Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES)

Purpose of the measure
The MESUPES measures quality of movement performance of the hemiparetic arm and hand in stroke patients.
Available versions
The original version of the MESUPES comprised 22 items within three categories of arm function (10 items), hand function (9 items) and functional tasks (3 items).
The final version of the measure, analyzed with Principle Component Analysis and Rasch analysis resulted in a 17-item version with two categories of arm function (8 items) and hand function (“range of motion” 6 items; and “orientation during functional tasks” 3 items) (Van de Winckel et al., 2006).

Features of the measure

Items
The original MESUPES is comprised of 22 items in three subscales:

  1. Arm function: 10 items
  2. Hand function: 9 items
  3. Functional tasks: 3 items

The final version of the MESUPES is comprised of 17 items in two subscales:

MESUPES–Arm function: 8 items with 6 response categories (0-5)
MESUPES–Hand function: 9 items with 3 response categories (0-2).

During the MESUPES–Arm subset, patients are required to perform specific movements of the upper limb in three consecutive phases:

  1. The task is performed passively
  2. The therapist assists the patient during the movement
  3. The patient performs the task by him/herself.

During the MESUPES–Hand subsets, patients are instructed to perform specific movements of the hand and fingers by themselves.

Scoring

As the MESUPES adopts an ordinal scale, Rasch analysis has been performed to translate ordinal data into interval measures (logit scores) (Van de Winckel et al., 2006).

Online scoring will soon be available to enable users to input the ordinal scores and retrieve logits scores immediately (personal correspondence, Van de Winckel, 2015).

Subset 1: Arm function

The MESUPES–Arm subset evaluates ‘normal’ movement of the hemiparetic limb, which can be judged by comparison with movement of the patient’s unaffected arm. Only qualitatively ‘normal’ movements of the arm are scored.

The tasks are performed in three phases. The number of phases evaluated depends on the level of ability the patient has, to perform the movement correctly.

Testing phase

Points achieved

1.    The therapist moves the patient’s arm and hand and evaluates muscle tone first.

 

No adequate adaptation of tone to movement:

0 points

Adequate adaptation of tone (normal tone) to at least part of the movement:

1 point

2.    If the patient exhibits normal tone, the patient participates in the movement and the therapist evaluates muscle contractions.

 

The patient demonstrates functionally and qualitatively correct muscle contraction in at least part of the movement:

2 points

3.    If the patient exhibits normal muscle contraction, the patient performs the movement independently and the therapist assesses range of movement.

A score is given for the range of motion that the patient can perform with good quality of motion.

 

Part of the movement is performed normally:

 

3 points

Total range of normal movement is done slowly or with great effort:

4 points

The patient demonstrates normal movement performance:

5 points

The patient is allowed to repeat test items with a maximum of three attempts; the patient is awarded the highest score achieved. See the measure for more scoring information.

Subset 2: Hand function (Range of Motion)

Performance of movement and measurement of range of motion is not compared with the unaffected hand for this subset. Only qualitatively normal movements of the hand and fingers are scored.

Testing procedure

Points achieved

The patient performs the instructed movement actively and the therapist assesses range of movement between 0-2cm qualitatively and quantitatively.

no movement:

movement amplitude < 2 cm

movement amplitude ≥ 2 cm

0-2 points

 

0 points

1 point

2 points

Subset 3: Hand function (Orientation during functional tasks)

Quality of movement is not compared with the unaffected hand for this subset.

Testing procedure

Points achieved

The patient manipulates materials as instructed and the therapist assesses whether the patient is able to orient the wrist and fingers to the object throughout the movement in a normal way.

no movement or movement with abnormal orientation of fingers and wrist towards the object: 

movement with normal orientation of fingers or wrist towards the object:

whole movement correct:

0-2 points

 

 

0 points

1 point

2 points

The maximum achievable score is 58 (MESUPES-Arm maximum score is 40; MESUPES-Hand maximum score is 18). The patient is awarded one score for each task, and the highest score is retained. A score of 0 is awarded when the patient demonstrated inadequate tone, abnormal muscle contractions, synergic (flexor/extensor) or mass movement patterns (Appendix 2, Instructions, Van de Winckel et al. , 2006).

What to consider before beginning

The first four items are performed in supine; all other items are performed in a sitting position with hips and knees at 90 degrees and elbows resting on the table. The patient can be provided support to maintain a sitting position if required. The patient cannot be assessed (and therefore awarded a point) if he/she is not able to sit in an upright position for a task. The therapist can reposition the patient’s upper extremity before beginning each new task, and should wait until the tone is normalized before starting a new task. If the patient is not able to achieve a relaxed starting position, he/she is awarded a score of 0 for the item.

The patient must be given clear instructions using the following steps:

  1. The therapist explains the task verbally and demonstrates the movement
  2. The patient is asked to perform the task with the non-affected side first to ensure he/she understands the demands of the task.

Time

It takes approximately 10 minutes to administer the evaluation (between 5min for patients with very poor or very good motor impairment – about 15min for patients with more severe hypertonia).

Training requirements

Instructions are given in Appendix 2 (Van de Winckel et al., 2006) and are available here online. These instructions should suffice for trained clinicians (physical therapists, occupational therapists etc).

For the original evaluation, seven raters were trained for an hour to familiarize them with the assessment protocol (Van de Winckel et al., 2006). In Johansson & Hager’s study (2012), raters underwent a 2h training session.

An instructional video will soon be made available online. In the meantime, the developer of the MESUPES (Prof. Ann Van de Winckel, avandewi@umn.edu) can be contacted to address questions concerning the use of the MESUPES.

Equipment

  • Plinth or mat
  • Desk and chair, positioned so that the patient is sitting with hip and knees in 90 degrees flexion
  • Wooden or plastic block marked with 1cm and 2cm to measure range of movement during hand tasks
  • One larger and one smaller plastic bottle (cylinder; diameter 6 cm, like a 20fl oz or 591ml soda or water bottle)
  • One smaller plastic bottle (cylinder, diameter 2.5cm, height 8cm, like a round correction fluid bottle, as shown in the figure)
  • Dice (1.5 x 1.5 cm)MESUPES_plasticbottle
Client suitability
 Differential item functioning was performed with Rasch analysis to test the stability of item hierarchy (from easy to difficult items) on several variables.

There is no differential item functioning across subgroups of gender, age (<60 / ≥60 years), time since stroke (< 3 months / ≥ 3 months), country of residence, side of lesion and type of stroke (hemorrhagic, ischemic) (Van de Winckel et al. 2006), meaning that the hierarchy of items (from easy to difficult) is maintained across all stroke patients groups with the above mentioned variables.

Can be used with:

  • Individuals with  stroke

Should not be used with:

  • The measure is intended for use with adult patients with stroke; there is insufficient evidence regarding psychometric properties of the tool with other populations, including a pediatric population.
In what languages is the measure available?
  • Catalan (available online, Van de Winckel A, 2015)
  • Dutch (Flemish) (available online, Van de Winckel, A., 2015)
  • English (available online, Van de Winckel et al., 2006)
  • French (available online, Van de Winckel A, 2015)
  • German (available online, Van Bellingen, T., Van de Winckel, A., et al. 2009. Chapter 1: Assessment in Neurorehabilitation. In Neurology (2nd ed.) (192-201). Huber.
  • Italian – (available online, Van de Winckel A, 2015) (Perfetti & Dal Pezzo, original version)
  • Portuguese (available online, Van de Winckel A, 2015)
  • Spanish (available online, Van de Winckel A, 2015)
  • Swedish (available online, Johansson & Hager, 2012)