By: Joyce Sabari, Ph.D, OTR, FAOTA
UPDATE: The Motor Assessment Scale Resources Web Site is NOW Live
Current evidence-based practice for motor rehabilitation after stroke is influenced by task-oriented approaches that aim to improve overall function related to balance, gross mobility, and use of the paretic limbs. Therapists are encouraged to use standardized assessment tools for objective measurement of client progress, communication about client status between different treatment sites within the continuum of care, and research investigating the efficacy of selected interventions.
The Motor Assessment Scale (MAS) is a standardized assessment devised by Carr, Shepherd, Nordholm & Lynne (1985) to assess motor function in stroke survivors and to correspond with the motor relearning approach to recovery after stroke (Carr & Shepherd, 1998; 2007). The MAS is a well-studied assessment with properties that make it useful for rehabilitation therapists, and is specifically recommended as a measure of post-stroke motor function in the American Heart Association’s Clinical Practice Guideline for Stroke Rehabilitation (Duncan, Zorowitz, et al, 2005) and the Canadian health system’s Evidence-Based Review of Stroke Rehabilitation (Salter et al, 2012). Objective reviews of stroke assessments typically commend the MAS for reliability and ease of administration (Poole & Whitney, 2001; Fasoli, 2003). The MAS continues to be used extensively as an outcome measure in studies of rehabilitation interventions for stroke survivors (Langhammer, Stanghelle, Lindmark, 2009; Hayward et al, 2013, Colomer, et al, 2013; Katrak, Black & Peeva, 2011, Kwah, et al, 2013).
The MAS provides a standardized scoring system for assessing eight categories of motor behavior:
- Supine to Side-lying
- Supine to Sit
- Balanced Sitting
- Sit to Stand
- Upper Arm Function
- Hand Movements
- Hand Activities
The full protocol is available at: http://www.rehabmeasures.org/pdf%20library/motor%20assessment%20scale%20testing%20form.pdf
Each category is scored on a 7 point scale (0-6), based on a person’s ability to perform specific tasks. The tasks in each category are intended to be hierarchical; that is, the ability to accomplish task 6 implies the ability to accomplish tasks 1 through 5. This arrangement reduces administration time and increases its appeal to clinicians.
Two of the 8 items on the MAS assess hand function. A third item on the MAS assesses upper arm function (defined as a person’s ability to functionally use the shoulder and elbow). In response to concerns raised in a previous study (Poole & Whitney, 1988) about the hierarchies used to assign scores on the hand items, Sabari et al. (2005) used Rasch analysis to evaluate the validity of the scoring hierarchy of the 3 upper limb items This Rasch analysis of a sample of 100 stroke rehabilitation patients provided support for the hierarchical scoring criteria proposed by the MAS developers for upper-arm function. However, the analysis showed significant problems with the scoring hierarchies for the hand movements and the advanced hand activities items. Specifically, several criteria were not in order of performance difficulty, significant gaps in difficulty were found between adjacent criteria, and some criteria were redundant with one another in their levels of difficulty. Subsequent studies by independent authors (Aamodt, Kjendahl & Jahnsen, 2006; Pickering et al, 2010) corroborated these findings.
Though many evaluations of motor function in stroke survivors have been developed and piloted, very few provide clinicians with a single tool that provides holistic information about the multiple aspects of motor performance that are critical components to neurorehabilitation interventions. Aside from its original problems in the hand items, the Motor Assessment Scale provides a quick, comprehensive assessment of motor function in stroke survivors. Therefore, I worked with colleagues to redesign the two hand items on the MAS, following a multi-step process of scale development, refinement and Rasch analysis (Sabari, Woodbury & Velozo, 2014). The published report is available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142312/
Data collectors at eight clinical sites were enthusiastic about the utility of the newly developed hand items, and it is my sincere hope that, with these suggested improvement, occupational therapy clinicians will consider adopting the MAS as a clinical assessment tool. I am currently working with colleagues at SUNY Downstate Medical Center to develop a resource web page, which will provide therapists with the complete test protocol, training videos and other materials to help them use the tool with confidence. We hope the webpage will be accessible by January 1, 2016. I invite you to send me an email if you would like to receive notification, with the link, when this webpage becomes available.
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About the Author
Joyce Sabari, PhD, OTR, FAOTA is Associate Professor and Chair of the Occupational Therapy Program at SUNY Downstate Medical Center. In addition to her published work related to the Motor Assessment Scale, she has written several textbook chapters about neurorehabilitation and task-based approaches to improving motor function in stroke survivors. She is also the author of the 2008 edition of Occupational Therapy Practice Guidelines for Adults with Stroke, published by AOTA Press.
Aamodt, G., Kjendahl, A., Jahnsen, R. (2006). Dimensionality and scalability of the Motor Assessment Scale (MAS). Disability and Rehabilitation, 28, 1007-1013.
Barker, R.N., Brauer, S.G., Carson, R.G. (2008). Training of reaching in stroke survivors with severe and chronic upper limb paresis using a novel nonrobotic device: a randomized clinical trial, Stroke, 39(6), 1800-1807.
Brauer, S.G., Bew, P.G., Kuys, S.S., Lynch, M.R., Morrison, G. (2008). Prediction of discharge destination after stroke using the Motor Assessment Scale on admission: A prospective, multisite study, Archives of Physical Medicine and Rehabilitation, 89(6), 1061-2065.
Carr, J.H. & Shepherd, R.B. (2003). Stroke rehabilitation: Guidelines for exercise and training to optimize motor skill, London: Butterworth Heinemann.
Carr, J.H. & Shepherd, R.B. (1998). Neurological rehabilitation: Optimizing motor performance, London: Carr, J.H. & Shepherd, R.B.
Carr, J.H., Shepherd, R.B. & Nordholm, L. (1985). Investigation of a new motor assessment scale for stroke patients. Physical Therapy, 65, 175-180.
Colomer, C., Baldovi, A., Torrome, S, et al. (2013) Efficacy of Armeo Spring during the chronic phase of stroke: Study in mild to moderate cases of hemiparesis, Neurologia, 28, 261-267.
Duncan, P.W., Zorowitz, R., Bates, B., Choi, J.Y., Glasberg, J.J., Graham, G.D., Katz, R.C., Lamberty, K. & Reker, D. (2005). Management of Adult Stroke Rehabilitation Care: A Clinical Practice Guideline – Appendix D, Stroke, 36, 100-143.
English, C.K., Hillier, S.L., Stiller, K.R., Warden-Flood, A. (2007). Circuit class therapy versus individual physiotherapy sessions during inpatient stroke rehabilitation: A controlled trial, Archives of Physical Medicine and Rehabilitation, 88, 955-963.
Fasoli, S. (2003). Assessing Upper-Limb Motor Function in Clients with Stroke. American Occupational Therapy Association Physical Disability Special Interest Section Quarterly. 26(2), 1-4.
Hayward, K.S., Barker, S.G., Brauer, D., Lloyd, S., Horsley, A., Carson, R.G. (2013). SMART arm with outcome-triggered electrical stimulation: a pilot randomized clinical trial, Topics in Stroke Rehabilitation, 20, 289-298.
Katrak, P.H., Black, D., Peeva, V. (2011). Stroke rehabilitation is Australia in a freestanding inpatient rehabilitation unit compared with a unit located in an acute care hospital, Physical Medicine & Rehabilitation, 3, 716-722.
Kwah, L.K., Harvey, A., Diong, J., Herbert, R.D. (2013). Models containing age and NIHSS predict recovery of ambulation and upper limb function six months after stroke: An observational study, Journal of Physiotherapy, 59,189-197.
Langhammer, B., Stanghelle, J.K., Lindmark, B. (2009). An evaluation of two different exercise regimes during the first year following stroke: A randomized controlled trial, Physiotherapy Theory and Practice, 25(2), 55-68.
Pickering, R.L., Hubbard, I.J., Baker, K.G., Parsons, M.W. (2010). Assessment of the upper limb in acute stroke: the validity of hierarchical scoring for the Motor Assessment Scale, Australian Occupational Therapy Journal, 57, 174-182.
Poole J, Whitney S. Motor Assessment Scale for stroke patients: Concurrent validity and interrater reliability. (1988). Archives of Physical Medicine and Rehabilitation, 69, 195-197.
Sabari, J.S., Lim, A.L., Velozo, C.A., Lehman, L., Kieran, O. & Lai, J.S. (2005). Assessing arm and hand function after stroke: a validity test of the hierarchical scoring system used in the motor assessment scales for stroke. Archives of Physical Medical Rehabilitation, 86, 1609-15.
Sabari, J.S., Woodbury, M., Velozo, C.A. (2014). Rasch analysis of a new hierarchical scoring system for evaluating hand function on the Motor Assessment Scale for Stroke, Stroke Research and Treatment, Volume 2014, Article ID 730298.
Salter, K., Campbell, N., Richardson, M., Mehta, S., Jutai, J., Zettler, L., Moses, M., McClure, A., Mays, R., Foley, N., Teasell, R. (2012). Outcome measures in stroke rehabilitation, in The Evidence-Based Review of Stroke Rehabilitation (EBRSR), R. Teasell, Ed., Chapter 21.