke:  


(Mao et al, 2002, Acute Stroke)&nbsp;<ref name="Mao et al">Mao, H.-F., Hsueh, I. P., et al. "Analysis and comparison of the psychometric properties of three balance measures for stroke patients." Stroke 2002 33: 1022-1027</ref>
(Mao et al, 2002, Acute Stroke)&nbsp;<ref name="Mao et al">Mao, H.-F., Hsueh, I. P., et al. "Analysis and comparison of the psychometric properties of three balance measures for stroke patients." Stroke 2002 33: 1022-1027</ref>  


*Excellent on the modified version of the FMA Balance score
*Excellent on the modified version of the FMA Balance score  
*&nbsp; Between assessments at 14, 30, 90 and 180 days post-stroke
*&nbsp; Between assessments at 14, 30, 90 and 180 days post-stroke  
*&nbsp; Responsiveness decreased as the time between stroke and assessments increased
*&nbsp; Responsiveness decreased as the time between stroke and assessments increased


<br>
<br>  


(Hsueh et al, 2009, Chronic Stroke)&nbsp;<ref name="Hsueh et al">Hsueh, Y. W., Wu, C. Y., et al. (2009). "Responsiveness and validity of three outcome measures of motor function after stroke rehabilitation." Stroke 2009 40(4): 1386-1391</ref>
(Hsueh et al, 2009, Chronic Stroke)&nbsp;<ref name="Hsueh et al">Hsueh, Y. W., Wu, C. Y., et al. (2009). "Responsiveness and validity of three outcome measures of motor function after stroke rehabilitation." Stroke 2009 40(4): 1386-1391</ref>  


*Small to moderate effect sizes were observed on the FMA, the Stroke Rehabilitation Assessment of Movement instrument (STREAM) and each of the measures shortened versions.
*Small to moderate effect sizes were observed on the FMA, the Stroke Rehabilitation Assessment of Movement instrument (STREAM) and each of the measures shortened versions.  
*Moderate effect sizes on the shortened version of both measures (0.53 and 0.51)
*Moderate effect sizes on the shortened version of both measures (0.53 and 0.51)  
*Small effect sizes on the long version of the measure (0.045 and 0.38)
*Small effect sizes on the long version of the measure (0.045 and 0.38)


=== Miscellaneous<span style="font-size: 20px; font-weight: normal;" class="Apple-style-span"></span><br>  ===
=== Miscellaneous<br>  ===


== Links  ==
== Links  ==


[http://reseauconceptuel.umontreal.ca/rid=1K6ZN0YYW-1Z7JDJS-Z5/FuglMeyer.pdf Fugl-Meyer Assessment of Motor Recovery After Stroke]
[http://reseauconceptuel.umontreal.ca/rid=1K6ZN0YYW-1Z7JDJS-Z5/FuglMeyer.pdf Fugl-Meyer Assessment of Motor Recovery After Stroke]  


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
Line 152: Line 150:
References will automatically be added here, see [[Adding References|adding references tutorial]].  
References will automatically be added here, see [[Adding References|adding references tutorial]].  


<references />
<references />  
 
[[Category:Outcome_Measures]]

Revision as of 12:17, 4 September 2014

 

Original Editor - Sinead Greenan

Top Contributors - Sinead Greenan, Adam Vallely Farrell, Andeela Hafeez, Kim Jackson, Areeba Raja, Oyemi Sillo, Vanessa Rhule, WikiSysop, Candace Goh, 127.0.0.1, Evan Thomas, Scott Buxton and Naomi O'Reilly  

Objective
[edit | edit source]

The Fugl-Meyer Assessment of Motor Recovery after Stroke is used to evaluate and measure recovery in post-stroke hemiplegic patients.

Intended Population
[edit | edit source]

The FMA was designed to be used for patients with post-stroke hemiplegic patients of all ages

Method of Use[edit | edit source]

Equipment Required:

Tennis ball

  • A small spherical container
  • Reflex hammer
  • Quiet, private space with little distraction

Description:

Items are scored on a 3-point ordinal scale

0 = cannot perform
1 = performs partially
2 = performs fully

  • Maximum Score = 226 points
  • The Five domains assessed include:

Motor function (UE maximum score = 66; LE maximum score = 34)
Sensory function (maximum score = 24)
Balance (maximum score = 14)
Joint range of motion (maximum score = 44)
Joint pain (maximum score = 44)

  • Subscales can be administered without the using the full test


Links to scoring sheet found below

Reference
[edit | edit source]

Evidence[edit | edit source]

Reliability[edit | edit source]

Test-retest Reliability:

General Rehab Sample:

(Platz et al, 2005; n = 37 stroke, 14 MS, and 5 TBI patients; assessed twice within a 7 day interval, General Rehab Sample) [1]

  • Excellent Total Motor Score (ICC = 0.97)
  • Excellent Sensation (ICC = 0.81)
  • Excellent Passive Joint motion (ICC = 0.95)

Interrater/Intrarater Reliability:

Stroke:
(Duncan et al, 1983; n = 19; mean age = 56 (13) years; same PT rating on 3 occasions each 3 weeks apart; VA sample, Chronic Stroke) [2]
Interrater Reliability

Rating Domain Pearson's r
Excellent FMA total score r = 0.98-0.99
Excellent Upper Extremity r = 0.995 - 0.996
Excellent Lower Extremity r = 0.96
Excellent Sensation r = 0.95 - 0.96
Excellent Joint Range / Pain r = 0.86 - 0.996
Excellent Balance r = 0.89 - 0.98


Validity[edit | edit source]

Criterion Validity:

Stroke:

(Malouin et al, 1994; n = 32; mean age = 60; mean time since stroke = 64.5 days, Acute Stroke) [3]

  • Excellent FMA & Motor Assessment Scale (MAS) total score correlations (r = 0.96)
  • Poor FMA & MAS sitting balance item correlations (r = -0.10)
  • Motor and sensory FMA scores 5 days post-stroke were the strongest predictor of motor recovery 6 months post-stroke (Duncan et al, 1992) [2]

Construct Validity:

Stroke:
Acute Stroke:

  • Excellent correlation: modified Balance Subscale on FMA and the Barthel Index; r = 0.86 - 0.89 (Mao et al, 2002) [4]
  • Excellent correlation: FMA and Functional Independence Measures (FIM) administered to 172 inpatients who had recently had a stoke; r = 0.63 (Shelton et al, 2000) [5]
  • FMA effectively distinguished between three levels of self care (Independent, Partly Dependant, and Dependant) in a sample of 109 recent (< 90 days) stroke survivors (Bernspang et al, 1987). [6]
  • FMA was a better measure of higher-level recovery than the MAS (Malouin, et al, 1994) [3]

Chronic Stroke
(Dettmann et al, 1987; n = 15; mean age = 64 years; mean time since stroke, 2 years, Chronic Stroke) [7]

  • The FMA and the Barthel Index were used to assess a group of 15 participants at an average of 2 years post stroke. Correlations between the measures were excellent (r = 0.67). The strongest correlations were observed in the Balance subscore (r = 0.76) the Upper Extremity subscore of the motor domain (r = 0.75) and FMA Motor total score (r = 0.74)

Responsiveness[edit | edit source]

Stroke:

(Mao et al, 2002, Acute Stroke) [4]

  • Excellent on the modified version of the FMA Balance score
  •   Between assessments at 14, 30, 90 and 180 days post-stroke
  •   Responsiveness decreased as the time between stroke and assessments increased


(Hsueh et al, 2009, Chronic Stroke) [8]

  • Small to moderate effect sizes were observed on the FMA, the Stroke Rehabilitation Assessment of Movement instrument (STREAM) and each of the measures shortened versions.
  • Moderate effect sizes on the shortened version of both measures (0.53 and 0.51)
  • Small effect sizes on the long version of the measure (0.045 and 0.38)

Miscellaneous
[edit | edit source]

Links[edit | edit source]

Fugl-Meyer Assessment of Motor Recovery After Stroke

Recent Related Research (from Pubmed)[edit | edit source]

Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10

References[edit | edit source]

References will automatically be added here, see adding references tutorial.

  1. ↑ Platz, T., Pinkowski, C., et al. "Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study." Clin Rehabil 2005 19: 404-411
  2. ↑ 2.0 2.1 Duncan, P. W., Propst, M., et al. "Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident." Phys Ther 1983 63: 1606-1610 Cite error: Invalid <ref> tag; name "Duncan et al" defined multiple times with different content
  3. ↑ 3.0 3.1 Malouin, F., Pichard, L., et al. "Evaluating motor recovery early after stroke: comparison of the Fugl-Meyer Assessment and the Motor Assessment Scale." Arch Phys Med Rehabil 1994 75: 1206-1212
  4. ↑ 4.0 4.1 Mao, H.-F., Hsueh, I. P., et al. "Analysis and comparison of the psychometric properties of three balance measures for stroke patients." Stroke 2002 33: 1022-1027
  5. ↑ Shelton, F. D., Volpe, B. T., et al. "Motor impairment as a predictor of functional recovery and guide to rehabilitation treatment after stroke." Neurorehabil Neural Repair 2001 15(3): 229-237
  6. ↑ Bernspang, B., Asplund, K., et al. (1987). "Motor and perceptual impairments in acute stroke patients: effects on self-care ability." Stroke 1987 18: 1081-1086
  7. ↑ Dettmann, M. A., Linder, M. T., et al. "Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient." Am J Phys Med 1987 66: 77-90
  8. ↑ Hsueh, Y. W., Wu, C. Y., et al. (2009). "Responsiveness and validity of three outcome measures of motor function after stroke rehabilitation." Stroke 2009 40(4): 1386-1391
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