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1993; 73:447-454.PHYS THER.

Stratford and Carolyn GowlandJulie Sanford, Julie Moreland, Laurie R Swanson, Paul WMotor Performance in Patients Following StrokeReliability of the Fugl-Meyer Assessment for Testing

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1993; 73:447-454.PHYS THER.

Stratford and Carolyn GowlandJulie Sanford, Julie Moreland, Laurie R Swanson, Paul WMotor Performance in Patients Following StrokeReliability of the Fugl-Meyer Assessment for Testing

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Research Report

Reliability of the Fugl-Meyer Assessment for Testing

Motor Performance in Patients Following Stroke

Key Words: FuglMeyer assessment, Motor performance, Reliability, Stroke,

Background a nd Purpose . The pulpose of thb study was to establish the inter-

rater reliability of assessments made with the Fugl-Meyer evaluation of physical

per$omzance in a rehabilitation setting. Suwects. Twelve patients (7male,5

female): aged 49 to 86 years @=66), who had sustained a cerebrovascular acci-

Stroke is a major cause of mortality average annual mortality rate for

and disability in many countries. The stroke per 100,000 people is 100.4 in

Julie Sanford

Juiie MoreiandLaurie R SwansonPaul W Stratford

- - - - - - -J Sanford, PT, s Research Coordinator, Rehabilitation Services, St Pcter's Ilospital, 88 Maplewood

Ave. Hamilton, Ontario, Canada L8N 325, and Assistant Clinical Professor, School of Occupational

Therapy and Physiotherapy, Faculty of Health Sciences, McMaster University, 1200 Main St W,

Hamilton, Ontario, Canada L8N 325. Address all correspondence to Ms Sanford at the first address.

dent participated in the study. All patients were admitted consecutively to a reha- Carolyrr Gowiandbilitation center and were between 6 days and 6 months poststroke. Metboa%.Three pbysical therapists, each with more than 10 years of expm'ence, assessed the

patients in a randomized and balanced order using thjs assessment. The therapists

standardized the assessment approach prior to the study but did not discuss the

procedure once the study began. Results. The overall reliability was high (overall

intrac lm correlation coeficient=.96), and the intraclm correlation coeficients

for the subsections of the assessment var iedj km .61 or pain to .97 or the upper

extremity. C d u s i o n and Dtscusston. The relative mm'ts of using the Fugl-

Meyer assessment as a research tool versus a clinical assessment or stroke are

discussed. [SanfordJ MorelandJ Swanson LR, et al. Reliability of the Fugl-Meyer

assessment for testing motor peformance in patients following stroke. Phys Ther.

1993;73:447454.]

J Moreland, PT, s Physical Therapist, Physiotherapy Department, Chedoke-McMaster Hospitals,

Chedoke Division, Hamilton. Ontario, Canada LEN 325, and Clinical Lecturer, School of Occupa-

tional Therapy and Physiotherapy, Faculty of Health Sciences, McMaster University.

LR Swanson, PT,s Doctoral Candidate, Medical Sciences Program, McMaster University

PW Stratford,PT, s Assistant Professor, School of Occupational Therapy and Physiotherapy, Faculty

of Health Sciences, McMaster University.

C Gowland PT, s Associate Professor, School of Occupational Therapy and Physiotherapy, Faculty

of Health Sciences, McMaster University.

This study was approved by the Research Project Advisory Committee of McMaster University and

Chedoke-McMaster Hospitals.

This research was supported by Grant 6606-3771-45, National Health Research and Development

Program, Ottawa, Ontario, Canada.

This article wa s submittedJuly 20, 1992, and wa s accepted March 17, 1993.

the United States, 116.2 in England

and Wales, and 96.6 in Canada.' Data

compiled from a number of surveys

in the United States show that the

annual incidence is approximately 100

to 150 per 100,000 people.' Following

a stroke, patients usually receive in-

tensive therapy to promote motor

recovery and help them cope with

their disability.

Reliable and valid measurements of

sensorimotor status are required for

clinical decision-making and research

purposes. One measure that has been

extensively discussed is the Fugl-

Meyer evaluation of physical perfor-

mance.* The Fugl-Meyer assessment

was developed to assess physical

recovery following stroke. It was pri-

marily developed from the earlier

works of Twitchell3 and Br~nnstrom.~

36 / 447 Physical Therapy/Volume 73, Number 7/July 1993



Twitchell examined the ontogeneticconcept of motor recovery, through

the assessment of sequen ced reflexand synergistic patterned movements

seen in patients recovering fromstroke.3 Based o n this reco very se-quence, Brunnstrom identified six

sequences o f temporal, stepwisestages as a method of assessing moto rrecovery in patients with hemiplegia

following stroke.* In addition t o mo-tor performance, balance, sensation,

range of movement, and pain are also

assessed by the Fugl-Meyer items,which examine volitional mo vement

within syne rgies, partially ou t of syn-

ergy, and ind ependen t o f synergies.

The Fugl-Meyer motor assessment

includes items dealing with the sh oul-

de r, elbow, forearm, wrist, and handin the u ppe r extremity and the hip,

knee, and ankle in the lower extrem-

ity. Reflex activity is assessed in the

upper and lower extremities at the

beginning and e nd of the motor as-

sessment. Balance is examined in

sitting and standing . Sensation , evalu-

ated by light touch, is examined o ntwo surfaces in both the upper and

lower extremities, and position se nse

(lunesthesia) and range of motion(ROM) are tested on eig ht joints, four

in each extremity.2

The Fugl-Meyer assessmen t, which

consists of 155 items, is an im pair-ment measure. Impaimzent is definedas any loss or abnormality in psycho-

logical, physiological, o r an atomica lstructure o r function.5 With the Fugl-

Meyer assessment, each item is ratedon a three-point ordinal scale (2points for the detail being performed

completely, 1 point fo r the detail

being p erformed partially, and 0 fo r

the detail not being performed). Themaximum score that can be attainedis 226. The maximu m moto r perfor-

mance score is 66 points for the up-per extremity, 34 points for the low erextremity, 14 points for balance, 24

points for sensation, and 44 pointseach for passive joint motion and

joint pain. Joint pain is assessed bymoving the joint through its availableROM to assess whether pain occurs at

any point in the range. Fugl-Meyerassigned motor function scores to

items that assessed motor function

alone, with a total possible score o f100 points. Scores wer e gro upe daccording to the v arious levels of

impairment, which were as follows:

<50 points =severe moto r impair-

ment, 50-84 points=marked mo torimpairment, 85-95 points=m oderatemotor impairment, and 96-99

points=slight motor impairment."

The properties of this instrument

have been described by various au -

th0rs~,~- l5Tab. 1 ). Most of these

authors exam ined the validity of the

instrument. In the o riginal study byFugl-Meyer et a1,2 28 patients we re

assessed on five occasions during aI-year period following stroke. Themean correlation coefficient between

the u ppe r- and low er-extremity scoreswas .88.2 Oth er researche rs com pared

scores from the Fugl-Meyer assess-ment with data from the B arthel In-

dexloJ1 ; a B obath assessment'z;

upper-extremity function testss; and

tests for balance in standing, walking

perform ance, an d postu ral stability.10

The correlation coefficients reportedfrom these studies varied from .54 for

the total score to .94 for the upperextremity, thus providing evidence ofconstruc t validity.

Studies to date have examined theconstruct validity of the Fugl-Meyer

assessment in samples of chronicallydisabled patients following stroke.

Less work has been done to deter-mine the reliability of measurementsobtained w ith this assessment. Dun-

can et all* reported the interraterreliability of motor performance in

the upper and lower extremities and

the intrarater reliability of all sub-

scores and the total Fugl-Meyer scoreusing four physical therapists as evalu-

ators. The 19 patients in their studywere m ore than 1 year poststroke,with a mean time of 51 mon ths sincethe onset of their stroke. lntrarater

Pearson correlations for each su b-score and the total score varied from.86 to .99. he interrater Pearson

correlations for the moto r scores ofthe upper and lower extremities var-ied from .79 to .99. Because Duncan

et a1 studied subjects wh o w erechronically disabled following stroke,

the generalizability of their results

limited to similar patient populati

The study described in this report

examined the overall interrater reability and the reliability of each s

section of the Fugl-Meyer assessmadministered by three raters to patients underg oing active rehabilita

following stroke.

The purposes of our study were (to examin e the interrater reliabilit

measurements obtained with the

Fugl-Meyer assessment and (2) todetermin e the relevance of the as

ment for clinical and research p ur

poses. The specific aims o f the stuwere to determine whether the Fu

Meyer assessment is able to discri

nate amo ng patients when it is us

to evaluate patients' motor recove

following stroke an d to determine

magnitude of the measurement er

for the total score and score of th

subsections of the assessment. Thpriori level of acceptable reliabilit

among raters was set at an intraclacorr elatio n coefficient (ICC [2,1 ])ogreater than .80 for the total score

and subscores.

This study was pan of a larger stu

that examined the measurement p

erties of the Chedoke-McMasterStroke Assessment.16

Subjects

Twelve patients consecutively adm

ted to the Chedoke-M cMaster Reh

itation C entre, Hamilton, Ontario,Canada, we re each assessed by thr

therapists (see T ab. 2 for descripti

of the patients) on separate occasiThe Chedoke-McMaster Rehabilita

Centre is a tertiary care setting atwhich patients are treated o n a dabasis by a m ultidisciplinary team.

average length of stay per patient 10 weeks. Patients were included ithey were less than 80 years of ag

were less than 6 months poststrok

and gave their consent to participin the study.

Physical Therapy /Volu me 73, Number



Table 1. Summay of Studies Examin ing Properties of the Fugl-MeyerAssessment

Study Subjects and Methods Type of Study Results

Fugl-Meyer et al,2 28 patients Content validity

1975 Stroke for at least 24 hours

Fugl-Meyer assessment administered at

6 weeks to 6 months

15 patients followed for 1 year

Badke and 10 healthy subjects and 10 patients Construct validity

Duncan,' 1983 with right hemiparesis secondary to

cerebrovascular accident

Balance tests in standing

De Weerdt and

Harrison,B 1985

Berglund and

Fugl-Meyer,g

1986

Dettmann et al,lo

1987

Di Fabio and

Badke,ls 1990

Wood Dauphinee et

al,ll 1990

Arsenault et al,l2

1988

Kusoffsky et al,13

1982

Duncan et al,l4

1983

53 subjects

Action Research Arm test and

Fugl-Meyer assessment used at 2

weeks and 8 weeks poststroke

10 patients with stroke and

upper-extremity mpairment

Fugl-Meyer assessment and DeSouza

functional arm test used to assess

upper extremity

15 men following cerebrovascular

accident tested using Barthel Index,

Fugl-Meyer assessment, and tests of

walking performance and postural

stability using light photography

10 patients assessed R= 14.9 weeks

poststroke with sensory organization

balance test and Fugl-Meyer

assessment

172 patients assessed at admission

and 5 weeks poststroke with

Fugl-Meyer assessment and Barthel

Index

62 subjects 3.1 months poststroke

Treated with Bobath approach for 3

months and assessed three times

Bobath evaluation and Fugl-Meyer

assessment (wrist and hand not

evaluated)

16 patients examined on six occasions

with Fugl-Meyer assessment from

subacute stage to 6 months

poststroke (motor control, touch, joint

position sense) and somatosensory

evoked potentials (STEP) test

19 subjects 1 year poststroke

4 physical therapists

Physical therapists administered 3 tests

at 3-week intervals

Construct validity

Construct validity

Construct validity

Construct validity

Construct validity

Fugl-Meyer

assessment used as

a reference measure

Criterion validity

Reliability

Mean correlation coefficient between

scores=.88

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=.91

8 weeks, r=.94

P< .01

Fugl-Meyer assessment and DeSouza test

total scores covaried closely, explaining

more than 90% of the variance

Motor assessments also closely associated,

explaining more than 80% of the variance

Pearson Product-Moment Correlation

Coefficient

r= .75, upper extremity

r=.74, motor control

r=.76, balance

r=.67, total scores

P<.01

Spearman rho

r=.55, sensory

r= .77, balance

r=.69, lower extremity

Pearson Product-Moment Correlation

Coefficient

r=.754 at admission

r=.854 at 5 weeks

P<.01

Spearman rho association between Bobath

approach and Fugl-Meyer assessment at

three times of testing

P< ,001

Analysis of variance

Fugl-Meyer assessment cumulated with

Bobath approach measurements

X2=20.6 (P<.OOO1)

Correlations highest in results from

upper-extremity scores

lntrarater Pearson Product-Moment Correlation

Coefficients

r= .8&.99

lnterrater upper extremity, r=.97-.99

Lower extremity, r=.79-.95

P<.001

Physical Therapy /Volume 73, Number 71July 1993



-able 2. Descrzption ofPatients (N=12)

No. ol Patients % SD Range

Cause of cerebrovascular accident

Infarction

Unknown

Time from onset to admission

Gender

Male

Female

Age (Y)

Side of plegia

Right

Left

Source of referral

Acute care center

Home

Raters

Three physical therapists who had

between 10 an d 20 years of experi-

enc e in stroke rehabilitation adminis-

tered the assessment. They reviewed

the orig inal article by Fugl-Meyer et

alz and de signed a form to rec ord the

results (Appendix). Prior to com -

mencing the study, the physical thera-

pists discussed the assessment and

tested three patients. Each therapist

performed and rated o ne assessmentwhile the other therapists rated the

patient's responses. They comp ared

their results after each assessment.

Approximately 2% hours was spent in

this preparation.

Design

The order in which the therapists saw

the patients was randomized andbalanced (equal numbers of subjects

we re assigned to the therapists). Allpatients we re tested within on e work-ing day of the previous assessment(ie, theoretically, there should have

been n o change in the patients) andwere see n on only on e occasion by

each therapist; that is, each patient

was assessed by all three physicaltherapists o n separate occasions. As-

sessments took ap proximately 30

minutes to administer. After the study

began , the therapists did n ot discuss

the results of the assessments.

Data Anaiysis

Desc riptive statistics, including the

mean and standard deviation for the

total Fugl-Meyer score and for the

subscores, were calculated for each

rater and for each testing occasion. A

three-w ay analysis of varianc e

(ANOVA) was performed to test for

differences between raters (threelevels) an d occasions ( three levels).

The third factor in th e analysis was

subjects (ie, subjectsX raters x occa-

sions). Differences were formally

tested by calculating the F statistic an d

the associated probability value. Th e

level of statistical significanc e was s et

at .05. Reliability was assessed by

calculatin g an ICC (type 2, I), a

random-effects mod el described by

Shr out an d Fleiss.17Reliability is de -

fined as the ability of an instru men t to

measure attributes in a reproducibleand consistent manner.18

A measurement is considere d to be

consistent if it produces similar re-

sults over a nu mb er of occasions in a

stable situation.'9 The ICC u sed to

calculate the reliability coefficients

represents the ratio of variance du e to

subjects com pared w ith the total vari-

ance; thus, its most direct interpret

tion relates to its ability to discrim

nate am ong patients. It is directly

reliant on the heterogeneity of th e

patients. Ninety-five percent confi-

dence limits were calculated to demine the precision of the estimate

reliability.20 Calculating the reliabil

of a n assessment also involves calc

lating the variability in an individu

score du e to factors irrelevant to tpurpose of the test. This variability

known as the error of measure-met~t.20~21he standard error of m

surement (SEM) was calculated fro

an error term that combined rater

occasion, and er ro r variances.18

The summary statistics (means andstandard deviations) for both time

and rater are shown in Tables 3 an

4. The ANOVA did not reveal anystatistically significant systematic di

ferences attributable to raters o r o

sions. The overall me an scores of raters varied from 161 to 167 poin

All raters had a mean score of 40

points for the upper extremity. Th

sensation subsection had the great

difference between means, a 3-poi

difference. The m ean total scores

according to occasion varied from

to 165 points, with the largest diff

ence between the means in any se

tion being 2 points.

The ICCs, confidence limits, varian

components, and SEMs are shown

Table 5. The inte rrater reliability f

the total score was .96.

The reliability coefficients for the

subsections of the Fugl-Meyer asse

ment varied from .61 for the pain

measurements to .97 for the uppe

extremity items (Tab. 5). The SEM

was 9 points for the total score an

varied from 1 for balance to 4 forpain. Table 5 provides the maxim

total score fo r each section as a re

enc e point fo r each of the SEMs.

Th e total scores for the patients va

from 79 to 220 points. Using the

guidelines developed by Fugl-Mey

fo r characterizing the various leve

motor performance6 to analyze ou

physical Thera py /Volu me 73, Num ber 7/July 1993



able 3. Time Results

d u e to rater erro r. The rater is reliant

o n the patient's verbal ability to de-scribe his o r her ~erceo t ions . his isin contrast to other items in the Fugl-

ComponentMaxlmum

Occaslon 1 Occaslon 2 Occaalon 3 Meyer assessment, which involve

Score X SD X SD R SD scoring through direct observation.

Total Fugl-Meyer 226 166 49 162 49 165 47

assessment score

Upper extremity 66 4 1 24 4 1 24 39 23

Lower extremity 34 23 12 21 11 22 11

Balance 14 8 3 8 8 8 4

Sensation 24 18 8 18 8 18 9

Range of motion 44 38 6 39 5 39 5

Pain 44 38 4 37 8 38 5

results, we found that 92% of the

patients in o ur study were in the firstthree categories (severe impairment,

n= 3; marked impairment, n= 4, and

moderate impairment, n=4). Only

one patient had scores that wouldindicate slight m otor impairment.

Dlscusslon

Overall, the reliability estimates in our

study were similar to those repo rted

by Duncan et a1 (r=.8&.99)l4 and DiFabio and Badke (rho=.95).'5 In ou r

study, the reliability coefficient for the

upp er extremity was higher than that

for the lower extremity. Recovery of

function often occurs faster and to agreater extent in the lo wer extremitythan in the up per extremity. There-

fore, many of the patients may have

been unable to perform com ponents-able 4. Rater Results

of the upper-extremity assessment,reducing the possibility of rater erro r.

Most patients were able to performalmost all of the lower-extremity

items. The lower-extremity perfor-

mance may have been less consistentfrom day to day, which m ay account

for a relatively greater amoun t ofresidual erro r. The relative heteroge-

neity of the scores for the upp er limbmay account for the hig her reliability

coefficient for the up pe r extremity

compared with the lower extremity.

Pain assessment was the least reliable

section. This finding may b e d ue tothe natural (rando m) variation in pain

from day to day o r to variation of

rater interpretation of the patients'pain. Although sensation had a rea-

sonable d egre e of reliability

(KC= .86), it had the greatest variance

There was very little variation in the

measurements attributable to occa-

sion . The small v ariances associated

with rater and o ccasion (Tab. 5) dem-onstrate the absence of systematic

differences related to these variables.

The main component of the assess-ment is motor recovery following

stroke. The inclusion of sections to

assess range of movement and painallows for the assessment of impair-

ments that may b e attributed to

causes oth er than the stroke. Theimpairment measures of the Fugl-

Meyer assessment have been shown

to corr elate with activities of dailyliving (ADL) measures (r= 92).22 This

finding suggests that patients withsimilar scores on the impairment

measures of the Fugl-Meyer assess-

men t will also have similar scores onADL measures. Because sensation has

been noted as a predictor of sensori-

mo tor recovery,23 assessmen t of thisarea by the Fugl-Meyer assessment

increases the strength of the tool.

The SEM provides an interpretation of

the magnitude of measurement erro rand is more appropriate than the

reliability coefficient for interpretingindividual scores.21 On e standard

erro r encompasses 68% of obtained

scores around the true score, and astandard error of 1.96 encompasses

95% of obtained scores. The SEM fo rthe Fugl-Meyer assessmen t is 9.4points, and the 95% confidence inter-

MaximumRater 1 Rater 2 Rater 3 ;a1 wo uld b e +- I8 points. Given that a

Component Score X SD X SD X SD clinician obtains a total score of 150points for the overall observed total

score at the 95% confidence levelTotal Fugl-Meyer 226 165 42 167 52 161

assessment score

53with any single administration of the

Upper extremity 66 40 23 40 24 40 24test, the sco re obtaine d will lie be-

tween 140.6 and 159.4 points.Lower extremity 34 21 10 23 12 23 13

Balance 14 7 4 8 4 8 In order to evaluate change in anSensation 24 17 6 20 8 17 individ ual patient, Otte nba cher et a124Range of motion 44 39 4 39 6 38 6 recommended that the "reliabilityPain 44 39 4 37 6 37 8 change index" be used. The standard

erro r of the difference is used to

40 / 451 Physical Therapy /Vo lum e 73, Num ber 7/July 1993



able 5. Analysis of Variance Resultsfor Fugl-MeyerAsessment

the SEM would be reduced, as the

error would be averaged across rat

or occasions.16

Varlance Component MaxlmumICC* Total

Subject Rater Occaslon Error (95%Cl)b SEMC Score

Total Fugl-Meyer 2,306 0.23 0

assessment

score

Upper extremity 540 0.0 0

Lower extremity 121 0.0 0

Balance 12 0.0 0

Sensation 55 1.5 0

Range of motion 23 0.08 0

Pain 23 0.0 0

OICC= ntraclass correlation coefficient.

b~~=confitiencenterval

'SEM=standard error of the measurement.

determine whether the change score

exceeds the score that would b e ex-

pected on the basis of measurement

error. Given that no true change oc-

curred 95% of the time, the score

obtained by a second rater at a differ-

ent point in time would be within-+26 points (13X 1 . 9 6 ~ 2 ) ~ ~f the

score of the first rater. This difference

represents about 11.5% of the maxi-

mum possible score. On the basis of

this result, the Fugl-Meyer assessment

is a moderately reliable tool. In our

study, evaluation using the instrument

involved more than one therapist;

thus, both the reliability coefficients

and the SEMs are conservative esti-

mates compared with the situation of

a single assessment by a therapist.

How can these results be interpreted

by a therapist in a clinical setting? The

results of this study indicate the reli-

ability and the SEM that would likely

be obtained among several raters with

a similar patient population in a clini-

cal setting. If two clinicians assessed a

patient who was receiving active reha-

bilitation following a stroke (ie, simi-

lar to the patients in our sample) on

different occasions using the Fugl-

Meyer assessment and derived total

scores that were 10 points apart, we

would not b e sure whether true

change had occurred or whether the

difference in scores was due to rateror residual error. Although the assess-

ment of intrarater reliability was not

part of our study, we would expect it

to be equal to or greater than the

interrater reliability coefficient. Fugl-

Meyer et a12 reported scores of 13

patients they assessed on five occa-

sions over a 12-month period. Pa-

tients' total scores from time 1 to time

5 improved from 7 to 83 points on

the assessment, with the average

change for the group calculated at

43.08 points (SD=29.13). If a largeamount of "true" change occurs, then

a SEM of 9.4 points is acceptable. If

smaller change in the patient occurs,

however, the magnitude of the erro r

may be unacceptable. Error can b e

reduced by averaging over raters or

occasions when change is not occur-

ring. By increasing the raters or occa-

sions on which a patient is assessed,

The Fugl-Meyer assessment is well

suited as a research tool because it

relatively easy to establish a high

degree of reliability among several

raters. In a clinical or research setti

standardization needs to be consid-

ered prior to using this assessment

limitation of this assessment is the

lack of administration guidelines. O

strategy for reducing the measure-

ment error is to standardize the

administration guidelines of this

assessment.

Anastasi2' suggests that separate reli

ability coefficients should be report

for the sample subgroups, as the

coefficients obtained are more likel

to b e applicable to clinical practice.

Our sample was too small to calcul

tight confidence limits for the reliab

ity coefficients for subgroups, but th

would be a worthwhile direction fo

further study.

The Fugl-Meyer assessment is de-

signed to assess motor recovery fol

lowing stroke. The interrater reliabi

ity of measurements obtained with

this assessment was tested by three

experienced physical therapists on

patients in a rehabilitation populatio

It is a relatively simple assessment t

administer and requires minimal

training. The overall reliability for th

instrument was high (ICC= 96), as

were the reliability measurements f

the subsections of this assessment,

with the exception of pain. Error

measured in absolute terms may be

significant, however, when only sma

changes in the patient's level of mo

performance are expected. These

results would suggest that the Fugl-

Meyer assessment is a moderately

reliable measure for assessing impa

ment in a population of patients un-

dergoing rehabilitation following

stroke.

Physical Therapy /Volume 73, Number 7duly 1993



-ppendb. Fugl-MeyerAssessment Score Sheet

Patient's Name Patient No.

Therapist's Name

UPPER EXTREMITY

A. Shoulder/Elbow/Forearm

I. Reflex activity

Flexors -Biceps

-Finger flexorsExtensors--Triceps

II. a. Flexor synergy

Shoulder-Retraction-Elevation-Abduction-Outward rotation

Elbow -Flexion

Forearm -Supination

b. Extensor synergy

Shoulder-Adductionlinward rotation

Elbow -Extension

Forearm -Pronation

Ill. Hand to lumbar spine

Hand -Move to lumbar spine

Shoulder -Flexion 0"-90"

Elbow 90"-Pronationlsupination

IV. Shoulder -Abduction 0"-90"-Flexion 90"-180"

Elbow 0" -Pronation/supination

V. Normal reflex activity

Total-Shoulder/Elbow/Forearm

B. Wrist

Elbow 90"-Wrist stability

Elbow 90"-Wrist flexionlextension

Elbow 0" -Wrist stabilityElbow 0" -Wrist flexionlextension

Circumduction

TotaC Wrist

C. Hand

Fingers mass llexion

Date

LOWER EXTREMITY

E. HipIKneelAnkle

I. Reflex activity

Flexors -Hamstrings

-Achilles

Extensors-Patellar

11. a. Flexor synergy

Hip -Flexion

Knee-Flexion

Ankle-Dorsiflexion

b. Extensor synergy

Hip -Extension

-Adduction

Knee-Extension

Ankle--Plantar flexion

Ill. Knee-Flexion

Ankle-DorsiflexionIV. Knee-Flexion

Ankle-Dorsiflexion

V. Normal reflex activity

Flexors -Hamstrings

-Achilles

Extensors--Patellar

Total-Hip/Knee/Ankle 0

F. CoordinationISpeed

Tremor

Dysmetria 0

Speed

TotaCCoordination/SpeedTotal Motor Score for the Lower Extremity

G. Balance

Sit without support 0

Parachute reaction, nonaffected side 0

Parachute reaction, affected side

Fingers mass extension Supported standing 0

Grasp a

Grasp b

Grasp c

Grasp d

Grasp e

Total--HandD. CoordinationISpeed

Tremor

Dysmetria

Speed

Total-Coordination/Speed

Total Motor Score for the Upper Extremity

Standing without support

Stand on nonaffected leg

Stand on affected leg

Total Score-Balance

H. Sensation

a. Light touchArm

Palm

Leg

Plantar

(continued)

Physical Therapy /Vo lum e 73, Numb er 7fluly 1993



ppendix. (continued)

b. Position

Shoulder

Elbow

Wrist

Thumb (interphalangeal)

Hip

Knee

Ankle

Great toe

Total Score--Sensation

I. Passive Joint MotionIJoint Pain

Shoulder Flexion

Abduction >90°

Outward rotation

Inward rotation

Elbow Flexion

Extension

Forearm Pronation

Supination

Wrist Flexion

Extension

Fingers Flexion

Extension

Hip Flexion

Abduction

Outward rotation

Inward rotation

Knee Flexion

Extension

Ankle Dorsiflexion

Plantar flexion

Foot Pronation

Supination

Total Score-Passive Joint Motion/Joint Pain

SUMMARY

A. Shoulder/Elbow/Forearm

B. Wrist

C. Hand

D. CoordinationISpeed

Total Upper Extremity

E. HipIKneelAnkle

F. CoordinationlSpeed

Total Lower Extremity

G. Balance

H. Sensation

I. Pass ive Joint MotionIJ oint Pain

TOTAL SCORE

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