Motor Activity Log (MAL)

Purpose of the measure

The Motor Activity Log (MAL) was developed by Taub et al. (1993) as a subjective outcome measure of an individual’s real life functional upper limb performance. The MAL is administered by semi-structured interview to determine (a) how much (Amount of Use – AOU), and (b) how well the individual uses his upper limb (Quality of Movement – QOM) in his own home (Ashford et al., 2008, Li et al., 2012; Simpson & Eng, 2013).

Available versions

There are four versions of the original MAL-30, according to number of items.

  • MAL-14: contains unilateral and simple items, to detect change in individuals with limited arm function.
  • MAL-26: contains the same items as the MAL-14 as well as 11 additional items and 1 optional item chosen by the patient; this version includes some bilateral tasks.
  • MAL-28: contains the same items as the MAL-14 and MAL-26, and additional items that challenge reach and strength.
  • MAL-12: a short version of the MAL-28 (Ashford et al., 2008).

Other adaptations of the MAL include:

  • Graded Motor Activity Log (Morera Silva et al., 2018)
  • Lower-Functioning Motor Activity Log (LF-MAL)
  • Lower-Extremity Motor Activity Log
  • Pediatric Motor Activity Log – Revised
Features of the measure

The MAL is comprised of two scales:

  • Amount of Use (AOU) scale – the amount the individual uses the paretic arm; and
  • Quality of Movement (QOM) scale – the patient’s perceived quality of movement while performing the functional activity (Ashford et al., 2008).

The MAL-QOM scale captures components of amount of arm use and has been shown to be more reliable than the MAL-AOU scale, and as such can be used independently (Uswatte & Taub, 2005).

Items:
Items the original MAL-30

  1. Turn on a light with a light switch
  2. Open drawer
  3. Remove an item from a drawer
  4. Pick up phone
  5. Wipe off a kitchen counter or other surface
  6. Get out of a car
  7. Open refrigerator
  8. Open a door by turning a door knob/handle
  9. Use a TV remote control
  10. Wash your hands
  11. Turning water on/off with knob/lever on faucet
  12. Dry your hands
  13. Put on your socks
  14. Take off your socks
  15. Put on your shoes
  16. Take off your shoes
  17. Get up from a chair with armrests
  18. Pull chair away from table before sitting down
  19. Pull chair toward table after sitting down
  20. Pick up a glass, bottle, drinking cup, or can
  21. Brush your teeth
  22. Put on makeup base, lotion, or shaving cream on face
  23. Use a key to unlock a door
  24. Write on paper
  25. Carry an object in your hand
  26. Use a fork or a spoon for eating
  27. Comb your hair
  28. Pick up a cup by a handle
  29. Button a shirt
  30. Eat half a sandwich or finger foods

Additional Items for the MAL-45

– Removing bills from a wallet
– Taking individual coins out of a pocket or purse
– Removing keys out of a pocket or purse
– Using a zipper pull
– Pouring liquid from a bottle
– Buckling a belt
– Popping top of beverage can
– Removing top from a medicine bottle
– Keypad press
– Use of keyboard/computer
– Putting on or taking off watch band
– Putting on glasses
– Pumping a soap dispenser
– Swiping a credit card or a card for an ATM
– Adjusting a home or hotel air conditioner or heat

Items of the MAL-12:

  1. Pick up phone
  2. Open a door by turning a door knob
  3. Eat half a sandwich or finger food
  4. Turn water on/off with faucet
  5. Pick up a glass
  6. Pick up toothbrush and brush teeth
  7. Use a key to open a door
  8. Letter writing/typing
  9. Use removeable computer storage
  10. Pick up fork or spoon, use for eating
  11. Pick up cup by handle
  12. Carry an object from place to place

Items of the MAL-14:

  1. Putting arm through coat sleeve
  2. Steady myself while standing
  3. Carry an object from place to place
  4. Pick up fork or spoon, use for eating
  5. Comb hair
  6. Pick up cup by handle
  7. Hand craft/card playing
  8. Hold a book for reading
  9. Use towel to dry face or other body part
  10. Pick up a glass
  11. Pick up toothbrush and brush teeth
  12. Shaving/makeup
  13. Use a key to open a door
  14. Letter writing/typing

The MAL-26 includes the 14 items from the MAL-14 as well as the following items:

  1. Pour coffee/tea
  2. Peel fruit/potatoes
  3. Dial number on the phone
  4. Open/close a window
  5. Open an envelope
  6. Take money out of a wallet or purse
  7. Undo buttons on clothing
  8. Buttons on clothing
  9. Undo a zip
  10. Do up a zip
  11. Cut fingernails (affected hand)
  12. Other optional activity

Items of the MAL-28:

  1. Turn on a light with a light switch
  2. Open a drawer
  3. Remove item of clothing from drawer
  4. Pick up phone
  5. Wipe kitchen counter
  6. Get out of car
  7. Open refrigerator
  8. Open a door by turning a door knob
  9. Use a TV remote control
  10. Wash your hands
  11. Turn water on/off with faucet
  12. Dry your hands
  13. Put on your socks
  14. Take off your socks
  15. Put on your shoes
  16. Take off your shoes
  17. Get up from chair with armrests
  18. Pull chair away from table before sitting
  19. Pull chair toward table after sitting
  20. Pick up a glass
  21. Pick up toothbrush and brush teeth
  22. Use a key to unlock a door
  23. Steady self while standing
  24. Carry an object from place to place
  25. Comb hair
  26. Pick up cup by handle
  27. Buttons on clothing (shirt, trousers)
  28. Eat half a sandwich or finger food

For each item, the individual is asked whether he/she attempted the activity in the past 7 days, and the relevant score is assigned according to his/her response. The examiner can verify the response by paraphrasing it back to the individual (Uswatte & Taub, 2005). The MAL can also be used with caregivers.

Scoring :
The MAL is administered by semi-structured interview and items are scored by patients according to their performance of each task over the past 7 days; the MAL-28 can also be used to score performance over the past 3 days (Ashford et al., 2008; Uswatte & Taub, 2005).

The MAL adopts a 6-point ordinal scale, although patients can attribute a half-score, resulting in 11-point Likert scales with specified anchoring definitions at 6 points (Uswatte & Taub, 2005):

Amount of Use scale scoring
0: Never – The weaker arm was not used at all for that activity.
1: Very rarely – Occasionally used the weaker arm, but only very rarely.
2: Rarely – Sometimes used the weaker arm but did the activity most of the time with the stronger arm.
3: Half pre-stroke – Used the weaker arm about half as much as before the stroke.
4: Three quarters pre-stroke – Used the weaker arm almost as much as before the stroke.
5: Same – Used the weaker arm as often as before the stroke.

Quality of Movement scale scoring
0: Never – The weaker arm was not used at all for that activity.
1: Very rarely – The weaker arm was moved during the activity but was not very helpful.
2: Rarely – The weaker arm was of some use during the activity but needed some help from the stronger arm but moved very slowly or with difficulty.
3: Fair – The weaker arm was used for that activity, but the movements were slow or were made only with some effort.
4: Almost normal – The movements made by the weaker arm for the activity were almost normal but not quite as fast or accurate as normal
5: Normal – The ability to use the weaker arm for that activity was as good as before the stroke.

Scale total scores (summary scores) are the mean of the item scores.

What to consider before beginning:
The MAL is subject to experimenter bias and also the patient’s ability to accurately recall upper limb use (Page & Levine, 2003; Uswatte & Taub, 2005).

Ashford et al. (2008) noted an inadequate relationship between overall/item scores and the qualitative meaning, and an unclear Minimal clinically important difference.

Taub & Uswatte (2000) discuss the use of the MAL as an outcome measure in Constraint-Induced Movement Therapy (CIMT) research and recommend an upper cut-off score of 2.5 on the MAL-AOU, as the effect of stroke can impose an upper physiological limit on the amount of improvement that can be produced. The authors also note that individuals who score > 2.5 do not demonstrate learned non-use, which is the aim of CIMT.

Time:
All versions of the MAL are administered through structured interview with the patient and/or carer and require more than 10 minutes to administer. (Ashford et al., 2008).

Training requirements:
The MAL can be administered by health professionals who have reviewed the manual and literature.

Equipment:
Survey instrument and pencil.

Client suitability

Can be used with:
The MAL is suitable for use with adults and elderly adults following stroke and their caregivers. It is suitable for use in the subacute and chronic stages of stroke recovery.

Should not be used in: 
Not specified.

The MAL is often used to measure outcomes following constraint induced movement therapy (Li et al., 2012; Page, 2003). The MAL is commonly used in research in conjunction with the Wolf Motor Function Test, Fugl-Meyer Assessment or the Action Research Arm Test (Santisteban et al., 2016; Simpson & Eng, 2013).

In what languages is the measure available?

Brazilian-Portuguese (Saliba et al., 2011)
English
German (Khan et al., 2013)
Portuguese (Pereira et al., 2011)
Turkish translation and cultural adaptation (Cakar et al., 2010).