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Motor assessment scale

Car JH, Shepherd RB.et.al

Application : Motor function examination following stroke.


Area : Course control mainly in studies
Range of results : 0-54 points where by 54 points indicate a high level of independence
Duration : 30-60 minutes
References : Car JH, Shepherd RB, Nordholm L, Lynne D, Investigatin of a new motor assesment
scale for stroke patient, phys ther 1985; 65(2):175-180
Poole JI,Whitney SL Motor Assessment Scale for stroke patients: concurrent validity and inter-rater
reliability.Arch Phys Med Rehabil1988:69:195-197

General Instruction
1. The test should be preferably be 9. Instruction should be repeated and
carried out in a quite private room or demonstration given to the patient if
cottoned of area. necessary.
2. The test should be carried out when 10. The order of administration of items
the patient is maximally alert and not can be varied according to
when the influnece of hypnotic or convenience.
sedative drug. Record if the patient is 11. If the patient become emotionally
under the influence of sedative drug. labile at any stage during scoring, the
3. Patient should be dressed in suitable physical therapist should wait 15
street clothes with sleeves rolled up second before attempting the
and without shoe and socks. Item 1-3 following procedures
inclusive may be scored if necessary • Ask the patient to close his
with the patient in his right clothes. mouth and take a deep breath
4. Each items is recorded on scale of 0-6. and
5. All items are to be performed • Hold the patient jaw closed
independently by the patient unless and ask the patient to stop
otherwise stated “Stand by help” crying
means that the physical therapist • If patient is unable to control
stands by and may steady patient but behaviour the examiner
must not actively assist. should sease testing him and
6. Item 1-8 recorded according to patient rescore this item and any
responses to specific instruction. other item unscored at a more
General tonus(Item 9) is scored from suitable time.
continuous observations and handling 12. If performance is scored differently
through out the assessment. on left and right, the physical
7. Patient should be scored on best therapist may indicate this with “L”
performance. Repeat 3 times unless in one box and an “R” in another box.
other specific instruction are given. 13. The patient should be informed when
8. Because the scale is designed to score timed.
the patient best performance, the 14. You will need a low wide plinth, a
physical therapist should give general stopwatch, a poly styrene cup eight
encouragement but should not give jelly-beans, two tea cups, a rubber
specific feedback or whether the ball (14cm diameter), a stool, a comb,
response is correct or incorrect. a top of a pen, a table, a desert spoon
Sensitivity to the patient is necessary and water, a pen, a prepared sheet for
to enable him to produce his best drawing linkes and a cylindrical
performance. object such as a jar.
Motor assessment scale
Car JH, Shepherd RB.et.al
Criteria for Scoring
1. Supine to side lying Criteria
1. for Scoring
Supine to Side lying onto intact
0 1 2 3 4 5 6 1. Pull himself into side lying. (Starting position must
be Supine lying, not knee flexed. Patient pulls himself
into side lying with intact arm, moves affected leg with
intact leg.)
2. Move leg across actively and the lower parts of
2. Supine to sitting over side of bed body follows. (Starting position as above. Arm is left
behind).
0 1 2 3 4 5 6 3. Arm is lifted across body with other arm. Leg is
moved actively and body follows in block(Starting
position as above)
4. Moves arm across body actively and rest of body is
3. Balanced sitting follows in block. (Starting position as above)
5. Moves arms and leg and rolls to side but over
balances. ( Starting position as above. Shoulder and arm
0 1 2 3 4 5 6 flexes forward)
6. Rolls to side in 3 seconds. (Starting position as
above. Must not use hand.)

4. Sitting to standing
2. Supine to sitting over side of bed
0 1 2 3 4 5 6 1. Side lying, lift head side ways but cannot sit
up(Patient assisted to Side lying)
2. Side lying to sitting over side to bed (The therapist
assist patient with movement. Patient control head
position through out)
5. Walking 3. Side lying to sitting over side of bed (The therapist
give standby help by assisting legs over side of bed)
0 1 2 3 4 5 6 4. Side lying to sitting over side of bed (With no
standby help)
5. Supine lying to sitting over side of bed (With no
stanby help)
6. Upper Arm Function 6. Supine lying to sitting over side of bed within 10
seconds(With no stanby help)

0 1 2 3 4 5 6
3. Balanced sitting
1. Sits only with supports (Therpist should assist into
7. Hand moments sitting)
2. Sits unsupported for 10 seconds (Without holding
0 1 2 3 4 5 6 on knees and feet together, feet can be supported on
floor)
3. Sits unsupported with weight well forward and
evenly distributed ( Weight should be well forward with
8. Advanced hand activites the hips, head and thoracic spine extended, weight
evenly distributed on both side)
4. Sits unsupported turns head and trunk to look
0 1 2 3 4 5 6 behind( feet supported and together on floor, do not
allow leg to abduct or feet to move, have hands resting
on thigh, do not allow hands to move onto plinth. )
5. Sits unsupported, reached forward to touch floor,
and returned to starting postition. (Feet supported on
9. General Tonus floor do not allow patient to hold on, do not allow legs
and feet to move. Support affected arm if necessary.
Hand must touch floor atleast 10 cm in front of feet)
0 1 2 3 4 5 6 6. Sit on stool unsupported, reaches sideways to touch
floor and return to starting postion. ( Feet supported on
floor, do not allow patient to hold on, do not allow legs
and feet to move, support arm if necessary, patient must
4. Sitting to standing 6. Hand Movements
1. Get to standing with help from Therapist (Any 1. Sitting, extension of wrist, (Therapist should
method) have patient sitting at a table with forearm resting on the
2. Get to standing with standby help ( Weight table, Therapist places cylindrical object in palm of
unevenly distributed, uses hands for support) patients hand, patient is asked to left object off the table
3. Get standing (Do not allow unevenly weight by extending the wrist. Do not allow elbow extension)
distribution or help from hands) 2. Sitting, radial deviation of wrist, (Therapist
4. Get to standing and stand for 5 second with hips should place forearm in midpronation-supination i.e
and knee extended (Do not allow uneven weight resting on ulnar side thumb in lying with forearm and
distribution) wrist in extension, fingers around a cylindrical object.
5. Sitting to standing to sitting with no stand by help Patient is asked to lift hand off the table. Do not allow
(Do not allow uneven weight distribution full extension elbow flexion or pronation)
of hips and knee) 3. Sitting, elbow into side, pronation and
6. Sitting to standing to sitting with no stand by help 3 supination. (Elbow unsupported and at the right angle.
times in 10 seconds (Do not allow uneven weight Three quarter range is acceptable)
distribution) 4. Reach forward, pickup a large ball of 15 cm
(5inch) diameter with both hand put it down (Ball should
be on table so far in front of patient that he has to extend
5. Walking arms fully to reach it. Shoulders must be protected,
elbow extended wrist neutral or extended, palms should
1. Stand on affected leg and steps forward with be kept in contact with ball)
other leg (Weight bearing hip must be extended, 5. Pickup polystyrene cup from table and put it
Therapist may give stand by help) on table across other side of body (Do not allow
2. Walk with stand by help with one person. alteration in shape of cup)
3. Walks 3m (10 fts) alone or uses any aid but no 6. Continuous opposition of thumb and each
stand by help. finger more than 14 times in 10 seconds (Each finger in
4. Walks 5m (16 fts) with no aid in 15 seconds. turn tabs the thumb, starting with index finger. Do not
5. Walks 10 m(33 fts) with no aid turns around, allow thumb to slide from one finger to other, or to go
pickup small sandbag from floor, and walk back in 25
seconds( may use either hands)
6. Walks up and down four steps with or without 8. Advance hand activities
an aid but without holding on to the rail three times in 35 1) Picking up top of the pen and putting it down again
seconds) (Patient stretches arm forward pickup pen top, releases it
on table close to body)
2) Pick up one jellybean from a cup and placing it in
another cup. (Tea cup contains 8 jellybeans. Both cups
8. Upper arm function must be arms length, left hand takes jelly beans from cup
on right and release it in cup and left.)
1. Lying, Shoulder girdle with arm in 3) Drawing horizontal lines to stop at a vertical line 10
elevation( Therapist places arm in position and support it times in 20 seconds. ( At least 5 lines must touch and
with elbow in extension) stop at the vertical line)
2. Lying, hold extended arm in elevation for 2 4) Holding a pencil, making rapid consecutive dots on
seconds (Therapist should place arm in position and a sheet of paper. (Patient must do at least two dots a
patient must maintain position with some external seconds for 5 seconds. Patient picks pencil up and
rotation. Elbow must be held within 200 of full extension) position it without assistance. Patient must hold pen as
3. Flexion and extension of elbow to take palm to for writing. Patient must make a dot not a stroke.)
forehead with arm as in 2. (Therapist may assist 5) Taking a desert spoon of liquid to the mouth. (Do
supinator of forearm) not allow head to lower towards spoon. Do not allow
4. Sitting, hold extended arm in forward flexion liquid to spill.)
at 90 degree to body for 2 seconds. (Therapist should 6) Holding a comb and combing hair at back of head.
place arm in position and patient must maintain position
with some external rotation and elbow extension. Do not
allow excess shoulder elevation)
5. Sitting, patient lift arm to above position and 9. General Tonus
hold it for 10 seconds, and then lowers it( patient must 1. Flaccid limb, no resistance when body parts
maintain position with some external rotation. Do not are handled.
allow pronation) 2. Some response felt at body parts are moved.
6. Standing, hand against wall. Maintain arm 3. Variables, sometimes flaccid, sometimes good
position while turning body towards wall (Have arm tone, sometime hypertonic.
abducted to 90 degree with palm flat against the wall.) 4. Consistently normal response.
5. Hypertonic 50% of the time.
6. Hypertonic at all times