Fugl-Meyer Assessment after a stroke

There are several words in the English vocabulary that denotes some form of ranking. In terms of number there are the words first, second and third, etc. There are also other words which can denote some form of status between people, objects and things such as good, better, and best, bad, worse and worst, etc.

In the field of stroke recovery, there are also words to denote some form of evaluation which can be used in patients who had just experienced a stroke. Examples of such words are weak or strong, weaker or stronger and others. These words are helpful in giving and determining the current status of a patient. Healthcare providers use them in assessing the difference between the unaffected and affected side of the stroke patient’s body.

However, these words are very subjective and will depend on the judgment of a person. A physician’s assessment of a stroke patient may differ from another member of the stroke rehab team. This may cause a problem since objectivity should always be practiced when assessing a stroke victim.

A complete assessment should be made for the benefit of the stroke survivor which will be used as reference for proper therapeutic management and for the stroke patient’s rehabilitation. Also, the advent of new treatments and rehab options for post-stroke therapy has made measuring recovery after a stroke very important. Aside from establishing the plan of treatment for the stroke patient, such assessments can also prepare the stroke survivor, his or her family and his or her significant other for any anticipated and expected outcomes. A tool currently employed by members of the healthcare team in properly evaluating patients is the Fugl-Meyer Assessment (FMA) for Motor Recovery after a Stroke.

The Fugl-Meyer Assessment (FMA)

The FMA is a stroke-specific and performance-based impairment index. This means that all stroke survivors are considered unique and that a grading system is in place for proper evaluation.  Basically, what it does is it can determine the severity of the stroke, describe motor recovery, plan the post-stroke treatment and evaluate these treatments. It also evaluates the capacity of the stroke survivor to perform activities of daily living (ADL) and pain. Evaluation can be done immediately after a stroke and can be repeated while the stroke patient is already undergoing therapy. It was developed  to be used in both clinical and research setting and is the first quantitative evaluation tool based on the chronological stages of motor and sensory return in hemiplegic (paralysis of either left or right side of the body) stroke patients. It allows the healthcare team to properly measure the motor and sensory recovery of survivors after a stroke (http://physical-therapy.advanceweb.com/Article/The-Fugl-Meyer-Assessment-After-Stroke.aspx).

Aside from motor and sensory functions, it can also assess balance and joint function in post-stroke patients.

A physical therapist, an occupational therapist or any other rehab professional trained on FMA can administer the evaluation on the stroke patient on a one-on-one basis. The person tasked to administer the test shall guide the stroke victim through test through demonstration and by giving out verbal instructions.

It can be applied in any setting – a hospital, a clinic even at the stroke survivor’s home. Most importantly, it does not need any special equipment. Although, it does require a mat or a bed and a number of small objects for assessment of sensation, reflexes and range of motion (ROM).

The test tracks the stroke patient’s progress from the initial day that he or she had the stroke to days, weeks, months or even years post-stroke.

Sections of the evaluation can be administered separately. The FMA is that it usually takes about 30-35 minutes to administer the whole test. A copy of the FMA can be obtained by following the link towards the Institute of Rehabilitation Medicine, University of Gothenburg, in Sweden http://www.neurophys.gu.se/sektioner/klinisk_neurovetenskap_och_rehabilitering/neurovetenskap/rehab_med/fugl-meyer/.

However, certain stroke patients may have difficulty with the assessments and may take longer than usual to finish the test. It had been found that the FMA is quite challenging to administer to aphasic (has problems with speech or language) and severely affected patients post-stroke.  Since it is based on direct observation, stroke victims who need a proxy to complete tasks will not be permitted to undergo the test.

Features and scoring

• Scoring in the FMA is based on direct observation of the stroke survivor’s performance and is based on the ability to complete an item in the test.  Items in the FMA are scored on a 3-point scale.
  • 0 = cannot perform
  • 1 = performs partially
  • 2 performs fully

• The maximum score that a stroke patient can have is 226 points

• There are five domains which is evaluated by the occupational or physical therapist
  • Motor function – this part of the test includes assessing the movement, coordination and reflex action of the shoulder, elbow, forearm, wrist, hand, hip knee and ankle. The score for this test range from 0 (paralysis) to 100 (normal motor function). The total score is divided into:
    • Upper extremity maximum score = 66
    • Lower extremity maximum score = 34
  • Sensory function (evaluates light touch on two surfaces of the arm and leg, and position sense for 8 joints) maximum score = 24
  • Balance (contains 7 tests, 3 seated and 4 standing) maximum score = 14
  • Joint range of motion (8 joints) maximum score = 44
  • Joint pain (maximum score 44)

Depending on the need, each of the five domains of the test can be administered without using the full FMA evaluation. This means that if the therapist wishes only to evaluate upper extremity function, the subsections which specifically deal with assessing upper extremity movement, sensation, joint motion and pain can be performed without having to administer the full test. Also, modified or shortened versions had been developed for these purposes.

References:

Ncbi.nlm.nih.gov

Medicine.mcgill.ca

Rehabmeasures.org

Neurophys.gu.se

Medical-dictionary.thefreedictionary.com

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