The minimal clinically important difference of fugl meyer assessment scale is 6 for lower limb in chronic stroke and 910 for upper limb in subacute stroke. Paper open access the effects of comprehensive core body. Attempt to elicit the achilles and patellar reflexes. Reflex activity 1a and 1b subject is supine or sitting. Fuglmeyer ar, jaasko l, leyman i, olsson s, steglind s. Motor functioning in the upper and lower extremities sensory functioning evaluates light touch on two surfaces of the arm and leg, and position sense for 8 joints balance contains 7 tests, 3 seated and 4 standing joint range of motion 8 joints joint pain. Reliability, concurrent validity, and responsiveness of. The maximum possible score in fugl meyer scale is 226, which corresponds to full sensorymotor recovery. Fuglmeyer assessment clinical neuroscience, university of. Table 1 from fuglmeyer assessment of sensorimotor function. It is designed to assess motor functioning, balance, sensation and joint functioning in patients with poststroke hemiplegia12. It is designed to assess motor functioning, balance, sensation and joint functioning in patients with poststroke hemiplegia. Cutoff score of the lowerextremity motor subscale of fugl. The spanish version of fma, validated in this study, is now first time available for use in research and clinical practice.
Three individuals with stroke enrolled in a separate research study were randomly selected from each of the three impairment strata of the fmaue. Translating measurement findings into rehabilitation practice. Items to be scored are achilles and patellar reflexes. The fugl meyer assessment fma of upper and lower extremity is the most used and recommended clinical scale for evaluation of sensorimotor impairment after stroke.
Deep fascia of the lower limb is well defined and forms a tough circumferential stocking like structure that contains the musculature. It is applied clinically and in research to determine disease severity, describe motor recovery, and to plan and assess treatment. Amongthe33items forueevaluation, wereselectedforkinect motion datarecording. Implementation fugl meyer assessment of lower extremity method. Neurotransplantation for patients with subcortical motor stroke. Fugl meyer assessment of the upper extremity fmaue was used to measure upper limb motor function excluding the 3 reflex items, yielding a maximum of 60. Fugl meyer assessment for upper extremity scores were significantly correlated with movement time, spectral arc length, and peak velocity. This assessment is a measure of upper extremity ue and lower extremity le motor and sensory impairment. Key method methods fifteen individuals with hemiparetic stroke, 17 trained physical therapists across 5 regional clinical sites, and an expert rater participated in an interrater reliability study of the fuglmeyer motor total, upper extremity, and lower extremity subscores and sensory total, light touch, and proprioception. Bernspang, asplund, eriksson, and fugl meyer 1987 administered the fma to 109 patients within two weeks of having an acute stroke. Subjects the participants were 140 communitydwelling hemiplegic stroke patients.
It involves the measurement of both upper and lower extremities ue, le however, the scores for ue are weighted more. Results kmean clustering analysis classified 42 stroke survivors in the high mobility function group. Reliability of the fuglmeyer assessment of sensorimotor. Fuglmeyer assessment of motor recovery after stroke. The fuglmeyer assessment fma is widely used to measure the extent of motor control of the upper and lower extremities post stroke. Upper vs lower extremity functional loss in neuromuscular disease. This study aims to determine intra and interrater reliability of the fmaue at item, subscale and total score level in patients with early subacute stroke. The reliability, validity, and responsiveness of the catfm were determined by. Purpose the purpose of this study was to investigate the psychometric properties of the lower extremity subscale of the fugl meyer assessment lower extremity fmale for communitydwelling hemiplegic stroke patients. At the end of rehabilitation training, the patients conditions were assessed by nursing and training staff using the fugl meyer assessment score. Pdf on oct 1, 2016, barbara singer and others published the fuglmeyer. Excellent correlations between wrist and hand upper extremity fugl meyer wh ue fm and the action research arm test across two trials.
Their performance on each item was displayed on the. The fugl meyer assessment of upper extremity fmaue is recommended for evaluation of sensorimotor impairment post stroke, but the itemlevel reliability of the scale is unknown. Psychometric properties of the lower extremity subscale of the fugl. The fugl meyer assessment of physical performance fma is an example of one widely used scale. Researcharticle upperextremityfunctionalevaluationby fugl. Fugl meyer assessment items were considered to be consistent with the recovery pattern observed correlation between abnormal postural adjustments made by lower extremity le on balance platform and fugl meyer assessment le scores spearman rho 2 weeks, r. The fma consists of five subscales that relate to various aspects of a patients upper and lower extremity, and the subscales are as follows. Quantifying motor impairment through the use of the fugl meyer assessment can assist therapists in. The hierarchy of item difficulty was then investigated with the same process as that used in a previous study of chronic stroke. Lower extremity motor subscale of fugl meyer assessment fmale, berg balance scale, 5 times sittostand test, comfortable walking speed, 6minute walk test, and timed up and go test. Methods fifteen individuals with hemiparetic stroke, 17 trained physical therapists across 5 regional clinical sites, and an expert rater participated in an interrater reliability study of the fugl meyer motor total, upper extremity, and lower extremity subscores and sensory total, light touch, and proprioception subscores assessments. Researcharticle upperextremityfunctionalevaluationby. Reliability of the fuglmeyer assessment for testing motor. Bernspang, asplund, eriksson, and fugl meyer 1987 administered the fma to.
These optimal cutoff scores may be able to identify upper limb feeding performance. Comparison of the action research arm test and the fugl. The fuglmeyer upper extremity assessment fma is a strokespecific and performancebased impairment index. Jul 01, 2014 spread of raw scores across all stages and subsections of the upper extremity and lower extremity sections of the fugl meyer assessment scale. Establishing criterion validity for the functional upper extremity levels fuel in comparison to the fugl meyer to classify functional motor recovery in the acute stroke population american journal of occupational therapy, august 2019, vol. Apta combined sections meeting 2008 incorporating valid and.
Fuglmeyer assessment upper and lower extremity components. Evaluation of upperlimb feeding performance using the. Spread of raw scores across all stages and subsections of the upper extremity and lower extremity sections of the fugl meyer assessment scale. The lower extremity motor subscale of the fugl meyer assessment fmale was used to measure the level of lower extremity motor recovery poststroke.
Translation and cultural validation of clinical observational. Fuglmeyer upper extremity assessment bilateral arm. It is designed to assess five domains in patients with poststroke hemiplegia consisting of. Psychometric properties of the lower extremity subscale of. Approved by fugl meyer ar 2010 1 fugl meyer assessment id. The items are summed to provide a final score, with maximum score no impairment of 66 points for the upper extremity and 34 points for the lower extremity. Establishing criterion validity for the functional upper. Green berets ultralight bug out bag with gear recommendations duration. Septa pass from the deep surface of the facial sheath to the bone within, confining the functional muscle groups within osteofascial compartments tough fascia gives additional areas of attachment to the muscles and ensures that they work to. Experimentaldesign subjects wereseatedcomfortablyin achair totestuefma.
Fuglmeyer assessment scale scoring item 0 1 2 lower extremity i. A standardized approach to the fuglmeyer assessment and. There is no consensus concerning which standardized upper extremity motor scale is best suited for routinely assessing recovery of motor function in the upper extremity poststroke. In the adult rehabilitation setting, occupational therapists are often responsible for addressing upper extremity dysfunction in the poststroke population.
Intertester reliability was found to be high for the total scores of upper and lower extremity motor performance. The fuglmeyer assessment for the upper extremity fmaue and the. The fugl meyer assessment of motor recovery after stroke. Reliability, concurrent validity, and responsiveness of the fugl meyer assessment fma for hemiplegic patients heesoo kim, phd student. Paper open access the effects of comprehensive core. Translating measurement findings into rehabilitation. The fugl meyer lower extremity fmale consisted of 4 domains that comprised of lower extremity motor function lemf, sensation s, passive joint motion pjm, and joint pain jp retrieved from rehabilitation medicine, university of gothenburg, 2010 was used to evaluate lower extremity. Sensation, upper extremity dysesteyes closed, compared with the unaffected side anesthesia hypoesthesia or hesia normal light touch upper arm, forearm palmary surface of the hand 0 0 1 1 2 2 less than 34 correct or absence 34 correct or considerable difference correct 100%. Cutoff score of the lowerextremity motor subscale of fuglmeyer.
Volitional movement within synergies, supine position none partial full flexor synergy. Fugl meyer ar, jaasko l, leyman i, olsson s, steglind s. Approved by fugl meyer ar 2010 1 updated 20150311 fugl meyer assessment id. Compensation in recovery of upper extremity function after stroke. A keyform map of poststroke upper limb recovery defined by items of the fugl meyer assessmentupper extremity fmaue was generated by a previously published rasch analysis. Reflex activity, supine position none can be elicited flexors.
Upper extremity ue hemiparesis constitutes a common strokeinduced impairment. This video shows how to complete the fuglmeyer assessment for both the upper and lower extremities. Sep 30, 2017 this video shows how to complete the fugl meyer assessment for both the upper and lower extremities. The fma was designed by fugl meyer et al 6 to provide a numeric score of motor status after stroke based on the sequential stages of motor recovery described by twitchell, 7 reynolds et al, 8 and brunnstrom 9 using measures such as limb synergy and range of motion. After four weeks of robotassisted therapy, experimental results showed that the patients score and their activities of daily living improved a lot. Measures recovery in poststroke hemiplegic patients fuglmeyer.
The fuglmeyer assessment of upper extremity fmaue is one of the most used and recommended assessment scales of sensorimotor function in stroke. Quantifying motor impairment through the use of the fugl meyer assessment can assist therapists in live webinar. Quality of reflexes, coordination, and voluntary movements of the paretic leg were assessed using a 34point scale. A chair, bedside table, reflex hammer, cotton ball, pencil, small piece of cardboard or paper, small can, tennis ball, stop watch, and blindfold. These exams were performed on 12 patients of the cohort of 31 described under reliability testing above, 4 separate visits across a treatment period, for a. Fuglmeyer motor assessment for the lower extremities fmale. Are the hierarchical properties of the fuglmeyer assessment. F uglmeyer assessment lower extremity fmale scalelibrary. Rehabilitation medicine, university of gothenburg approved by fugl meyer ar 2010 1 fugl meyer assessment id. Test 6mwt, and fugl meyer assessment of lower extremity fmale. Fuglmeyer assessment of sensorimotor function after. Reflex activity no reflex activity can be elicited. The fuglmeyer motor assessment fma, originally described by fugl meyer, jaasko, leyman, olson, and steglind 1975 as a system for the evaluation of motor function, balance, sensation qualities, and joint function, is now one of the most widely used clinical assessments of motor impairment and recovery such as that. Apta combined sections meeting 2008 incorporating valid.
Application of the fuglmeyer assessment fma and the. The sensation domain includes light touch and position, and the score range is 0 to 24 points. The fugl meyer assessment fma scale is a welldesigned, comprehensive, and efficient clinical examination method that has been widely used by therapists to. How is the fugl meyer assessment of sensorimotor recovery completed. Areas of interest where fma fuglmeyer assessment is mostly used.
The fma lower extremity subscore was able to distinguish between patients who needed assistance in walking better than gait speed at speeds less than 0. A standardized approach to the fuglmeyer assessment and its. Fugl meyer assessment upper and lower extremity components author. The fma was designed by fugl meyer et al6 to provide a numeric score of motor status after stroke based on the sequential stages of motor recovery described by twitchell, 7 reynolds et al, 8 and brunnstrom 9 using measures such as limb synergy and range of motion. A manual was produced with a standardised content, procedure and scoring for the fugl meyer assessment upper limb section part 2.
Fuglmeyer assessment of sensorimotor function after stroke. The 2 catfm item banks upper extremity and lower extremity include 37 items from the original fugl meyer scale. Pdf the fuglmeyer upper extremity scale researchgate. Fuglmeyer assessment scale item scoring 0 1 2 lower extremity i. Fuglmeyer assessment evaluation of upper extremity. Fuglmeyer assessment of sensorimotor recovery after. Maximal hip flexion abductionexternal rotation, maximal flexion in knee and ankle joint. The fugl meyer lower extremity fmale consisted of 4 domains that comprised of lower extremity motor function lemf, sensation s, passive joint motion pjm, and joint pain jp retrieved from rehabilitation medicine, university of gothenburg, 2010 was used to evaluate lower extremity motor functions. This study establishes intratester reliability for all components of physical performance and intertester reliability for the total scores of upper and lower extremity motor performance in a cumulative numerical scoring system devised by fugl meyer et al. The ue portion assesses voluntary movement, reflex activity, grasp and coordination. Intra and interrater reliability of fuglmeyer assessment. The fugl meyer assessment fma is a quantitative measure that is widely used to assess motor recovery poststroke in hemiplegic patients. To measure ue hemiparesis, researchers have frequently administered the ue section of the fugl meyer assessment ue fm. As the implementation of procedure, five respondents of stroke patients who had.
One of the most widely recognized and clinically relevant measures of body function impairment after stroke is the fugl meyer fm assessment. Key method methods fifteen individuals with hemiparetic stroke, 17 trained physical therapists across 5 regional clinical sites, and an expert rater participated in an interrater reliability study of the fugl meyer motor total, upper extremity, and lower extremity subscores. The fma motor assessments for the upper maximum score 66 points and lower extremity maximum score 34 points are recommended as core measures to be. The wolf motor function test wmft and fugl meyer assessment fma scales are the instruments most commonly mentioned in the literature. Fifteen individuals with hemiparetic stroke, 17 trained physical therapists across 5 regional clinical sites, and an expert rater participated in an interrater reliability study of the fugl meyer motor total, upper extremity, and lower extremity subscores and sensory total, light touch, and proprioception subscores assessments. The fugl meyer assessment fma is a strokespecific, performancebased impairment index. Lowerlimb robotassisted therapy in rehabilitation of. Approved by fuglmeyer ar 2010 1 updated 20150311 fuglmeyer assessment id. Pdf determining levels of upper extremity movement. This study investigated the reliability of the scale when different therapists assessed the patients performance at the same test session and when the assessment was performed by the same. The fugl meyer assessment cutoff values to identify can use spoon and can use chopsticks were 5453 and 6261 points, with sensitivity and specificity of 86.