Motor Assessment Scale

Objective

The Motor Assessment Scale (MAS) is used to assess everyday motor function in patients with stroke.[1]

Intended Population

Used widely in assessing functional ability for patients with stroke

Method of Use

Description:

  • 8 items assess 8 areas of motor function
  • Patients perform each task 3 times, only the best performance is recorded
  • Items (with the exception of the general tonus item*) are assessed using a 7-point scale (0 to 6)
  • A score of 6 indicates optimal motor behavior
  • Item scores (with the exception of the general tonus item) are summed to provide an overall score (out of 48 points)
  • Completing a higher-level item suggests successful performance on lower-level items and thus lower-items can be skipped.
  • For the general tonus item, the score is based on continuous observations throughout the assessment. A score of 4 on this item indicates a consistently normal response, a score > 4 indicates persistent hypertonus, and a score < 4 indicates various degrees of hypotonus (Carr et al, 1985[2]).


Equipment Required:

  • Stopwatch
  • 8 Jellybeans
  • Polystyrene cup
  • Rubber ball
  • Stool
  • Comb
  • Spoon
  • Pen
  • 2 Tea cups
  • Water
  • Prepared sheet for drawing lines
  • Cylindrical shaped object like a jar
  • Table

Evidence

Reliability

Test-retest Reliability:

Chronic Stroke:

(Carr et al, 1985; n = 15; mean age = 70 years, range = 42 to 85) [2]

  • Excellent test-retest reliability: r ranged from 0.87 to 1.00 (mean r = 0.98)


Interrater/Intrarater Reliability:

Chronic & Acute Stroke:

(Carr et al, 1985; 20 clinical raters; n = 5; mean age = 65 years, range = 55 to 78; mean time since stroke onset = 14 (range = 6 to 40) weeks) [2]

  • Excellent Interrater Reliability; 87% overall agreement between raters (mean correlation r = 0.95; most agreement = balanced sitting (r = 0.99); least agreement = sitting to standing (r = 0.89).

Validity

Criterion Validity:

Acute Stroke:

(Malouin et al, 1994, n = 32, mean age = 60 years, mean time since stroke = 64.5 days) [3]

  • Excellent Concurrent Validity with Fugl-Meyer (FMA) total scores (r = 0.96, not including general tonus items)
  • Adequate to Excellent item level Concurrent Validity between MAS items and similar FMA items (r = 0.65 to 0.93)
  • Poor Concurrent Validity with MAS and FMA sitting balance (r = -0.10)


Construct Validity:

Acute Stroke:

(Tyson & DeSouza, 2004; n = 48; mean age = 66.7 (12.5) years; median time since stroke = 11 weeks) [4]

MAS and functional balance test:

  • Adequate Convergent Validity: Sitting arm raise (no. of raises; r = 0.33*)
  • Adequate Convergent Validity: Sitting forward reach (cm, r = 0.54**)
  • p < 0.05
    ** p < 0.01


Content Validity:

The MAS was developed by Carr and Shepherd (1985) based on many years of experience with similar measures

Responsiveness

Chronic & Acute Stroke:

(English et al, 2006) [5]

MAS sensitivity:

Item Dimension Effect Effect Size (d)  % Change
1 Rolling Large 1.03 31.1
2 Lie to sit Moderate 0.74 44.3
3 Balanced Sitting Moderate 0.61 60.7
4 Sit to Stand Large 0.85 18
5 Walking Large 1.02 19.7
6 Upper arm function Small 0.36 44.3
7 Hand movements Small 0.43 55.7
8 Advanced hand activities Moderate 0.50 63.9

Miscellaneous

Complimentary and Alternative Medicine (CAM)

Complementary and alternative medicine refers to therapies which are not typically taught at medical schools, and which are not available at most hospitals.Patients with severe stroke, limb weakness, dysphagia, dyslipidemia, hypertension, or hemorrhagic stroke were among the most common individuals in India who used CAM treatments. The National Centre for Complementary and Alternative Medicine (NCCAM) classifies Complementary and Alternative Medicine (CAM) therapies into five categories, or domains and includes: alternative medical systems, such as homeopathy, mind-body medicine (prayer or mental healing), biologically based therapies using herbs, foods, and vitamins, manipulative and body-based methods including chiropractic or osteopathic manipulation, and massage and energy therapies which are intended to affect energy fields that purportedly surround and penetrate the human body, although the existence of such fields have not yet been scientifically proven.

Traditional Chinese Medicine (TCM)

TCM includes a variety of treatments including acupuncture, massage, and Chinese herbal medicines. Several studies have been conducted on the use of TCM, mostly in the acute stage of stroke(Wang et al. 2013).The use of acupuncture has recently gained attention as an adjunct to stroke rehabilitation in Western countries even though acupuncture has been a primary treatment in China for about 2000 years (Baldry
2005).The Chinese accepted acupuncture as a time-efficient, simple, safe and economical form of treatment extensively used to ameliorate motor, sensation, verbal communication and further neurological functions in post-stroke patients,” (JL et al. 2003).

Massage is the practice of applying structured pressure, tension, motion or vibration — manually or with mechanical aids — to the soft tissues of the body, including muscles, connective tissue, tendons, ligaments, joints and lymphatic vessels, to achieve a beneficial response.Massage is among the most frequently used alternative nursing interventions and has been used as a complementary form of treatment following stroke (Holland & Pokorny 2001).

Combination Therapy

Combination therapy refers to a combination of various herbal medicines, massage, acupuncture, and conventional care, depending on the study authors and the origin of the study. For instance, combination therapy of acupuncture, Chinese herbal medicines and conventional care is commonly used for stroke treatment in most TCM hospitals in China (Zhao et al. 2012). The common aim of these studies focus on the effectiveness of combination therapy for treating stroke when compared with conventional therapy or rehabilitation.

Hyperbaric Oxygen Therapy

The evidence showed no effectiveness for hyperbaric oxygen therapy in post-stroke patients. The observational studies reported 20% to 83% of selected stroke patients showed improvements following hyperbaric oxygen therapy, although it’s possible the results could be a product of bias and/or confounding. Also, nine of the observational studies reported adverse effects or complications. The study concluded that, “the overall evidence is insufficient to determine the effectiveness of hyperbaric oxygen therapy in any
subgroup of stroke patients.”

Links

References

  1. Dean, C. M., Mackey, F. M. Motor assessment scale scores as a measure of rehabilitation outcome following stroke. Aust J Physiother 1992; 38, 31-35.
  2. 2.0 2.1 2.2 Carr, J. H., Shepherd, R. B., et al. "Investigation of a new motor assessment scale for stroke patients." Phys Ther 1985 65: 175-180
  3. Malouin, F., Pichard, L., et al. "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
  4. Tyson, S. F. and DeSouza, L. H. "Reliability and validity of functional balance tests post stroke." Clin Rehabil 2004 18(8): 916-923
  5. English, C. K., Hillier, S. L., et al. "The sensitivity of three commonly used outcome measures to detect change among patients receiving inpatient rehabilitation following stroke." Clin Rehabil 2006 20(1): 52-55