Assessment Overview

Purpose: Examine and quantify the recovery of post-stroke hemiplegic patients and is used in both clinic and research settings.

Summary: Functional tasks are not quantified in this assessment. Across the five domains there are 155 items that are evaluated, however, it is not required for each domain to be assessed. If needed each domain can be separated to assess only lower or upper body functioning. If all domains are assessed, the FMA takes approximately 30 minutes to administer, however, it can take longer to complete if patients are more severely affected by their condition.

Equipment: Various items including a scrap of paper, ball, cotton ball, pencil, reflex hammer, cylinder, goniometer, stopwatch, blindfold, chair, and bedside table are needed to complete the test.

ICF Category: Body Function

Assessment Handout

Assessment Psychometrics

The FMA is highly recommended for use in those with acute, subacute, or chronic strokes and is highly recommended for use in acute care, inpatient rehabilitation, skilled nursing facilities, outpatient rehabilitation, and home health. This measure should be taught to students and is appropriate for use in research. The psychometrics are reported below:

• Concurrent Validity: Excellent correlation with Motor Assessment Scale (MAS) total score (r=0.96); Poor correlation with MAS sitting balance (r=-0.10); Motor and sensory scores 5 days post were strongest predictor of motor recovery; Excellent correlation with Action Research Arm Test across two trials (r=0.74, 0.67)

• Construct Validity: Acute: Excellent correlation with Barthel Index (r=0.86-0.89); Excellent correlation with FIM (r=0.63); Chronic: Excellent correlation with Barthel Index (r=0.67)

• Content Validity: All items except the hook grasp item were assessing the same underlying construct. If the patient is able to complete more difficult items on the test, they should be able to complete easier items within the category, allowing for a shortened version of the test

• Criterion Validity: Motor and sensory scores 5 days post stroke were the strongest predictor of motor recovery 6 months post stroke

• Cutoff Score: >90

• Floor/Ceiling Effects: Ceiling effects with sensation subscore; Floor effects with the modified balance domain

• Interrater Reliability: Excellent total score (ICC=0.89), UE (ICC=0.99), LE (ICC=0.91), Sensory total (ICC=0.46), Sensory light (ICC=0.87), sensory proprioception (ICC=0.96)

• Intrarater Reliability: Excellent total score (ICC=0.99), UE (ICC=0.95), LE (ICC=0.99), Sensory total (ICC=0.96), Sensory light (ICC=1.0), sensory proprioception (ICC=0.95)

• MCID: Grasping: 4.25; Releasing: 5.25; Ability to move arm: 7.25; Ability to perform COPM: 4.25; Overall UE function: 5.25

• Mean Data: Percent that recovered (Fugl-Meyer >90); Baseline: 13.07%; 1 Month: 12.85%; 3 Month: 13.94%; 6 Month: 9.15%; Never: 63.20%

• MDC: Upper Extremity Portion: 5.2

• Responsiveness: Acute: Excellent on modified balance domain; Moderate to low for sensation domain; Chronic: Small to moderate on total measure (moderate on shortened version, small on long version)

• SEM: Total score: 9.4