Review article| Volume 95, ISSUE 6, P1174-1183, June 2014

Scales to Assess Gross Motor Function in Stroke Patients: A Systematic Review

Published:March 03, 2014DOI:



      To assess the clinical and psychometric properties of stroke motor assessment scales.

      Data Sources

      The databases consulted for the literature research were MEDLINE, PEDro, ISI Web of Knowledge, and Cumulative Index to Nursing and Allied Health (CINAHL). The search was carried out between March 2011 and January 2014.

      Study Selection

      Studies that describe and validate a measurement scale designed to assess gross motor function in stroke. The articles were classified according to the levels of evidence and grades of recommendation for diagnosis studies of the Oxford Center for Evidence-Based Medicine.

      Data Extraction

      General characteristics of the studies, including number of patients, motor function assessment scales analyzed, and their psychometric properties, were collected.

      Data Synthesis

      After the literature search, 19 articles were included in this review; 32 articles were excluded for not meeting the inclusion criteria. Four of the 19 articles studied the Motor Assessment Scale, 5 the Fugl-Meyer Assessment, 3 investigated the Sodring Motor Evaluation for Stroke Patients, 4 the Stroke Rehabilitation Assessment of Movement, 2 were about the Motricity Index, and 2 about the Rivermead Motor Assessment. All of them were classified as level 2b according to the levels of evidence and grades of recommendation.


      All the scales compiled in this review have been shown to be useful both in clinical practice and in terms of research. The most suitable scales to be used in the clinical field would be the short versions of the Fugl-Meyer Assessment and the Stroke Rehabilitation Assessment of Movement. A real consensus about the measurement of gross motor function in patients with stroke is not available in the recent literature.


      List of abbreviations:

      BI (Barthel Index), FAI (Franchay Activity Index), FMA (Fugl-Meyer Assessment), ICC (intraclass correlation coefficient), MAS (Motor Assessment Scale), MI (Motricity Index), MMAS (modified MAS), RMA (Rivermead Motor Assessment), S-FM (short version of the FMA), SMES (Sodring Motor Evaluation for Stroke Patients), SRM (standardized response mean), STREAM (Stroke Rehabilitation Assessment of Movement), S-STREAM (15-item simplified version of STREAM)
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      1. World Health Organization. The atlas of heart disease and stroke. Available at: Accessed March 10, 2013.

        • Díaz-Guzmán J.
        • Egido-Herrero J.A.
        • Gabriel-Sánchez R.
        • et al.
        Incidence of strokes in Spain: the Iberictus study. Data from the pilot study [in Spanish].
        Rev Neurol. 2008; 47: 617-623
      2. Instituto Nacional de Estadística. Defunciones según la causa de muerte 2008. Available at: Accessed March 10, 2013.

        • Duran-Heras M.A.
        Informe Sobre el Impacto Social de los Enfermos Dependientes por ICTUS. INFORME ISEDIC.
        2nd ed. Engraf, SA, Madrid2004
        • Hallett M.
        Plasticity of the human motor cortex and recovery from stroke.
        Brain Res Brain Res Rev. 2001; 36: 169-174
        • Kasner S.E.
        Clinical interpretation and use of stroke scales.
        Lancet Neurol. 2006; 5: 603-612
        • Levin M.F.
        • Kleim J.A.
        • Wolf S.L.
        What do motor “recovery” and “compensation” mean in patients following stroke?.
        Neurorehabil Neural Repair. 2009; 23: 313-319
      3. Task Force on Standards for Measurement in Physical Therapy. Standards for tests and measurements in physical therapy practice.
        Phys Ther. 1991; 71: 589-622
        • Fermanian J.
        Validation des échelles d’évaluation en médecine physique et de réadaptation: comment apprécier correctement leurs qualités psychométriques.
        Ann Readapt Med Phys. 2005; 48: 281-287
        • Poole J.L.
        • Whitney S.L.
        Assessments of motor function post stroke: a review.
        Phys Occup Ther Geriatr. 2001; 19: 1-22
        • Croarkin E.
        • Danoff J.
        • Barnes C.
        Evidence-based rating of upper-extremity motor function tests used for people following a stroke.
        Phys Ther. 2004; 84: 62-74
        • Gellez-Leman M.C.
        • Colle F.
        • Bonan I.
        • Bradai N.
        • Yelnik A.
        Évaluation des incapacités fonctionnelles chez le patient hémiplégique: mise au point.
        Ann Readapt Med Phys. 2005; 48: 361-368
        • Marzo Castillejo M.
        • Viana Zulaica C.
        Calidad de la evidencia y grado de recomendación.
        Guías Clínicas. 2009; 9 (Available at:) (Accessed March 10, 2013): 6
        • Carr J.H.
        • Shepherd R.B.
        • Nordholm L.
        • Lynne D.
        Investigation of a new motor assessment scale for stroke patients.
        Phys Ther. 1985; 65: 175-180
        • Poole J.L.
        • Whitney S.L.
        Motor assessment scale for stroke patients: concurrent validity and interrater reliability.
        Arch Phys Med Rehabil. 1988; 69: 195-197
        • Loewen S.C.
        • Anderson B.A.
        Reliability of the Modified Motor Assessment Scale and the Barthel Index.
        Phys Ther. 1988; 68: 1077-1081
        • 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
        • Fugl-Meyer A.R.
        • Jääskö L.
        • Leyman I.
        • Olsson S.
        • Steglind S.
        The post-stroke hemiplegic patient, 1: a method for evaluation of physical performance.
        Scand J Rehabil Med. 1975; 7: 13-31
        • Duncan P.W.
        • Propst M.
        • Nelson S.G.
        Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident.
        Phys Ther. 1983; 63: 1606-1610
        • Sanford J.
        • Moreland J.
        • Swanson L.R.
        • Stratford P.W.
        • Gowland C.
        Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke.
        Phys Ther. 1993; 73: 447-454
        • Hsieh Y.W.
        • Hsueh I.P.
        • Chou Y.T.
        • Sheu C.F.
        • Hsieh C.L.
        • Kwakkel G.
        Development and validation of a short form of the Fugl-Meyer motor scale in patients with stroke.
        Stroke. 2007; 38: 3052-3054
        • Hsueh I.P.
        • Hsu M.J.
        • Sheu C.F.
        • Lee S.
        • Hsieh C.L.
        • Lin J.H.
        Psychometric comparisons of 2 versions of the Fugl-Meyer Motor Scale and 2 versions of the Stroke Rehabilitation Assessment of Movement.
        Neurorehabil Neural Repair. 2008; 22: 737-744
        • Sødring K.M.
        • Bautz-Holter E.
        • Ljunggren A.E.
        • Wyller T.B.
        Description and validation of a test of motor function and activities in stroke patients: the Sødring Motor Evaluation of Stroke Patients.
        Scand J Rehabil Med. 1995; 27: 211-217
        • Halsaa K.E.
        • Sødring K.M.
        • Bjelland E.
        • Finsrud K.
        • Bautz-Holter E.
        Inter-rater reliability of the Sødring Motor Evaluation of Stroke patients (SMES).
        Scand J Rehabil Med. 1999; 31: 240-243
        • Daley K.
        • Mayo N.
        • Danys I.
        • Cabot R.
        • Wood-Dauphinee S.
        The Stroke Rehabilitation Assessment of Movement (STREAM): refining and validating the content.
        Physiother Can. 1997; 49: 269-278
        • Daley K.
        • Mayo N.
        • Wood-Dauphinée S.
        Reliability of scores on the Stroke Rehabilitation Assessment of Movement (STREAM) measure.
        Phys Ther. 1999; 79: 8-19
        • Hsueh I.P.
        • Wang W.C.
        • Wang C.H.
        • et al.
        A simplified stroke rehabilitation assessment of movement instrument.
        Phys Ther. 2006; 86: 936-943
        • Hsieh Y.W.
        • Lin J.H.
        • Wang C.H.
        • Sheu C.F.
        • Hsueh I.P.
        • Hsieh C.L.
        Discriminative, predictive and evaluative properties of the simplified stroke rehabilitation assessment of movement instrument in patients with stroke.
        J Rehabil Med. 2007; 39: 454-460
        • Lincoln N.
        • Leadbitter D.
        Assessment of motor function in stroke patients.
        Physiotherapy. 1979; 65: 48-51
        • Kurtaiş Y.
        • Küçükdeveci A.
        • Elhan A.
        • et al.
        Psychometric properties of the Rivermead Motor Assessment: its utility in stroke.
        J Rehabil Med. 2009; 41: 1055-1061
        • Collin C.
        • Wade D.
        Assessing motor impairment after stroke: a pilot reliability study.
        J Neurol Neurosurg Psychiatry. 1990; 53: 576-579
        • Cameron D.
        • Bohannon R.W.
        Criterion validity of lower extremity Motricity Index scores.
        Clin Rehabil. 2000; 14: 208-211
        • Demeurisse G.
        • Demol O.
        • Robaye E.
        Motor evaluation in vascular hemiplegia.
        Eur Neurol. 1980; 19: 382-389
        • Wyller T.B.
        • Sødring K.M.
        • Sveen U.
        • Ljunggren A.E.
        • Bautz-Holter E.
        Predictive validity of the Sødring Motor Evaluation of Stroke Patients (SMES).
        Scand J Rehabil Med. 1996; 28: 211-216
        • Hsieh Y.W.
        • Wang C.H.
        • Sheu C.F.
        • Hsueh I.P.
        • Hsieh C.L.
        Estimating the minimal clinically important difference of the Stroke Rehabilitation Assessment of Movement measure.
        Neurorehabil Neural Repair. 2008; 22: 723-727
        • Lin J.H.
        • Hsu M.J.
        • Sheu C.F.
        • et al.
        Psychometric comparisons of 4 measures for assessing upper-extremity function in people with stroke.
        Phys Ther. 2009; 89: 840-850
        • Hsieh Y.W.
        • Wu C.Y.
        • Lin K.C.
        • Chang Y.F.
        • Chen C.L.
        • Liu J.S.
        Responsiveness and validity of three outcome measures of motor function after stroke rehabilitation.
        Stroke. 2009; 40: 1386-1391
        • Langhammer B.
        • Stanghelle J.K.
        Co-variation of tests commonly used in stroke rehabilitation.
        Physiother Res Int. 2006; 11: 228-234
        • Rabadi M.H.
        • Rabadi F.M.
        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
        • Beckerman
        • Vogelaar T.W.
        • Lankhorst G.J.
        • Verbeek A.L.
        A criterion for stability of the motor function of the lower extremity in stroke patients using the Fugl-Meyer Assessment Scale.
        Scand J Rehabil Med. 1996; 28: 3-7
        • Filiatrault J.
        • Arsenault A.B.
        • 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
        • Crow J.L.
        • Harmeling-van der Wel B.C.
        Hierarchical properties of the motor function sections of the Fugl-Meyer assessment scale for people after stroke: a retrospective study.
        Phys Ther. 2008; 88: 1554-1567
        • Miller K.J.
        • Slade A.L.
        • Pallant J.F.
        • Galea M.P.
        Evaluation of the psychometric properties of the upper limb subscales of the Motor Assessment Scale using a Rasch analysis model.
        J Rehabil Med. 2010; 42: 315-322
        • Van der Lee J.H.
        • Beckerman H.
        • Lankhorst G.J.
        • Bouter L.M.
        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
        • Pickering R.L.
        • Hubbard I.J.
        • Baker K.G.
        • Parsons M.W.
        Assessment of the upper limb in acute stroke: the validity of hierarchal scoring for the Motor Assessment Scale.
        Aust Occup Ther J. 2010; 57: 174-182
        • Brauer S.G.
        • Bew P.G.
        • Kuys S.S.
        • Lynch M.R.
        • Morrison G.
        Prediction of discharge destination after stroke using the motor assessment scale on admission: a prospective, multisite study.
        Arch Phys Med Rehabil. 2008; 89: 1061-1065
        • Aamodt G.
        • Kjendahl A.
        • Jahnsen R.
        Dimensionality and scalability of the Motor Assessment Scale (MAS).
        Disabil Rehabil. 2006; 28: 1007-1013
        • English C.K.
        • Hillier S.L.
        • Stiller K.
        • Warden-Flood A.
        The sensitivity of three commonly used outcome measures to detect change amongst patients receiving inpatient rehabilitation following stroke.
        Clin Rehabil. 2006; 20: 52-55
        • Sabari J.S.
        • Lim A.L.
        • Velozo C.A.
        • Lehman L.
        • Kieran O.
        • Lai J.S.
        Assessing arm and hand function after stroke: a validity test of the hierarchical scoring system used in the motor assessment scale for stroke.
        Arch Phys Med Rehabil. 2005; 86: 1609-1615
        • Lannin N.
        Reliability, validity and factor structure of the upper limb subscale of the Motor Assessment Scale (UL-MAS) in adults following stroke.
        Disabil Rehabil. 2004; 26: 109-116
        • Hsueh I.P.
        • Hsieh C.L.
        Responsiveness of two upper extremity function instruments for stroke inpatients receiving rehabilitation.
        Clin Rehabil. 2002; 16: 617-624
        • Safaz I.
        • Yilmaz B.
        • Yaşar E.
        • Alaca R.
        Brunnstrom recovery stage and motricity index for the evaluation of upper extremity in stroke: analysis for correlation and responsiveness.
        Int J Rehabil Res. 2009; 32: 228-231
        • Adams S.A.
        • Ashburn A.
        • Pickering R.M.
        • Taylor D.
        The scalability of the Rivermead Motor Assessment in acute stroke patients.
        Clin Rehabil. 1997; 11: 42-51
        • Adams S.A.
        • Pickering R.M.
        • Ashburn A.
        • Lincoln N.B.
        The scalability of the Rivermead Motor Assessment in nonacute stroke patients.
        Clin Rehabil. 1997; 11: 52-59
        • Lu W.S.
        • Wang C.H.
        • Lin J.H.
        • Sheu C.F.
        • Hsieh C.L.
        The minimal detectable change of the simplified stroke rehabilitation assessment of movement measure.
        J Rehabil Med. 2008; 40: 615-619
        • Woodbury M.L.
        • Velozo C.A.
        • Richards L.G.
        • Duncan P.W.
        • Studenski S.
        • Lai S.M.
        Longitudinal stability of the Fugl-Meyer Assessment of the upper extremity.
        Arch Phys Med Rehabil. 2008; 89: 1563-1569
        • Woodbury M.L.
        • Velozo C.A.
        • Richards L.G.
        • Duncan P.W.
        • Studenski S.
        • Lai S.M.
        Dimensionality and construct validity of the Fugl-Meyer Assessment of the upper extremity.
        Arch Phys Med Rehabil. 2007; 88: 715-723
        • Ahmed S.
        • Mayo N.E.
        • Higgins J.
        • Salbach N.M.
        • Finch L.
        • Wood-Dauphinée S.L.
        The Stroke Rehabilitation Assessment of Movement (STREAM): a comparison with other measures used to evaluate effects of stroke and rehabilitation.
        Phys Ther. 2003; 83: 617-630
        • Collen F.M.
        • Wade D.T.
        • Bradshaw C.M.
        Mobility after stroke: reliability of measures of impairment and disability.
        Int Disabil Stud. 1990; 12: 6-9
        • Van de Winckel A.
        • Feys H.
        • Lincoln N.
        • De Weerdt W.
        Assessment of arm function in stroke patients: Rivermead Motor Assessment arm section revised with Rasch analysis.
        Clin Rehabil. 2007; 21: 471-479
        • Johnson L.
        • Selfe J.
        Measurement of mobility following stroke: a comparison of the Modified Rivermead Mobility Index and the Motor Assessment Scale.
        Physiother. 2004; 90: 132-138
        • Tucak C.
        • Scott J.
        • Kirkman A.
        • Singer B.
        Relationships between initial Motor Assessment Scale scores and length of stay, mobility at discharge and discharge destination after stroke.
        NZ J Physiother. 2010; 38: 7-13
        • Bohannon R.W.
        Motricity Index scores are valid indicators of paretic upper extremity strength following stroke.
        J Phys Ther Sci. 1999; 11: 59-61
        • Chen H.F.
        • Lin K.C.
        • Wu C.Y.
        • Chen C.L.
        Rasch validation and predictive validity of the action research arm test in patients receiving stroke rehabilitation.
        Arch Phys Med Rehabil. 2012; 93: 1039-1045