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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:

To notify us of a missing reference, please use: contact@scale-library.com

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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Wolf Motor Function Test (WMFT)		Download / Print : PDF

Initially developed by Wolf in 1987 [1], it was later modified by Taub [9]. The WMFT quantifies the ability to move the upper limb by simple or multi-joint movements and timed functional tasks in patients in post-stroke chronic phase [7, 11] or sub-acute [12] phase.

It is frequently used to assess motor recovery of the upper member of a brain-injured patient.

Tasks are listed in order of complexity, progressing from the participation of proximal joints to the more distal, and testing overall movements and speed of movement.

This assessment requires few tools and minimal training to run the test [11] and thus avoid ambiguity in how each performance can be scored [8].

All tasks are performed on the same side as quickly as possible and are limited to 120 seconds.

There are 15 tasks and 2 trials of strength.

There are 2 different scores: the WMFT -Time (time required to complete the tasks) and WMFT -FAS (functional Ability Scale, where a score of 6 points is used to assess the functional capacity of each task: 0 indicating that the patient cannot attempt the task, and 5 where the movement seems normal) [5].

It takes a period of 30 to 45 minutes to complete the entire test [2].

There is no difference between the use of video and direct observation by evaluators [10].

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Criteria	Psychometric properties		References
Validity	Face validity
	Content validity
	Criterion validity	Concurrent validity	[2] [3] [6] [8] [10] [11] [12]
		Predictive validity	[2] [5] [6]
	Construct validity	Convergent validity	[3] [5] [11]
		Divergent validity	[3] [5] [11]
		Discriminant validity (sensitivity and distinctiveness)	[3] [5] [11]
Reliability	Intra-rater reliability		[4] [8]
	Inter-rater reliability		[2] [4] [5] [6] [7] [8] [11]
	Test-retest		[5] [6] [7] [10]
Internal consistency (alpha)			[2] [3] [7] [8] [11]
Responsiveness			[3] [5] [6]

General comment on reliability:

The WMFT is a highly reliable tool [2, 7] (ICC between 0.96 and 0.98) [4]. Internal consistency [2, 7, 8, 11] and inter and intra-judge reproducibility [2, 6, 8, 11] is high. However, according to Nijland [8], the inter-judge reproducibility is worse than intra judge reproducibility, hence the need to train observers for better standardisation of the test.
Post acute stroke, WMFT has an acceptable internal coherence, validity and sensitivity to change. However, compared to the ARAT, the burden of training and testing is not compensated by the much higher psychometric advantages [3].
If we look at the different components of the test: moderate predictive validity for the WMFT Time (compared to the FIM score) and good built validity. For the WMFT FAS, average built validity and low predictive validity. Sensitivity to change is better for the WMFT-FAS than TIME [5]. For WMFT -Time, MDC is 0.7 seconds. For the WMFT -FAS, the MDC is 0.1 percentage point [4].
Concurrent validity is raised using as criterion against the FMA [2, 6, 11] or ARAT [8]. Satisfactory predictive validity [6].
Sensitivity to change is moderate [6]
The MDC (Minimal Change Detection, which is a statistical estimate of the smallest amount of change that can be detected by a measure which corresponds to a significant change) is satisfactory for the ARAT and FMA, hence the usefulness of the 2 tests in a clinical setting with respect to the WMFT [6].

Reference update:

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Action Research Arm test (ARAT)

Arm Motor Ability Test (AMAT)

Frenchay Arm Test

Nine Hole Peg test (NHP)

Fugl Meyer (FMA)

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] Wolf SL, Lecraw DE, Barton LA, Jann BB. "Forced use in hemiplegic upper extremities to reserve the effect of learned nonuse among chronic stroke and headinjured patients". Exp Neurol. 1989 May;104(2):125-32.

Psychometric references:

[2] Bürge E, Kupper D, Badan Bâ M, Leemann B, Berchtold A. "Qualities of a French version of the Wolf Motor Function Test: a multicenter study." nn Phys Rehabil Med. 2013 May;56(4):288-99. doi: 10.1016/j.rehab.2013.03.003. Epub 2013 Mar 28.

[3] Edwards DF, Lang CE, Wagner JM, Birkenmeier R, Dromerick AW. "An evaluation of the Wolf Motor Function Test in motor trials early after stroke." Arch Phys Med Rehabil. 2012 Apr;93(4):660-8. doi: 10.1016/j.apmr.2011.10.005. Epub 2012 Feb 13.

[4] Fritz SL, Blanton S, Uswatte G, Taub E, Wolf SL. "Minimal detectable change scores for the Wolf Motor Function Test." Neurorehabil Neural Repair. 2009 Sep;23(7):662-7. doi: 10.1177/1545968309335975. Epub 2009 Jun 4.

[5] Hsieh YW, Wu CY, Lin KC, Chang YF, Chen CL, Liu JS. "Responsiveness and validity of three outcome measures of motor function after stroke rehabilitation." Stroke. 2009 Apr;40(4):1386-91. doi: 10.1161/STROKEAHA.108.530584. Epub 2009 Feb 19.

[6] Lin JH, Hsu MJ, Sheu CF, Wu TS, Lin RT, Chen CH, Hsieh CL. "Psychometric comparisons of 4 measures for assessing upper-extremity function in people with stroke." Phys Ther. 2009 Aug;89(8):840-50. doi: 10.2522/ptj.20080285. Epub 2009 Jun 25.

[7] Morris DM, Uswatte G, Crago JE, Cook EW 3rd, Taub E. "The reliability of the wolf motor function test for assessing upper extremity function after stroke." Arch Phys Med Rehabil. 2001 Jun;82(6):750-5.

[8] Nijland R, van Wegen E, Verbunt J, van Wijk R, van Kordelaar J, Kwakkel G. "A comparison of two validated tests for upper limb function after stroke: The Wolf Motor Function Test and the Action Research Arm Test." J Rehabil Med. 2010 Jul;42(7):694-6. doi: 10.2340/16501977-0560.

[9] Taub E, Miller NE, Novack TA, Cook EW 3rd, Fleming WC, Nepomuceno CS, Connell JS, Crago JE. "Technique to improve chronic motor deficit after stroke". Arch Phys Med Rehabil. 1993 Apr;74(4):347-54.

[10] Whitall J, Savin DN Jr, Harris-Love M, Waller SM. "Psychometric properties of a modified Wolf Motor Function test for people with mild and moderate upper-extremity hemiparesis." Arch Phys Med Rehabil. 2006 May;87(5):656-60.

[11] Wolf SL, Catlin PA, Ellis M, Archer AL, Morgan B, Piacentino A. "Assessing Wolf motor function test as outcome measure for research in patients after stroke." Stroke. 2001 Jul;32(7):1635-9.

[12] Wolf SL, Thompson PA, Morris DM, Rose DK, Winstein CJ, Taub E, Giuliani C, Pearson SL. "The EXCITE trial: attributes of the Wolf Motor Function Test in patients with subacute stroke." Neurorehabil Neural Repair. 2005 Sep;19(3):194-205.