Fugl-Meyer Assessment of Motor Recovery after Stroke

 

Original Editor - Sinead Greenan

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

Objective

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

Intended Population

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

Method of Use

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

Evidence

Reliability

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) 

• 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) 
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

Criterion Validity:

Stroke:

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

• 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) 

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) 
• 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) 
• 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). 
• FMA was a better measure of higher-level recovery than the MAS (Malouin, et al, 1994) 

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

• 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

Stroke:

(Mao et al, 2002, Acute Stroke) 

• 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) 

• 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)

Links

Fugl-Meyer Assessment of Motor Recovery After Stroke

References

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