Rivermead Motor Assessment (RMA)

Purpose of the measure

The RMA assesses the motor performance of patients with stroke and was developed for both clinical and research use.

Available versions

The RMA was developed by Lincoln and Leadbitter in 1979.

Features of the measure

Items:
The RMA consists of test items in three sections that are ordered hierarchically, that is, the first items are easier and become increasingly more difficult toward the end of the evaluation.

The three sections test:

  • Gross function (13 items)

e.g. walking with and without out an aid, negotiating stairs with and without the rail, walking, turning and retrieving an object, and running

  • Leg and trunk movements (10 items)

e.g. standing on one leg and flexing the knee in a weight bearing position

  • Arm movements (15 items)

e.g. control items such as pronating/supinating the forearm and bouncing a ball, and functional items such as cutting putty, grasping and releasing objects, and tying a bow

The items are scored as pass or fail. Traditionally, when three consecutive attempts to complete an item are failed within a given subsection, the test is stopped as it is assumed that all subsequent items in the subsection will also be failed, so not all items in the section need to be administered (known as ‘Guttman scaling’). However, recent studies suggest that the hierarchical ordering of the items in all three subscales differ from that proposed by the developers (Adams, Ashburn, Pickering & Taylor, 1997; Adams Pickering, Ashburn & Lincoln, 1997; Kurtais et al., 2009) and as a result, it has been recommended that all items in each of the subscales be administered. In an effort to avoid over-burdening patients and to reduce administration time, the ceiling effect of three consecutive failures should be applied (Kurtais et al., 2009).

For patients with an additional disability, for example, an amputation, the principle of stopping after 3 consecutive errors should not be applied (Lincoln & Leadbitter, 1979).

As an example of the RMA items and Guttman scaling, below are the items for the Gross Function subscale of the RMA.

Can the patient:

1. Sit unsupported (without holding on edge of bed feet unsupported)

2. Transfer from lying to sitting on side of bed (using any method)

3. Transfer from sitting to standing

4. Transfer from wheelchair to chair towards unaffected side (may use hands)

5. Transfer from wheelchair to chair towards affected side (may use hands)

6. Walk 10 meters indoors with an aid (any walking aid, no standby help)

7. Climb flight of stairs independently (any method, may use banister and aid)

8. Walk 10 meters indoors without an aid (no standby help or walking aid)

9. Walk 10 meters, pick up beanbag from floor, turn and carry back (may use aid to walk)

10. Walk outside 40 meters (may use walking aid, no standby help)

11. Walk up and down 4 steps (may use any aid but may not hold on to railing)

12. Run 10 meters (must be symmetrical)

13. Hop on affected leg 5 times on the spot (must hop on ball of foot without stopping to regain balance, no help with arms)

Scoring:
Each item on the RMA is coded 0 or 1, depending on whether the client does the activity according to specific instructions. A score of 0 = a ‘no’ response; a score of 1 = a ‘yes’ response. Each subscale is scored by summing the points allocated for all items within that subscale.

If a patient refuses to perform an item (e.g. out of anxiety), score a ‘0’ for that item.

Time:
The ambulatory client with a recovering upper extremity takes approximately 45 minutes to assess; more severely disabled patients take less time (Lincoln & Leadbitter, 1979).

Subscales:
The RMA has three subscales: Upper Limb/Extremity (‘Arm’); Lower Limb/Extremity (‘Leg’) and Trunk; Gross Function.

Equipment:

  • Block of 20 cm height
  • Pencil
  • Volleyball
  • Tennis ball
  • Piece of paper
  • Fork and knife
  • Plate and container (use box of putty as container)
  • Beanbag
  • Cord
  • Putty
  • Watch with chronometer
  • Non-slip mat

Training:
No specialized training is required to administer the RMA. However, the RMA should be administered by a physiotherapist with knowledge on how to safely manage those with stroke. The RMA is a risky assessment where a patient could fall if not supervised by someone with stroke expertise.

Alternative forms of the RMA

The Rivermead Mobility Index (RMI) (Collen, Wade, & Bradshaw, 1991).
The RMI was developed from the RMA Gross Function subscale. This measure focuses on body mobility and is comprised of a series of 14 questions and one direct observation. The RMI covers a range of activities from turning over in bed to running and has been reported to be a reliable and valid measure of mobility in patients with stroke (Collen et al., 1991; Hsieh, Hsueh, & Mao, 2000).

Client suitability

Can be used with: patients with acute and chronic stroke.

Should not be used with:

  • In individuals with chronic stroke aged 65 and older, Guttman scaling is only retained with the gross function subscale (Adams, Pickering, Ashburn, & Lincoln, 1997) and therefore should be used with caution in these individuals as they may not be able to perform some of the specific tasks (e.g. a patient with osteo-arthritis may not be able to climb stairs) but may be able to perform subsequent tasks that are deemed more challenging (e.g. walking for an extended period of time).
  • Guttman scaling (i.e. the notion that if the patient agrees with any specific item on the list, they will also agree with all previous questions) may not be appropriate to assess function in the hemiplegic stroke client. This method of test administration is also not appropriate in assessing the kind of loss in function owing to focal lesions that arise in stroke clients, in whom impairment of some function may be unrelated to impairment of other functions
In what languages is the measure available?

The RMA is only available in English (United Kingdom).