The Motor Assessment Scale (MAS) is a performance-based scale that was developed as a means of assessing everyday motor function in patients with stroke (Carr, Shepherd, Nordholm, & Lynne, 1985). The MAS is based on a task-oriented approach to evaluation that assesses performance of functional tasks rather than isolated patterns of movement (Malouin, Pichard, Bonneau, Durand, & Corriveau, 1994).
In 1985, Janet H. Carr and Roberta B. Shepherd published the MAS.
The MAS is comprised of 8 items corresponding to 8 areas of motor function. Patients perform each task 3 times and the best performance is recorded.
- Supine to side lying
- Supine to sitting over the edge of a bed
- Balanced sitting
- Sitting to standing
- Upper-arm function
- Hand movements
- Advanced hand activities
Also included is a single item, general tonus, intended to provide an estimate of muscle tone on the affected side (Carr et al., 1985).
All items (with the exception of the general tonus item) are assessed using a 7-point scale from 0 – 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 (Carr et al., 1985).
Item scores (with the exception of the general tonus item) can be summed to provide an overall score out of a possible 48 points (Malouin et al., 1994). Successfully completing a higher-level item suggests that the individual is able to perform the lower level items that correspond to lower scores, and thus these lower items can be skipped from the assessment (Sabari et al., 2005).
A major criticism of the MAS is that the general tonus item is difficult to assess, as there are no guidelines regarding the testing of tone, where it should be tested or how to score the item when the tone varies between the leg, arm, and trunk (Poole & Whitney, 1988). For this reason, this item is often omitted (Malouin et al., 1994; Loewen & Anderson, 1990).
Another issue with the MAS is that scoring hierarchies are not always consistent. Sabari et al. (2005) used Rasch analysis to examine the validity of the scoring hierarchies for the Upper Arm Function, Hand Movements and Advanced Hand Activities’ subscales and found that only the Upper Arm Function subscale demonstrated an appropriate hierarchy in terms of task difficulty. A later study by Miller, Slade, Pallant and Galea (2010), validated the test item difficulty hierarchy in the Upper Arm Function and Hand Movements subscales, but not the Advanced Hand Activities subscale. For example, some studies have reported that patients who could complete the most difficult task of the Advanced Hand Activities category (holding a comb and combing hair at the back of head) were unable to complete an easier item (drawing horizontal lines) (Poole & Whitney, 1988; Malouin et al., 1994), meaning that the items are not ordered according to their estimated difficulty (Miller et al., 2010).
Although a number of items are required to administer the MAS, the equipment is easy to acquire. The following equipment is needed:
- Eight Jellybeans
- Polystyrene cup
- Rubber ball
- Two Teacups
- Prepared sheet for drawing lines
- Cylindrical object like a jar
The upper limb items of the MAS can be used independent of the rest of the scale.
The instructions for the proper administration of the MAS are provided directly on the scale itself. Carr et al. (1985) recommend a short instruction and practice period, where the MAS is administered to at least six patients prior to using the test in a formal setting.
Carr et al. (1985) state that the MAS should take approximately 15 minutes to complete, however, other studies have reported administration times ranging from 15 to 60 minutes (Poole & Whitney, 1988; Malouin et al., 1994).
- Modified Motor Assessment Scale (MMAS).
Loewen and Anderson (1988) modified item descriptions and deleted the general tonus item. In a study on 7 patients with stroke, the MMAS demonstrated acceptable inter-rater reliability. This modified version is still scored on a 7-point scale from 0 – 6.
- Upper Limb/Extremity Motor Assessment Scale (UL-MAS or UE-MAS).
In this form of the MAS, only the three upper limb items are used as a scale to assess upper limb function. In a study evaluating this version, substantial reliability and validity (Cronbachs alpha = 0.83; Spearmans rho = 0.70) (Lannin, 2004; Hsueh & Hsieh, 2002).
- Modified Motor Assessment Scale (MMAS).
Can be used with:
Patients with stroke.
Should not be used in:
- Patients who require a proxy to complete. As with other impairment indices, the MAS is scored by direct observation and should not be used with proxy respondents.
- When assessing severely affected patients or patients with aphasia, we recommend that although it takes longer to administer, the Fugl-Meyer Assessment of Sensorimotor Recovery After Stroke (FMA) – another measure to assess motor functioning in patients with stroke – should be used instead of the MAS.
English (Carr et al., 1985)
Norwegian (Kjendahl, Jahnsen, & Aamodt, 2005)