Motor Assessment Scale: Difference between revisions

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== Objective  ==
== Objective  ==


The '''Motor Assessment Scale''' (MAS) is used to assess everyday motor function in patients with stroke.<ref name="Dean and Mackey">Dean, C. M., Mackey, F. M. Motor assessment scale scores as a measure of rehabilitation outcome following stroke. Aust J Physiother 1992; 38, 31-35.</ref><br>  
The Motor Assessment Scale (MAS) is a performance-based scale used to assess level of impairment and everyday motor function in patients with [[stroke]]<ref name="Dean and Mackey">Dean, C. M., Mackey, F. M. Motor assessment scale scores as a measure of rehabilitation outcome following stroke. Aust J Physiother. 1992; 38, 31-35.</ref><ref>Carr JH, Shepherd RB, Nordholm L, Lynne D. Investigation of a new motor assessment scale for stroke patients. Physical therapy. 1985 Feb 1;65(2):175-80.</ref>.<br>  


== Intended Population ==
== Intended Population ==


Used widely in assessing functional ability for patients with stroke<br>
Used widely in assessing functional ability for patients with stroke by Physical therapists and Occupational therapists.<br>


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


<u>Description:</u>  
<u>Description:</u>  
*8 items assess 8 areas of motor function  
*9 items to assess areas of motor function. Takes 15 mins to complete.
*Patients perform each task 3 times, only the best performance is recorded  
*Patients perform each task 3 times, only the best performance is recorded. 
*Items (with the exception of the general tonus item*) are assessed using a 7-point scale (0 to 6)  
*Items (with the exception of the general tonus item*) are assessed using a 7-point scale (0 to 6)  
*A score of 6 indicates optimal motor behavior  
*A score of 6 indicates optimal motor behavior
*Item scores (with the exception of the general tonus item) are summed to provide an overall score (out of 48 points)
<nowiki>*</nowiki>For the general tonus item, the score is based on continuous observations throughout the assessment. A score of 4 on this item indicates a consistently normal response, a score &gt; 4 indicates persistent hypertonus, and a score &lt; 4 indicates various degrees of hypotonus<ref name="p2">Carr, J. H., Shepherd, R. B., Nordholm, L., Lynne, D. Investigation of a new motor assessment scale for stroke patients. Phys Ther 1985 65: 175-180</ref>.
*Completing a higher-level item suggests successful performance on lower-level items and thus lower-items can be skipped.


*For the general tonus item, the score is based on continuous observations throughout the assessment. A score of 4 on this item indicates a consistently normal response, a score &gt; 4 indicates persistent hypertonus, and a score &lt; 4 indicates various degrees of hypotonus (Carr et al, 1985<ref name="p2">Carr, J. H., Shepherd, R. B., et al. "Investigation of a new motor assessment scale for stroke patients." Phys Ther 1985 65: 175-180</ref>).
<u>The 9 items assessment evaluates 5 Mobility and 3 Upper Limb activities, and 1 the severity of involuntary movements UMN lesions (clonus):</u>


<br>
# Supine to Side-Lying to intact side
# Supine to Sitting over side of bed
# Balance sitting
# Sitting to standing
# Walking
# Upper arm function
# Hand movements
# Advanced Hand Activities
# General Clonus


<u>Equipment Required:</u>  
<u>Equipment Required:</u>  
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*Prepared sheet for drawing lines
*Prepared sheet for drawing lines
*Cylindrical shaped object like a jar
*Cylindrical shaped object like a jar
*Table<br>
*Table
<u>Scoring</u>:
*Item scores (with the exception of the general tonus item) are summed to provide an overall score (out of 48 points)
*For  MAS 1 to 5, completing a higher-level item suggests successful performance on lower-level items and thus lower-items can be skipped.
*The upper limb section (MAS 6-8) should be scored non-hierarchical, meaning that every item within the subsets should be scored regardless of its position within the hierarchy<ref>Pickering RL, Hubbard IJ, Baker KG, Parsons MW. Assessment of the upper limb in acute stroke: the validity of hierarchal scoring for the Motor Assessment Scale. Australian Occupational Therapy Journal. 2010 Jun;57(3):174-82.</ref>.


==Evidence
== Evidence ==


=== Reliability  ===
=== Reliability  ===
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''Chronic Stroke:''  
''Chronic Stroke:''  


(Carr et al, 1985; n = 15; mean age = 70 years, range = 42 to 85)&nbsp;<ref name="p2" />
(Carr et al, 1985; n = 15; mean age = 70 years, range = 42 to 85)<ref name="p2" />  
 
*Excellent test-retest reliability: r ranged from 0.87 to 1.00 (mean r = 0.98)
 
<br>  


*Excellent test-retest reliability: r ranged from 0.87 to 1.00 (mean r = 0.98)<br>
<u>Interrater/Intrarater Reliability:</u>  
<u>Interrater/Intrarater Reliability:</u>  


''Chronic & Acute Stroke:''  
''Chronic & Acute Stroke:''  


(Carr et al, 1985; 20 clinical raters; n = 5; mean age = 65 years, range = 55 to 78; mean time since stroke onset = 14 (range = 6 to 40) weeks)&nbsp;<ref name="p2" />  
(Carr et al, 1985; 20 clinical raters; n = 5; mean age = 65 years, range = 55 to 78; mean time since stroke onset = 14 (range = 6 to 40) weeks)<ref name="p2" />  


*Excellent Interrater Reliability; 87% overall agreement between raters (mean correlation r = 0.95; most agreement = balanced sitting (r = 0.99); least agreement = sitting to standing (r = 0.89).
*Excellent Interrater Reliability; 87% overall agreement between raters (mean correlation r = 0.95; most agreement = balanced sitting (r = 0.99); least agreement = sitting to standing (r = 0.89).
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''Acute Stroke:''  
''Acute Stroke:''  


(Malouin et al, 1994, n = 32, mean age = 60 years, mean time since stroke = 64.5 days)&nbsp;<ref>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 years, mean time since stroke = 64.5 days)<ref>Malouin, F., Pichard, L., Bonneau, C., Durand, A., Corriveau, D . 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 Concurrent Validity with Fugl-Meyer (FMA) total scores (r = 0.96, not including general tonus items)  
*Excellent Concurrent Validity with Fugl-Meyer (FMA) total scores (r = 0.96, not including general tonus items)  
*Adequate to Excellent item level Concurrent Validity between MAS items and similar FMA items (r = 0.65 to 0.93)  
*Adequate to Excellent item level Concurrent Validity between MAS items and similar FMA items (r = 0.65 to 0.93)  
*Poor Concurrent Validity with MAS and FMA sitting balance (r = -0.10)
*Poor Concurrent Validity with MAS and FMA sitting balance (r = -0.10)<br>
 
<br>  
 
<u>Construct Validity:</u>  
<u>Construct Validity:</u>  


''Acute Stroke:''  
''Acute Stroke:''  


(Tyson &amp; DeSouza, 2004; n = 48; mean age = 66.7 (12.5) years; median time since stroke = 11 weeks)&nbsp;<ref>Tyson, S. F. and DeSouza, L. H. "Reliability and validity of functional balance tests post stroke." Clin Rehabil 2004 18(8): 916-923</ref>  
(Tyson &amp; DeSouza, 2004; n = 48; mean age = 66.7 (12.5) years; median time since stroke = 11 weeks)<ref>Tyson, S. F. and DeSouza, L. H. Reliability and validity of functional balance tests post stroke. Clin Rehabil 2004; 18(8): 916-923</ref>  


MAS and functional balance test:  
MAS and functional balance test:  
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*Adequate Convergent Validity: Sitting arm raise (no. of raises; r = 0.33*)  
*Adequate Convergent Validity: Sitting arm raise (no. of raises; r = 0.33*)  
*Adequate Convergent Validity: Sitting forward reach (cm, r = 0.54**)
*Adequate Convergent Validity: Sitting forward reach (cm, r = 0.54**)
 
<nowiki>*</nowiki>p &lt; 0.05<br>** p &lt; 0.01
*p &lt; 0.05<br>** p &lt; 0.01
 
<br>


<u>Content Validity:</u>  
<u>Content Validity:</u>  


The MAS was developed by Carr and Shepherd (1985) based on many years of experience with similar measures  
The MAS was developed by Carr and Shepherd (1985) based on many years of experience with similar measures<ref name="p2" />


=== Responsiveness  ===
=== Responsiveness  ===


''Chronic & Acute Stroke:''  
''Chronic & Acute Stroke:''
 
(English et al, 2006)&nbsp;<ref>English, C. K., Hillier, S. L., et al. "The sensitivity of three commonly used outcome measures to detect change among patients receiving inpatient rehabilitation following stroke." Clin Rehabil 2006 20(1): 52-55</ref><br> <br>MAS sensitivity:


<br>MAS sensitivity<ref>English, C. K., Hillier, S. L. The sensitivity of three commonly used outcome measures to detect change among patients receiving inpatient rehabilitation following stroke. Clin Rehabil, 2006; 20(1): 52-55</ref>:
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= Miscellaneous  =
=== Complimentary and Alternative Medicine (CAM)  ===
Complementary and alternative medicine refers to therapies which are not typically taught at medical schools, and which are not available at most hospitals.Patients with severe stroke, limb weakness, dysphagia, dyslipidemia, hypertension, or hemorrhagic stroke were among the most common individuals in India who used CAM treatments. The National Centre for Complementary and Alternative Medicine (NCCAM) classifies Complementary and Alternative Medicine (CAM) therapies into five categories, or domains and includes: alternative medical systems, such as homeopathy, mind-body medicine (prayer or mental healing), biologically based therapies using herbs, foods, and vitamins, manipulative and body-based methods including chiropractic or osteopathic manipulation, and massage and energy therapies which are intended to affect energy fields that purportedly surround and penetrate the human body, although the existence of such fields have not yet been scientifically proven.<br>
=== Traditional Chinese Medicine (TCM)  ===
TCM includes a variety of treatments including acupuncture, massage, and Chinese herbal medicines. Several studies have been conducted on the use of TCM, mostly in the acute stage of stroke(Wang et al. 2013).The use of acupuncture has recently gained attention as an adjunct to stroke rehabilitation in Western countries even though acupuncture has been a primary treatment in China for about 2000 years (Baldry <br>2005).The Chinese accepted acupuncture as a time-efficient, simple, safe and economical form of treatment extensively used to ameliorate motor, sensation, verbal communication and further neurological functions in post-stroke patients,” (JL et al. 2003).
Massage is the practice of applying structured pressure, tension, motion or vibration — manually or with mechanical aids — to the soft tissues of the body, including muscles, connective tissue, tendons, ligaments, joints and lymphatic vessels, to achieve a beneficial response.Massage is among the most frequently used alternative nursing interventions and has been used as a complementary form of treatment following stroke (Holland & Pokorny 2001).<br>
=== Combination Therapy  ===
Combination therapy refers to a combination of various herbal medicines, massage, acupuncture, and conventional care, depending on the study authors and the origin of the study. For instance, combination therapy of acupuncture, Chinese herbal medicines and conventional care is commonly used for stroke treatment in most TCM hospitals in China (Zhao et al. 2012). The common aim of these studies focus on the effectiveness of combination therapy for treating stroke when compared with conventional therapy or rehabilitation.<br>
=== Hyperbaric Oxygen Therapy  ===
The evidence showed no effectiveness for hyperbaric oxygen therapy in post-stroke patients. The observational studies reported 20% to 83% of selected stroke patients showed improvements following hyperbaric oxygen therapy, although it’s possible the results could be a product of bias and/or confounding. Also, nine of the observational studies reported adverse effects or complications. The study concluded that, “the overall evidence is insufficient to determine the effectiveness of hyperbaric oxygen therapy in any <br>subgroup of stroke patients.”<br>


== Links  ==
== Links  ==
 
*[https://www.sralab.org/rehabilitation-measures/motor-assessment-scale Motor Assessment Scale]
*[http://www.rehabmeasures.org/PDF%20Library/Motor%20Assessment%20Scale%20Testing%20Form.pdf Motor Assessment Scale for Stroke]
*[https://www.physio-pedia.com/images/5/5d/Motor_Assessment_Scale.pdf Motor Assessment Scale]


== References  ==
== References  ==
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[[Category:Outcome_Measures]]  
[[Category:Outcome_Measures]]  
[[Category:Neurology_Outcome_Measures]]  
[[Category:Assessment]]  
[[Category:Stroke]] [[Category:Assessment and Examination - Stroke]] [[Category:Outcome Measures - Stroke]]
[[Category:Neurology]]  
[[Category:Neurological - Assessment and Examination]]
[[Category:Neurological - Outcome Measures]]
[[Category:Neurological - Outcome Measures]]
[[Category:Stroke]]  
[[Category:Stroke - Assessment and Examination]]
[[Category:Stroke - Outcome Measures]]
[[Category:Head]]
[[Category:Head - Assessment and Examination]]
[[Category:Head - Outcome Measures]]
[[Category:Occupational Health]]
[[Category:Occupational Health]]

Latest revision as of 16:06, 10 January 2024

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Objective[edit | edit source]

The Motor Assessment Scale (MAS) is a performance-based scale used to assess level of impairment and everyday motor function in patients with stroke[1][2].

Intended Population[edit | edit source]

Used widely in assessing functional ability for patients with stroke by Physical therapists and Occupational therapists.

Method of Use[edit | edit source]

Description:

  • 9 items to assess areas of motor function. Takes 15 mins to complete.
  • Patients perform each task 3 times, only the best performance is recorded.
  • Items (with the exception of the general tonus item*) are assessed using a 7-point scale (0 to 6)
  • A score of 6 indicates optimal motor behavior

*For the general tonus item, the score is based on continuous observations throughout the assessment. A score of 4 on this item indicates a consistently normal response, a score > 4 indicates persistent hypertonus, and a score < 4 indicates various degrees of hypotonus[3].

The 9 items assessment evaluates 5 Mobility and 3 Upper Limb activities, and 1 the severity of involuntary movements UMN lesions (clonus):

  1. Supine to Side-Lying to intact side
  2. Supine to Sitting over side of bed
  3. Balance sitting
  4. Sitting to standing
  5. Walking
  6. Upper arm function
  7. Hand movements
  8. Advanced Hand Activities
  9. General Clonus

Equipment Required:

  • Stopwatch
  • 8 Jellybeans
  • Polystyrene cup
  • Rubber ball
  • Stool
  • Comb
  • Spoon
  • Pen
  • 2 Tea cups
  • Water
  • Prepared sheet for drawing lines
  • Cylindrical shaped object like a jar
  • Table

Scoring:

  • Item scores (with the exception of the general tonus item) are summed to provide an overall score (out of 48 points)
  • For MAS 1 to 5, completing a higher-level item suggests successful performance on lower-level items and thus lower-items can be skipped.
  • The upper limb section (MAS 6-8) should be scored non-hierarchical, meaning that every item within the subsets should be scored regardless of its position within the hierarchy[4].

Evidence[edit | edit source]

Reliability[edit | edit source]

Test-retest Reliability:

Chronic Stroke:

(Carr et al, 1985; n = 15; mean age = 70 years, range = 42 to 85)[3]

  • Excellent test-retest reliability: r ranged from 0.87 to 1.00 (mean r = 0.98)

Interrater/Intrarater Reliability:

Chronic & Acute Stroke:

(Carr et al, 1985; 20 clinical raters; n = 5; mean age = 65 years, range = 55 to 78; mean time since stroke onset = 14 (range = 6 to 40) weeks)[3]

  • Excellent Interrater Reliability; 87% overall agreement between raters (mean correlation r = 0.95; most agreement = balanced sitting (r = 0.99); least agreement = sitting to standing (r = 0.89).

Validity[edit | edit source]

Criterion Validity:

Acute Stroke:

(Malouin et al, 1994, n = 32, mean age = 60 years, mean time since stroke = 64.5 days)[5]

  • Excellent Concurrent Validity with Fugl-Meyer (FMA) total scores (r = 0.96, not including general tonus items)
  • Adequate to Excellent item level Concurrent Validity between MAS items and similar FMA items (r = 0.65 to 0.93)
  • Poor Concurrent Validity with MAS and FMA sitting balance (r = -0.10)

Construct Validity:

Acute Stroke:

(Tyson & DeSouza, 2004; n = 48; mean age = 66.7 (12.5) years; median time since stroke = 11 weeks)[6]

MAS and functional balance test:

  • Adequate Convergent Validity: Sitting arm raise (no. of raises; r = 0.33*)
  • Adequate Convergent Validity: Sitting forward reach (cm, r = 0.54**)

*p < 0.05
** p < 0.01

Content Validity:

The MAS was developed by Carr and Shepherd (1985) based on many years of experience with similar measures[3]

Responsiveness[edit | edit source]

Chronic & Acute Stroke:


MAS sensitivity[7]:

Item Dimension Effect Effect Size (d)  % Change
1 Rolling Large 1.03 31.1
2 Lie to sit Moderate 0.74 44.3
3 Balanced Sitting Moderate 0.61 60.7
4 Sit to Stand Large 0.85 18
5 Walking Large 1.02 19.7
6 Upper arm function Small 0.36 44.3
7 Hand movements Small 0.43 55.7
8 Advanced hand activities Moderate 0.50 63.9

Links[edit | edit source]

References[edit | edit source]

  1. ↑ Dean, C. M., Mackey, F. M. Motor assessment scale scores as a measure of rehabilitation outcome following stroke. Aust J Physiother. 1992; 38, 31-35.
  2. ↑ Carr JH, Shepherd RB, Nordholm L, Lynne D. Investigation of a new motor assessment scale for stroke patients. Physical therapy. 1985 Feb 1;65(2):175-80.
  3. ↑ 3.0 3.1 3.2 3.3 Carr, J. H., Shepherd, R. B., Nordholm, L., Lynne, D. Investigation of a new motor assessment scale for stroke patients. Phys Ther 1985 65: 175-180
  4. ↑ Pickering RL, Hubbard IJ, Baker KG, Parsons MW. Assessment of the upper limb in acute stroke: the validity of hierarchal scoring for the Motor Assessment Scale. Australian Occupational Therapy Journal. 2010 Jun;57(3):174-82.
  5. ↑ Malouin, F., Pichard, L., Bonneau, C., Durand, A., Corriveau, D . 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
  6. ↑ Tyson, S. F. and DeSouza, L. H. Reliability and validity of functional balance tests post stroke. Clin Rehabil 2004; 18(8): 916-923
  7. ↑ English, C. K., Hillier, S. L. The sensitivity of three commonly used outcome measures to detect change among patients receiving inpatient rehabilitation following stroke. Clin Rehabil, 2006; 20(1): 52-55
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