Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 6 , Pages 715-723 , June 2007

Dimensionality and Construct Validity of the Fugl-Meyer Assessment of the Upper Extremity

Presented as a poster to the American Occupational Therapy Association Annual Conference. May 13, 2005, Long Beach, CA.

  • Michelle L. Woodbury, PhD

      Affiliations

    • Brain Rehabilitation Research Centers, Malcolm Randall VA Medical Center, Gainesville FL
    • Department of Occupational Therapy, University of Florida, Gainesville, FL
    • Rehabilitation Science Doctoral Program, University of Florida, Gainesville, FL
    • Corresponding Author InformationReprint requests to Michelle L. Woodbury, PhD, Dept of Occupational Therapy, College of Public Health and Health Professions, University of Florida, PO Box 100164, Gainesville, FL 32610
  • ,
  • Craig A. Velozo, PhD

      Affiliations

    • Rehabilitation Outcomes Research Center, Malcolm Randall VA Medical Center, Gainesville FL
    • Department of Occupational Therapy, University of Florida, Gainesville, FL
    • Rehabilitation Science Doctoral Program, University of Florida, Gainesville, FL
  • ,
  • Lorie G. Richards, PhD

      Affiliations

    • Brain Rehabilitation Research Centers, Malcolm Randall VA Medical Center, Gainesville FL
    • Department of Occupational Therapy, University of Florida, Gainesville, FL
    • Rehabilitation Science Doctoral Program, University of Florida, Gainesville, FL
  • ,
  • Pamela W. Duncan, PhD

      Affiliations

    • Rehabilitation Outcomes Research Center, Malcolm Randall VA Medical Center, Gainesville FL
    • Rehabilitation Science Doctoral Program, University of Florida, Gainesville, FL
    • Department of Aging and Geriatric Research, University of Florida, Gainesville, FL
  • ,
  • Stephanie Studenski, MD

      Affiliations

    • Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA
  • ,
  • Sue-Min Lai, PhD

      Affiliations

    • Department of Preventative Medicine, University of Kansas, Kansas City, KS.

References 

  1. Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient: a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7:13–31
  2. Van Wijck FM, Pandyan AD, Johnson GR, Barnes MP. Assessing motor deficits in neurological rehabilitation: patterns of instrument usage. Neurorehabil Neural Repair. 2001;15:23–30
  3. Malouin F, Pichard L, Bonneau C, Durand A, Corriveau D. Evaluating motor recovery early after stroke: comparison of the Fugl-Meyer Assessment and the Motor Assessment Scale. Arch Phys Med Rehabil. 1994;75:1206–1212
  4. Filiatrault J, Arsenault AB, Dutil E, Bourbonnais D. Motor function and activities of daily living assessments: a study of three tests for persons with hemiplegia. Am J Occup Ther. 1991;45:806–810
  5. Katz RT, Rovai GP, Brait C, Rymer WZ. Objective quantification of spastic hypertonia: correlation with clinical findings. Arch Phys Med Rehabil. 1992;73:339–347
  6. Gowland C, Stratford P, Ward M, et al. Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment. Stroke. 1993;24:58–63
  7. van der Lee JH, Beckerman H, Lankhorst GJ, Bouter LM. The responsiveness of the Action Research Arm Test and the Fugl-Meyer Assessment Scale in chronic stroke patients. J Rehabil Med. 2001;33:110–113
  8. Wang CH, Hsieh CL, Dai MH, Chen CH, Lai YF. Inter-rater reliability and validity of the Stroke Rehabilitation Assessment of Movement (STREAM) instrument. J Rehabil Med. 2002;34:20–24
  9. Wolf SL, Catlin PA, Ellis M, Archer AL, Morgan B, Piacentino A. Assessing the Wolf Motor Function Test as an outcome measure for research in patients after stroke. Stroke. 2001;32:1635–1639
  10. Rabadi MH, Rabadi FM. Comparison of the Action Research Arm Test and the Fugl-Meyer Assessment as measures of upper-extremity motor weakness after stroke. Arch Phys Med Rehabil. 2006;87:962–966
  11. Broeks JG, Lankhorst GJ, Rumping K, Prevo AJ. The long-term outcome of arm function after stroke: results of a follow-up study. Disabil Rehabil. 1999;21:357–364
  12. Duncan PW, Lai SM, Keighley J. Defining post-stroke recovery: implications for design and interpretation of drug trials. Neuropharmacology. 2000;39:835–841
  13. Boissy P, Bourbonnais D, Kaegi C, Gravel D, Arsenault BA. Characterization of global synkineses during hand grip in hemiparetic patients. Arch Phys Med Rehabil. 1997;78:1117–1124
  14. Desrosiers J, Noreau L, Rochette A, Bourbonnais D, Bravo G, Bourget A. Predictors of long-term participation after stroke. Disabil Rehabil. 2006;28:221–230
  15. Duncan P, Richards L, Wallace D, et al. A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke. Stroke. 1998;29:2055–2060
  16. Raghavan P, Petra E, Krakauer JW, Gordon AM. Patterns of impairment in digit independence after subcortical stroke. J Neurophysiol. 2006;95:369–378
  17. Harris-Love ML, McCombe Waller S, Whitall J. Exploiting interlimb coupling to improve paretic arm reaching performance in people with chronic stroke. Arch Phys Med Rehabil. 2005;86:2131–2137
  18. Levin MF, Selles RW, Verheul MH, Meijer OG. Deficits in the coordination of agonist and antagonist muscles in stroke patients: implications for normal motor control. Brain Res. 2000;853:352–369
  19. Michaelsen SM, Jacobs S, Roby-Brami A, Levin MF. Compensation for distal impairments of grasping in adults with hemiparesis. Exp Brain Res. 2004;157:162–173
  20. Levin MF. Interjoint coordination during pointing movements is disrupted in spastic hemiparesis. Brain. 1996;119:281–293
  21. Stinear JW, Byblow WD. Rhythmic bilateral movement training modulates corticomotor excitability and enhances upper limb motricity poststroke: a pilot study. J Clin Neurophysiol. 2004;21:124–131
  22. Luft AR, McCombe-Waller S, Whitall J, et al. Repetitive bilateral arm training and motor cortex activation in chronic stroke: a randomized controlled trial. [published erratum in: JAMA 2004;292:2470] JAMA. 2004;292:1853–1861
  23. Chae J, Bethoux F, Bohine T, Dobos L, Davis T, Friedl A. Neuromuscular stimulation for upper extremity motor and functional recovery in acute hemiplegia. Stroke. 1998;29:975–979
  24. Francisco G, Chae J, Chawla H, et al. Electromyogram-triggered neuromuscular stimulation for improving the arm function of acute stroke survivors: a randomized pilot study. Arch Phys Med Rehabil. 1998;79:570–575
  25. Page SJ, Levine P. Back from the brink: electromyography-triggered stimulation combined with modified constraint-induced movement therapy in chronic stroke. Arch Phys Med Rehabil. 2006;87:27–31
  26. Viriyavejakul A, Vachalathiti R, Poungvarin N. Botulinum treatment for post-stroke spasticity: low dose regime. J Med Assoc Thai. 1998;81:413–422
  27. Pang MY, Harris JE, Eng JJ. A community-based upper-extremity group exercise program improves motor function and performance of functional activities in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2006;87:1–9
  28. Krebs HI, Volpe BT, Aisen ML, Hogan N. Increasing productivity and quality of care: robot-aided neuro-rehabilitation. J Rehabil Res Dev. 2000;37:639–652
  29. Finley MA, Fasoli SE, Dipietro L, et al. Short-duration robotic therapy in stroke patients with severe upper-limb motor impairment. J Rehabil Res Dev. 2005;42:683–692
  30. Piron L, Cenni F, Tonin P, Dam M. Virtual Reality as an assessment tool for arm motor deficits after brain lesions. Stud Health Technol Inform. 2001;81:386–392
  31. Page S. Imagery improves upper extremity motor function in chronic stroke patients: a pilot study. Occup Ther J Res. 2000;23:200–215
  32. van der Lee JH, Wagenaar RC, Lankhorst GJ, Vogelaar TW, Deville WL, Bouter LM. Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. Stroke. 1999;30:2369–2375
  33. Page SJ, Sisto SA, Levine P, Johnston MV, Hughes M. Modified constraint induced therapy: a randomized feasibility and efficacy study. J Rehabil Res Dev. 2001;38:583–590
  34. Page SJ, Sisto S, Johnston MV, Levine P. Modified constraint-induced therapy after subacute stroke: a preliminary study. Neurorehabil Neural Repair. 2002;16:290–295
  35. Page SJ, Sisto S, Johnston MV, Levine P, Hughes M. Modified constraint-induced therapy in subacute stroke: a case report. Arch Phys Med Rehabil. 2002;83:286–290
  36. Bonifer NM, Anderson KM, Arciniegas DB. Constraint-induced movement therapy after stroke: efficacy for patients with minimal upper-extremity motor ability. Arch Phys Med Rehabil. 2005;86:1867–1873
  37. De Weerdt W, Harrison MA. Measuring recovery of arm-hand function in stroke patients: a comparison of the Brunnstrom-Fugl-Meyer test and Action Research Arm test. Physiother Can. 1985;37:65–70
  38. Duncan PW, Propst M, Nelson SG. Reliability of the Fugl-Meyer Assessment of sensorimotor recovery following cerebrovascular accident. Phys Ther. 1983;63:1606–1610
  39. Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer Assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair. 2002;16:232–240
  40. Sanford J, Moreland J, Swanson LR, Stratford PW, Gowland C. Reliability of the Fugl-Meyer Assessment for testing motor performance in patients following stroke. Phys Ther. 1993;73:447–454
  41. Platz T, Pinkowski C, van Wijck F, Kim IH, di Bella P, Johnson G. Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study. Clin Rehabil. 2005;19:404–411
  42. Wood-Dauphinee SL, Williams JI, Shapiro SH. Examining outcome measures in a clinical study of stroke. Stroke. 1990;21:731–739
  43. Poole JL, Whitney SL. Motor assessment scale for stroke patients: concurrent validity and interrater reliability. Arch Phys Med Rehabil. 1988;69(3 Pt 1):195–197
  44. Chae J, Labatia I, Yang G. Upper limb motor function in hemiparesis: concurrent validity of the Arm Motor Ability test. Am J Phys Med Rehabil. 2003;82:1–8
  45. Dettmann MA, Linder MT, Sepic SB. Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient. Am J Phys Med. 1987;66:77–90
  46. De Souza LH, Hewer RL, Miller S. Assessment of recovery of arm control in hemiplegic stroke patients (1. Arm function tests). Int Rehabil Med. 1980;2:3–9
  47. Berglund K, Fugl-Meyer AR. Upper extremity function in hemiplegia (A cross-validation study of two assessment methods). Scand J Rehabil Med. 1986;18:155–157
  48. McDowell I, Newell C. The theoretical and technical foundations of health measurement. In:  McDowell I,  Newell C editor. Measuring health: a guide to rating scales and questionnaires. New York: Oxford Univ Pr; 1996;p. 10–46
  49. Twitchell TE. The restoration of motor function following hemiplegia in man. Brain. 1951;74:443–480
  50. Brunnstrom S. Motor testing procedures in hemiplegia: based on sequential recovery stages. Phys Ther. 1966;46:357–375
  51. Zehr EP, Stein RB. What functions do reflexes serve during human locomotion?. Prog Neurobiol. 1999;58:185–205
  52. Cramer SC. Functional imaging in stroke recovery. Stroke. 2004;35(11 Suppl 1):2695–2698
  53. Welmer AK, Holmqvist LW, Sommerfeld DK. Hemiplegic limb synergies in stroke patients. Am J Phys Med Rehabil. 2006;85:112–119
  54. Murray IA, Johnson GR. A study of the external forces and moments at the shoulder and elbow while performing everyday tasks. Clin Biomech (Bristol, Avon). 2004;19:586–594
  55. Wu C, Trombly CA, Lin K, Tickle-Degnen L. A kinematic study of contextual effects on reaching performance in persons with and without stroke: influences of object availability. Arch Phys Med Rehabil. 2000;81:95–101
  56. Velozo CA, Kielhofner G, Lai JS. The use of Rasch analysis to produce scale-free measurement of functional ability. Am J Occup Ther. 1999;53:83–90
  57. Linacre JM. A users guide to Winsteps and Ministeps Rasch-Model computer programs. Chicago: Winsteps; 2006;
  58. Bond TG, Fox CM. Applying the Rasch Model: fundamental measurement in the human sciences. Mahwah: Erlbaum; 2001;
  59. Wright BD, Stone MH. Best test design. Chicago: Mesa Pr; 1979;
  60. Wright BD, Linacre JM. Reasonable mean-square fit values. Rasch Meas Trans. 1994;8(3):370
  61. Linacre JM. Detecting multidimensionality: which residual data-type works best?. J Outcome Meas. 1998;2:266–283
  62. Hattie J. Methodology review: assessing unidimensionality of tests and items. Appl Psychol Meas. 1985;9:139–164
  63. Smith EV, Johnson BD. Attention deficit hyperactivity disorder: scaling and standard setting using Rasch measurement. J Appl Meas. 2000;1:3–24
  64. SAS (version 8.2) [computer program]. Cary: SAS Institute; 2003;
  65. Lattin J, Carroll JD, Green P. Analyzing multivariate data. Pacific Grove: Thomson Brooks-Cole; 2003;
  66. Floyd FJ, Widaman KF. Factor analysis in the development and refinement of clinical assessment instruments. Psychol Assess. 1995;7:286–299
  67. Duncan P, Studenski S, Richards L, et al. Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke. 2003;34:2173–2180
  68. Patel AT, Duncan PW, Lai SM, Studenski S. The relation between impairments and functional outcomes poststroke. Arch Phys Med Rehabil. 2000;81:1357–1363
  69. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;13:61–65
  70. Ware JE, Sherbourne CE. MOS-36 item short form health survey (SF-36): conceptual framework and item selection. Med Care. 1992;30:473–483
  71. Van Swieten JC, Koudstaal PF, Visser MC, Schouten HJA, van Gigin J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19:604–607
  72. Luft AR, Waller S, Forrester L, et al. Lesion location alters brain activation in chronically impaired stroke survivors. Neuroimage. 2004;21:924–935
  73. Wright BD, Masters GN. Rating scale analysis. Chicago: Mesa Pr; 1982;
  74. Gordon C. Assumptions underlying physical therapy interventions, theoretical and historical perspectives. In:  Carr JH,  Shepherd RB editor. Movement science: foundations for physical therapy in rehabilitation. 2nd ed.. Gaithersburg: Aspen; 2000;
  75. Warren M. Strategies for sensory and neuromotor remediation. In:  Christiansen C,  Baum C editor. Occupational therapy: overcoming human performance deficits. Thorofare: Slack; 1991;p. 633–664
  76. Pedretti LW. In: Occupational therapy: practice skills for physical dysfunction. 4th ed.. St. Louis: Mosby; 1996;
  77. Kamper DG, Harvey RL, Suresh S, Rymer WZ. Relative contributions of neural mechanisms versus muscle mechanics in promoting finger extension deficits following stroke. Muscle Nerve. 2003;28:309–318
  78. Platz T, Pinkowski C, van Wijck F. ARM: Arm rehabilitation measurement. Manual for performance and scoring. Baden-Baden: Deutscher Wissenschafts-Verlag; 2005;
  79. Flora DB, Curran PJ. An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychol Methods. 2004;9:466–491

 Supported by the North Florida/South Georgia Veterans Health System, Gainesville, FL, a National Institutes of Health T-32 Neuromuscular Plasticity Institutional Training Grant Fellowship (grant no. T32HD043730), and the National Institute on Aging, Claude D. Pepper Center Older Americans Center (grant no. 5P60AG14635).No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

PII: S0003-9993(07)00173-6

doi: 10.1016/j.apmr.2007.02.036

Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 6 , Pages 715-723 , June 2007