Fugl-Meyer Assessment of Sensorimotor Recovery After Stroke (FMA)

 

Fugl-Meyer Assessment of Sensorimotor Recovery After Stroke (FMA) Evaluation Summary

  What does the tool measure? Motor function, sensation, balance, joint range of motion and joint pain.
  What types of clients can the tool be used for? Patients with post-stroke hemiplegia
  Is this a screening or assessment tool? Assessment
Time to administer It takes approximately 30-35 minutes to administer the total FMA. Administration of the motor, sensation and balance subscores range from 34 to 110 minutes, with a mean administration time of 58 minutes. When the motor scale is administered on its own, it takes approximately 20 minutes to complete.
  Versions Modified FMA-Balance subscore
12-item short form
Other Languages Translated and validated in French
Measurement Properties
  Reliability

– Out of 3 studies examining internal consistency, all 3 reported excellent internal consistency.
– Out of 6 studies examining test-retest reliability, 5 reported excellent test-retest reliability. Two studies examined item-level agreement and found that light touch items on the FMA Sensation subscale ranged from poor to adequate; the Joint pain subscale was found to have only adequate reliability, however total FMA test-retest remained excellent in these studies. The study that examined longitudinal stability of the FMA items, as calculated using Rasch Analysis, reported that scores across 2 testing occasions are comparable.
– Out of 4 studies examining inter-rater reliability, all 4 reported excellent inter-rater reliability (with the exception of the Balance subscore, which was found to be poor in one study).

  Validity

Content:
Items in a modified 30-items FMA reflect the same construct, except for the item hook grasp. Based on a Guttman Scale Analysis, the motor functioning subscales can be arranged in a hierarchical sequence, allowing the use of a shortened method of administration of the FMA.

Criterion:
Predicted Motor Assessment Scale scores at 180 days after stroke onset. FMA lower extremity (FMA-LE) admission subscores predicted the rehabilitation discharge Functional Independence Measure mobility and locomotion scores. FMA admission scores predicted the rehabilitation discharge Barthel Index scores. FMA-LE scores were poor predictors of mean steps per day.

Excellent correlations with Barthel Index, Motor Assessment Scale (except sitting balance items on both scales), Sensory Organization Balance Test, Action Research Arm Test, DeSouza scale, Chedoke-McMaster Stroke Assessment scale, Berg Balance Scale, Postural Assessment Scale for Stroke, Stroke Rehabilitation Assessment of Movement (STREAM), the shortened versions of the FMA and STREAM, performance assessments of walking velocity and velocity index, and Arm Motor Ability Test.

Construct:
The FMA lower extremity subscore was able to distinguish between patients who needed assistance in walking and between three levels of self-care ability (dependent, partly dependent, and independent). Excellent correlations between the FMA and Barthel Index (except with FMA Sensastion subscale); the FMA Motor upper extremity subscale and the Action Research Arm Test; the FMA and Bobath Assessment of upper extremity; the FMA and Functional Independence Measure; the FMA Motor subscale and various measures of gait.

  Floor/Ceiling effects A poor ceiling effect has been found with the Sensation subscore. A poor floor effect has been found with the modified Balance subscore of the FMA at 14 days after stroke. Another study reported an excellent floor effect and an adequate ceiling effect for the FMA motor scores both at admission and discharge from a rehabilitation program.
  Does the tool detect change in patients? Out of 5 studies examined, 1 reported that the FMA has a large ability to detect change, 1 reported moderate, 1 reported small to moderate, and 2 reported a small ability to detect change.
  Acceptability Administration of the entire FMA is lengthy. The test is scored by direct observation and cannot be completed by proxy respondent.
Feasibility The FMA must be administered by a trained physical or occupational therapist. It does not require any specialized equipment and can be administered across a variety of settings and has been tested for use in longitudinal assessments.
How to obtain the tool? The FMA can be obtained by following the link below (from the Institute of Rehabilitation Medicine, University of Goteberg, Goteberg, Sweden).
http://www.neurophys.gu.se/sektioner/klinisk_neurovetenskap_och_rehabilitering/neurovetenskap/rehab_med/fugl-meyer/

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.

The FMA manual of procedures developed by Sullivan et al. (2011), can be obtained by following the link below:
http://stroke.ahajournals.org/cgi/content/full/STROKEAHA.110.592766/DC1