Fugl-Meyer Assessment (Upper and lower extremity components) Author: Axel R.

Fugl-Meyer Purpose: The Fugl-Meyer Assessment (FMA) is a stroke-specific, performance-based impairment index. It is designed to assess motor functioning, balance, sensation and joint functioning in patients with post-stroke hemiplegia. It is applied clinically and in research to determine disease severity, describe motor recovery, and to plan and assess treatment. Target Population: Patients with post-stroke hemiplegia What it tests: The FMA tests motor functioning, balance, sensation, and joint functioning. Specifically the upper and lower extremity components assess motor function of shoulder, elbow, wrist, hand, hip, knee, ankle, and foot. Psychometric characteristics; reliability, validity: High inter-rater reliability has been found for the FMA (upper and lower extremity components). In one study, Galdstone and others1, Pearsons correlation coefficients were between 0.995-0.996 for upper extremity and 0.96 for lower extremity. High validity was also found for the upper and lower extremity components of the FuglMeyer Assessment. Galdstone and others1, found the r=0.95 and a p < 0.001. Administration: The FMA should be administered by a trained physical therapist, occupational therapist or other rehabilitation professional on a one-to-one basis with the patient. The FMA is an impairment measure. It consists of 155 items and each item is rated on a three-point ordinal scale, 2 points for the detail being performed completely, 1 point for the detail being partially completed, and 0 points for the detail not being performed. A maximum score totals 226 points, 100 for the motor performance, 14 for the balance, 24 points for sensations and 44 points for passive joint motion and joint pain. The maximum score for the motor performance is divided into 66 points for the upper extremity and 34 for the lower extremity. Less than 50 points in the motor performance equals severe motor impairment. If Scores are between 50 and 84 this equals marketable impairment. If Scores are between 85 and 99 this equals slight motor impairment. Time required: Administration of the motor, sensation and balance sub scores range from 34 to 110 minutes, with a mean administration time of 58 minutes. When the motor scale (upper and lower extremities components) is administered on its own, it takes approximately 20 minutes to complete. Advantages: Has been shown to be highly accurate, reliable, and valid No costly materials are needed.

Can be used a cross a variety of settings. Measures a variety of components

Limitations: The whole assessment is very time consuming A poor ceiling effect has been found with the Sensation sub score. A poor floor effect has been found with the modified Balance sub score of the FMA at 14 days after stroke. The test is scored by direct observation and cannot be completed by untrained people. References: 1. Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer assessment of motor recovery after stroke: A critical review of its measurement properties. Neurorehabilitation and Neural Repair. 2002;16:232-240. 2. Lin J-, Hsueh I-, Sheu C-, Hsieh C-. Psychometric properties of the sensory scale of the fugl-meyer assessment in stroke patients. Clinical Rehabilitation. 2004;18:391-397. 3. Mao H-, Hsueh I-, Tang P-, Sheu C-, Hsieh C-. Analysis and comparison of the psychometric properties of three balance measures for stroke patients. Stroke. 2002;33:1022-1027. 4. Sanford J, Moreland J, Swanson LR, Stratford P W, Gowland C. Reliability of the fugl-meyer assessment for testing motor performance in patients following stroke. Phys Ther. 1993;73:447-454. Ordering/acquisition information: The FMA can be obtained by contacting the developers at the Institute of Rehabilitation Medicine, University of Goteberg, Goteberg, Sweden. A version of the measure is also provided in Fugl-Meyer et al. (1975), and in the book by Dittmar, S. S. and Gresham, G. E. (1997) entitled Functional assessment and outcome measures for the rehabilitation health professional.

Appraised by: Riley Phelps

Date appraised: 8/1/08