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	Subject of the scale: Impairment: prehension

Arm Motor Ability Test (AMAT)		Download / Print : PDF

AMAT was developed in 1988 by McCulloch [1] to measure the qualitative and quantitative aspects of a range of activities of daily living (ADL) in stroke patients receiving rehabilitation by induced constraint.

It was created to supplement the WMFT, which has the advantage of being quantitative and measuring performance variables of time and strength, but is not linked to improvements in ADL.

Initially composed of 17 items [1], it was later reduced to 13 [2] and 9 items [3] to facilitate its use in clinical practice.

Each task is divided into 1-3 sub-tasks or movements, and the elements of each task may involve different contributions of the two arms, or the distal and proximal part of the paretic arm.
The various components of each task are timed individually, but each task is performed fluidly, continuously. Patients are not aware of the division of tasks.

2 scales relevant to motor recovery are used: the functional or FA Ability (ability to perform the task) and the quality of movement or QoM (how the task is performed).

Scores range from 0 to 5 (5 : the movement is normal). Example: the "cutting meat" task is divided into: take the knife and fork, then cut the meat and finally put the fork in the mouth.

The instructions for each task are first read and then the evaluator performs the task three times, using the same arm as the paretic side of the patient. The patient then performs the task without any possible training.
Each task is limited to 60 or 120 seconds (arbitrarily).

The median is calculated for all the time taken, and the average scores for FA and Qom.

The AMAT does not require specialized hardware but is quite long to perform and requires training of evaluators that can last up to 32 hours depending on the study [2].

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Criteria	Psychometric properties		References
Validity	Face validity
	Content validity		[3]
	Criterion validity	Concurrent validity	[2] [5]
		Predictive validity
	Construct validity	Convergent validity	[3] [4]
		Divergent validity	[3] [4]
		Discriminant validity (sensitivity and distinctiveness)
Reliability	Intra-rater reliability		[2] [4]
	Inter-rater reliability		[1] [2] [3] [4]
	Test-retest		[2]
Internal consistency (alpha)			[2] [3]
Responsiveness			[2] [3]

General comment on reliability:

Inter-judge reproducibility is high [1, 2]. Very good internal consistency. High sensitivity to change [2]. However, validity against criterion (comparison with the Motricity Index Arm Score) is worse than other psychometric properties but satisfactory [2].
Good reliability of the test. Strong correlation with the WMFT, FMA, ARAT and SIS hand function sub -score. The hierarchy of items by difficulty is appropriate, as is the dimensionality of the test. Similar responsiveness to other tests [3].
The scale has been found to have concurrent criterion validity with the upper limb FMA. Both the FA and the QoM parts of the AMAT can distinguish different levels of motor deficit in patients with slight to moderate disability. However, in patients with severe motor disability, they tend to underestimate the motor deficit [5].

Reference update:

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For more details of the scale, the comments or the psychometric properties presented here, please contact Thibaud Honoré : honore.thibaud@gmail.com

References: Inaugural references: [1] McCulloch KL, Cook EW III, Fleming WC, Novack TA, Taub E. "A reliable test of upper extremity ADL function (abstract)". Arch Phys Med Rehabil 1988; 69: 755. Psychometric references: [2]Kopp B, Kunkel A, Flor H, Platz T, Rose U, Mauritz KH, Gresser K, McCulloch KL, Taub E. "The Arm Motor Ability Test: reliability, validity, and sensitivity to change of an instrument for assessing disabilities in activities of daily living." Arch Phys Med Rehabil. 1997 Jun;78(6):615-20. [3] O'Dell MW, Kim G, Rivera L, Fieo R, Christos P, Polistena C, Fitzgerald K, Gorga D. "A psychometric evaluation of the Arm Motor Ability Test." J Rehabil Med. 2013 Jun;45(6):519-27. doi: 10.2340/16501977-1138. [4] Daly JJ, Hogan N, Perepezko EM, Krebs HI, Rogers JM, Goyal KS, Dohring ME, Fredrickson E, Nethery J, Ruff RL. "Response to upper-limb robotics and functional neuromuscular stimulation following stroke." J Rehabil Res Dev. 2005 Nov-Dec;42(6):723-36. [5] 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 Jan;82(1):1-8.

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Box and Blocks Test (BBT)		Download / Print : PDF

The BBT was created originally for adult patients with cerebral palsy, to be a measure of gross dexterity. This test was then validated in patients within the framework of a stroke, a CT, MS and other neurological disorders [5], such as Charcot Marie Tooth disease [14], and also in the elderly [7].

It has recently been evaluated in fibromyalgia [2].

This test was patented in 1957 by Patricia Buehler Holser and Elizabeth Fuchs.

It goes like this: The patient is seated at a table in front of him with a wooden box with 2 compartments of equal size (25 x 15 x 7.5 cm). At the beginning of the test, all coloured wooden cubes (150 in number, 2.5 cm edge) are placed in a compartment. The aim is to move the most cubes possible, cube after cube, from one compartment to another, in 60 seconds, and with one hand.
The examiner is opposite the patient.

The total score is the number of cubes located in the initially empty compartment. [1].

Norms in healthy [9] and healthy adult children were defined. And for adults under 50, the average score is higher than 80, between 50 and 70 years it is between 70 and 80, and for patients older than 70 years it is between 64 and 69 [1].

The total time for performing the test is less than 5 minutes. A complete kit costs about 250-300 Euros.

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Criteria	Psychometric properties		References
Validity	Face validity
	Content validity
	Criterion validity	Concurrent validity	[3] [6] [8]
		Predictive validity
	Construct validity	Convergent validity	[7] [10]
		Divergent validity	[7] [10]
		Discriminant validity (sensitivity and distinctiveness)	[7] [10]
Reliability	Intra-rater reliability		[3]
	Inter-rater reliability		[4] [9] [10]
	Test-retest		[6] [7] [9] [10] [12]
Internal consistency (alpha)
Responsiveness			[3] [8]

General comment on reliability:

Very good inter-judge reproducibility [10] and high test-retest reliability [4, 7, 10, 12].
The BBT has a sensitivity to change ranging from high [3] to moderate [8] as well as excellent concurrent validity with the ARAT.
It can effectively evaluate the function of paretic MS [3].
The ARAT also seems more appropriate for evaluating dexterity than the Nine Hole Peg Test [8].
The significant correlations between the BBT, upper limb performance and functional independence measurements show the validity of BBT [7].
Also strong correlations with ARAT and FMA but different ceiling and floor effects between these 3 tests [10].
The MDC (Minimal Change Detection, which is a statistical estimate of the smallest amount of change that can be detected by measuring and representing a significant change) is quite high: for the most affected side, 5.5 cubes / min and the least affected side 7.8 cubes/min [4].
A literature review was performed [5] to examine the psychometric properties and clinical utility of various assessment tools of the upper limbs in people with motor disabilities of neurological origin in order to provide recommendations for practice. Of a total of 31 tools identified, only two measures meet the psychometric properties and clinical utility criteria: the BBT and ARAT.
Among fibromyalgia patients, the BBT is a reliable measurement of upper extremity function and is able to reveal a reduction of upper limb function in these patients compared to healthy individuals and standard scores [2].

Reference update:

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Action Research Arm test (ARAT)

Arm Motor Ability Test (AMAT)

Nine Hole Peg test (NHP)

Wolf Motor Function Test (WMFT)

Fugl Meyer

For more details of the scale, the comments or the psychometric properties presented here, please contact Dr. Thibaud Honoré : honore.thibaud@gmail.com

Inaugural references:

[1] Mathiowetz V, Volland G, Kashman N, Weber K. "Adult norms for the Box and Block Test of manual dexterity." Am J Occup Ther. 1985 Jun;39(6):386-91.

Psychometric references:

[2] Canny ML, Thompson JM, Wheeler MJ. "Reliability of the box and block test of manual dexterity for use with patients with fibromyalgia." Am J Occup Ther. 2009 Jul-Aug;63(4):506-10.

[3] Chanubol R, Wongphaet P, Ot NC, Chira-Adisai W, Kuptniratsaikul P, Jitpraphai C. "Correlation between the action research arm test and the box and block test of upper extremity function in stroke patients." J Med Assoc Thai. 2012 Apr;95(4):590-7.

[4] Chen HM, Chen CC, Hsueh IP, Huang SL, Hsieh CL.. "Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke." Neurorehabil Neural Repair. 2009 Jun;23(5):435-40. doi: 10.1177/1545968308331146. Epub 2009 Mar 4.

[5] Connell LA, Tyson SF. "Clinical reality of measuring upper-limb ability in neurologic conditions: a systematic review." Arch Phys Med Rehabil. 2012 Feb;93(2):221-8. doi: 10.1016/j.apmr.2011.09.015.

[6] Cromwell FS. "Occupational Therapist's Manual for Basic Skill Assessment; Primary Prevocational Evaluation". Altadena, CA: Fair Oaks Printing, 1976, pp 29-30c.

[7] Desrosiers J, Bravo G, Hébert R, Dutil E, Mercier L. "Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies." rch Phys Med Rehabil. 1994 Jul;75(7):751-5.

[8] Lin KC, Chuang LL, Wu CY, Hsieh YW, Chang WY. "Responsiveness and validity of three dexterous function measures in stroke rehabilitation." J Rehabil Res Dev. 2010;47(6):563-71.

[9] Paltamaa J, West H, Sarasoja T, Wikström J, Mälkiä E. "Reliability of physical functioning measures in ambulatory subjects with MS." Physiother Res Int. 2005;10(2):93-109.

[10] 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 Jun;19(4):404-11.

[11] Smith DA. "The Box and Block Test: Normative Datafor 7, 8, 9 Year-Old Children (master's thesis)". Los Angeles: Univ of Southern California, 1961.

[12] Svensson E, Häger-Ross C. "Hand function in Charcot Marie Tooth: test retest reliability of some measurements." Clin Rehabil. 2006 Oct;20(10):896-908.