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Subject of the scale: Physical and cognitive disability

Fugl-Meyer Assessment scale (FMA)


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The Fugl-Meyer scale was developed as the first quantitative evaluation instrument to measure post-CVA motor and sensory recovery. It is based on the concept of the Twitchell and Brunnstrom recovery (series of well identified stereotypical stages).

The FMA includes five sections: • Motor function (including an assessment of the upper and lower extremities), • Balance, • Sensory function, • Joint range of motion, • Joint pain.

A three-point ordinal scale (0: cannot perform; 1: performs partially; 2: performs fully) is applied to each item.

The maximum score is 226.

The scores for each of the sections can be used as independent sub-scales [4] (but they have not all demonstrated their validity). The total motor function score is out of 100 (divided into 66 points for the upper limb and 34 for lower limb), the sensory function score out of 24 points, balance (sitting and standing) out of 14 points, and the joint range of motion out of 44, as is pain.

The test lasts around 30 minutes.

There is no material cost, but it requires a trained administrator.

There is no material cost, but it requires a trained administrator.

> Access to the scale is free.

Psychometric properties:


Psychometric properties



Face validity


Content validity


Criterion validity

Concurrent validity

[9] [11] [12] [17] [18] [21] [24] [27] [32]

Predictive validity

[17] [19] [24] [27]

Construct validity

Convergent validity

[3] [4] [5] [10] [11] [14] [17] [19] [20] [26]

Divergent validity


Discriminant validity
(sensitivity and distinctiveness)



Intra-rater reliability

[2] [29]

Inter-rater reliability

[2] [3] [8] [17] [19] [20] [26] [27] [28] [29] [33


[15] [20] [24] [26] [27] [31]

Internal consistency (alpha)

[4] [17] [19] [22] [23] [32]


[15] [17] [19] [21] [24] [26] [27] [30]

General comment on reliability:

This scale, and its sub-groups, has been widely studied in the press.
With regard to the validity:
1) Strong correlations between the initial upper limb + lower limb motor function score and the final upper limb + lower limb score, and with the final FIM (Functional Independence Measure) [14, 26], and between the total FMA and the two components of the ARAT (Functional Ability and Quality of Movement) [18, 20, 21]. However, the concomitant validity between the FMA motor function upper limb (wrist and hands) and the ARAT is moderate [32].
2) Good concomitant validity with the STREAM and the short versions of the STREAM and the FMA, but less good predictive validity [24].
3) High correlations with the Functional Test for the Hemiplegic/Paretic Upper Extremity [5].
4) Good validity between the FMA motor function and Gait speed and Gait comfort, but poor correlations between the FMA sensory and Gait speed and Gait comfort [12].
5) The sub-scale of the FMA evaluating balance has a poor validity in evaluating balance [11].
With regard to accuracy:
1) High inter- [2, 3, 8, 17, 20, 27] and intra-rater reproducibility [2].
2) Very good accuracy for the subgroups upper limb and lower limb motor function [28, 29] and joint range of motion [28], average for the sensory function sub-group [28], sometimes high depending on the studies [29], and low for the pain component [28].
3) Test retest high [24].
With regard to internal consistency:
1) Excellent correlations between the upper limb and lower limb subsections with the total FMA [4].
2) It has been proposed to delete the reflex assessment, which would give a modified FMA motor function in upper limbs with 30 items (which demonstrates a unidimensional structure) [22].
3) High level of internal consistency for the FMA motor function upper limb wrist and hands [32].
With regard to the sensitivity to change:
1) This varies according to the studies:
- The ARAT is more sensitive to change than the FMA in assessing the upper limb function in patients in chronic phase post-CVA [15].
- The sensitivity to change of the FMA motor function upper limb is better than that of the ARAT [26] but remains moderate [27],
- Good sensitivity to change for the motor component in the upper limb [21, 30].
- Sensitivity to change quite poor for the FMA and the STREAM [24].
2) Good sensitivity to change for the FMA Balance in the first 90 days, but low subsequently [17].
Other comments:
1) The combination of the motor and sensory scores 5 days post-CVA predict 75% of the variance in the final motor function of the patients after 6 months. [7].
2) Significant ceiling and floor effects [17].
3) The MDC (Minimal Detection Change, which is a statistical estimate of the smallest quantity of change that can be detected by a measurement and which corresponds to a notable change) is satisfactory for the FMA and ARAT, hence a usefulness of these 2 tests in a clinical context in comparison to the WMFT [27].
4) The PASS (Postural Assessment Scale for Stroke Patients) demonstrates a slight superiority concerning the psychometric characteristics over the FMA Balance and the Berg Balance Scale. [17].
5) The FMA or the MSS (Motor Status scale) would be the best choice to evaluate the functional improvement in robotic training studies of the upper limbs post-CVA, with a high sensitivity to change and a good correlation with the ARAT [30].
6) Compared to the ARAT and the WMFT, the FMA is a relatively good criterion for evaluation of motor function post-CVA [26].
7) It can specifically detect changes in motor function in patients after the rehabilitation period [26].
8) The FMA makes it possible to distinguish the degree of motor function better than the MAS (Motor Assessment Scale) at the start of recovery or in the most disabled subjects [11].
9) The psychometric properties of the FMA-sensory function do not make it possible in clinical practice to measure sensory function post-CVA [19].
10) The FMA motor function upper limb wrist and hands is not yet a validated scale for evaluating distal movement of the upper limbs post-CVA with mild motor deficit [32].

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For more details of the scale, the comments or the psychometric properties presented here, please contact Dr Thibaud HONORE :


Inaugural references:

[1] Fugl-Meyer, A. R., L. Jaasko, et al. (1975). "The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance." Scand J Rehabil Med 7(1): 13-31.

Psychometric references:

[2] Duncan, P. W., M. Propst, et al. (1983). "Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident." Phys Ther 63(10): 1606-1610.

[3] Berglund, K. and A. R. Fugl-Meyer (1986). "Upper extremity function in hemiplegia. A cross-validation study of two assessment methods." Scand J Rehabil Med 18(4): 155-157

[4] Wood-Dauphinee, S. L., J. I. Williams, et al. (1990). "Examining outcome measures in a clinical study of stroke." Stroke 21(5): 731-739.

[5] Filiatrault, J., A. B. Arsenault, et al. (1991). "Motor function and activities of daily living assessments: a study of three tests for persons with hemiplegia." Am J Occup Ther 45(9): 806-810.

[6] Duncan, P. W., L. B. Goldstein, et al. (1992). "Measurement of motor recovery after stroke. Outcome assessment and sample size requirements." Stroke 23(8): 1084-1089.

[7] Duncan, P. W., L. B. Goldstein, et al. (1992). "Measurement of motor recovery after stroke. Outcome assessment and sample size requirements." Stroke 23(8): 1084-1089.

[8] Sanford, J., J. Moreland, et al. (1993). "Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke." Phys Ther 73(7): 447-454.

[9] Kusoffsky A, Waddell I, Nilsson BY. The relationship between sensory impairment and motor recovery in patients with hemiplegia. ScandJ Rehabil Med. 1982;14:27-32.

[10] Badke MB, Duncan PW. Patterns of rapid motor responses during postural adjustments, when standing, in healthy subjects and hemiplegic patients. Pbys Thm 1983;63:1520.

[11] Malouin, F., L. Pichard, et al. (1994). "Evaluating motor recovery early after stroke: comparison of the Fugl-Meyer Assessment and the Motor Assessment Scale." Arch Phys Med Rehabil 75(11): 1206-1212.

[12] Nadeau, S., A. B. Arsenault, et al. (1999). "Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke." Am J Phys Med Rehabil 78(2): 123-130.

[13] Duncan, P. W., S. M. Lai, et al. (2000). "Defining post-stroke recovery: implications for design and interpretation of drug trials." Neuropharmacology 39(5): 835-841.

[14] Shelton, F. D., B. T. Volpe, et al. (2001). "Motor impairment as a predictor of functional recovery and guide to rehabilitation treatment after stroke." Neurorehabil Neural Repair 15(3): 229-237.

[15] van der Lee, J. H., H. Beckerman, et al. (2001). "The responsiveness of the Action Research Arm test and the Fugl-Meyer Assessment scale in chronic stroke patients." J Rehabil Med 33(3): 110-113.

[16] Gladstone, D. J., C. J. Danells, et al. (2002). "The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties." Neurorehabil Neural Repair 16(3): 232-240.

[17] Mao, H. F., I. P. Hsueh, et al. (2002). "Analysis and comparison of the psychometric properties of three balance measures for stroke patients." Stroke 33(4): 1022-1027.

[18] Chae, J., I. Labatia, et al. (2003). "Upper limb motor function in hemiparesis: concurrent validity of the Arm Motor Ability test." Am J Phys Med Rehabil 82(1): 1-8.

[19] Lin, J. H., I. P. Hsueh, et al. (2004). "Psychometric properties of the sensory scale of the Fugl-Meyer Assessment in stroke patients." Clin Rehabil 18(4): 391-397.

[20] Platz, T., C. Pinkowski, et al. (2005). "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 19(4): 404-411.

[21] Rabadi, M. H. and F. M. Rabadi (2006). "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 87(7): 962-966.

[22] Woodbury, M. L., C. A. Velozo, et al. (2007). "Dimensionality and construct validity of the Fugl-Meyer Assessment of the upper extremity." Arch Phys Med Rehabil 88(6): 715-723.

[23] Crow, J. L. and B. C. Harmeling-van der Wel (2008). "Hierarchical properties of the motor function sections of the Fugl-Meyer assessment scale for people after stroke: a retrospective study." Phys Ther 88(12): 1554-1567.

[24] Hsueh, I. P., M. J. Hsu, et al. (2008). "Psychometric comparisons of 2 versions of the Fugl-Meyer Motor Scale and 2 versions of the Stroke Rehabilitation Assessment of Movement." Neurorehabil Neural Repair 22(6): 737-744.

[26] Hsieh, Y. W., C. Y. Wu, et al. (2009). "Responsiveness and validity of three outcome measures of motor function after stroke rehabilitation." Stroke 40(4): 1386-1391

[27] Lin, J. H., M. J. Hsu, et al. (2009). "Psychometric comparisons of 4 measures for assessing upper-extremity function in people with stroke." Phys Ther 89(8): 840-850

[28] Michaelsen, S. M., A. S. Rocha, et al. (2011). "Translation, adaptation and inter-rater reliability of the administration manual for the Fugl-Meyer assessment." Rev Bras Fisioter 15(1): 80-88.

[29] Sullivan, K. J., J. K. Tilson, et al. (2011). "Fugl-Meyer assessment of sensorimotor function after stroke: standardized training procedure for clinical practice and clinical trials." Stroke 42(2): 427-432.

[30] Wei, X. J., K. Y. Tong, et al. (2011). "The responsiveness and correlation between Fugl-Meyer Assessment, Motor Status Scale, and the Action Research Arm Test in chronic stroke with upper-extremity rehabilitation robotic training." Int J Rehabil Res 34(4): 349-356.

[31] Hiengkaew, V., K. Jitaree, et al. (2012). "Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed "Up & Go" Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone." Arch Phys Med Rehabil 93(7): 1201-1208.

[32] Page, S. J., P. Levine, et al. (2012). "Psychometric properties and administration of the wrist/hand subscales of the Fugl-Meyer Assessment in minimally impaired upper extremity hemiparesis in stroke." Arch Phys Med Rehabil 93(12): 2373-2376.

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