CHAPTER 69: CHEDOKE-MCMASTER STROKE ASSESSMENT (CMSA)

Description

The Chedoke-McMaster Stroke Assessment (CMSA) is a comprehensive standardized assessment of global motor function that was developed by Gowland et al. (1993) in conjunction with the Chedoke Rehabilitation Centre in Hamilton, Ontario, Canada. Originally validated for use with stroke clients, its application has been widely demonstrated in other populations as well where motor impairment is of primary concern (Miller et al., 2008). The CMSA comprises two components: an Impairment Inventory (II), which is used to assess motor control across six dimensions, including the arm, hand, leg, and foot, postural control, and shoulder pain where performance is quantified using a seven-point staging system based on Brunnstrom’s stages of recovery, and Activity Inventory (AI), that assesses functional mobility across such items as gross motor function and walking (Dang et al., 2014; McMaster University, 2015). During assessment the II section requires the subject to perform various motor movements such as shoulder flexion or abduction which are then graded in relation to normal motor movement criteria, whereas the AI section is scored using a method that is analogous to the Functional Independence Measure (FIM; i.e., the amount of assistance needed by the client to complete the functional activity) (McMaster University, 2015). The AI section is further represented by two indices: the Gross Motor Function Index, which measures functional mobility across 10 items and includes such items as moving in bed, transferring in and out of bed, and getting on and off the floor and the Walking Index which assesses a person’s ability to walk on various surfaces as well as climb stairs (Dang et al., 2014). The CMSA can take up to an hour to complete across several therapy days where higher scores represent more impairment

Psychometrics

Original research by the authors of 32 subjects in a stroke rehabilitation unit showed that the II section had excellent intra-rater and inter-rater reliability (r = 0.98 and 0.97) as well as excellent test-retest and intra-rater reliability for the AI section (r = 0.98 and 0.99) (Gowland et al., 1993). The same study found significant positive correlations between the CMSA and the Fugl-Meyer assessment (r = 0.95, p < 0.001) as well as with the disability inventory of the FIM (r = 0.79, p < 0.05) (Gowland et al., 1993). A separate study found that correlation values between the CMSA (AI section) and the Clinical Outcome Variables Scale ranged from r = 0.59 to 0.93 across subscales and total scales with a confidence level of p < 0.01 (Sacks et al., 2010). Poole, et al. (2001) explored the utility of eleven assessments, which included the Fugl-Meyer Assessment Scale (FMA), the Motor Assessment Scale, the Rivermead Motor Assessment, the Frenchay Arm Test, and the Action Research Arm Test among others and determined that the FMA and CMSA had the most sound psychometric evidence compared to the other tests reviewed.

Advantages

There is a good amount of research in support of the use of the CMSA in clinical practice and research. The assessment manual is inexpensive, only $25 dollars, and when purchased it provides a thorough descriptive analysis of all testing parameters. McMaster University also supports a unique interactive website devoted to the scale. Training for use of the CMSA is also available via a 1-day training workshop, videoconferencing, and a bilingual (French) CD-ROM for self-directed learning (Dang et al., 2014).

Disadvantages

The CMSA is a somewhat complex assessment to administer and score, thus it may be beneficial for the clinician to consider training in one form or another. Also, depending on client endurance more than one session may be needed to complete the battery. Finally, the CMSA measure has not been validated for use with clients who are less than 1-week post-stroke.

Administration

The CMSA manual has detailed instructions for testing as well as for scoring and score interpretations. The use of therapy equipment is necessary and includes such things as a foot stool, pillows, stop watch, floor mat, chair with armrests, ball, adjustable table, and a 1-liter plastic pitcher with water (Miller et al., 2008). Scores of the II are determined by the quality of movement (rated 1 to 7) with a score of 1 indicating severe motor impairment and a score of 7 suggesting normal movement. The AI scoring uses a similar 7-point scale with a range of (1) needs maximal assistance to (7) completely independent. The 2-minute walk test is scored according to a paradigm related to age-specific walking speed outlined in the manual. The maximum total score of the AI section is 100 with higher scores indicating better occupational performance. The CMSA scoring manual also includes an index of predictive discharge scores.

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