CHAPTER 70: FUGL-MEYER MOTOR ASSESSMENT (FMA)

Description

The Fugl-Meyer Motor Assessment (FMA), originally described by Fugl-Meyer, Jaasko, Leyman, Olson, and Steglind (1975) as a system for the evaluation of motor function, balance, sensation qualities, and joint function, is now one of the most widely used clinical assessments of motor impairment and recovery such as that found in individuals post-stroke or with hemiplegia. The assessment, as described by Fugl-Meyer et al. (1975), is based on the theoretical hypothesis that the restoration of motor function follows a definable stepwise course such that for persons with hemiparalysis the recurrence of reflexes always precedes volitional motor action, and after initial dependence on those synergies, active motion becomes successively less dependent upon the primitive reflexes and reactions, and finally complete voluntary motor function with normal muscle reflexes may be regained. This is in many ways similar to Brunnstrom’s description of the stages of motor recovery; however, the FMA uses only 5 of the 6 stages defined by Brunnstrom, considering the recovery of wrist and hand function as independent of shoulder-arm recovery (Crow & Harmeling-van der Wel, 2008). The hierarchical stages of recovery according to the FMA include (1) reflex activity, (2) voluntary movement in flexor and extensor synergies, (3) voluntary movement partially independent of synergies, (4) voluntary movement independent of synergies, and finally (5) normal reflex activity. The FMA is composed of several domains that measure motor performance, sensory function, balance, joint range of motion, and joint pain where during assessment the person is asked to complete certain movements in order to elicit motor response synergies associated with the levels of recovery described above where they are then scored relative to the presence or absence those synergies using a 3-point ordinal scale as follows: (0) cannot perform, (1) performs partially, or (2) performs fully. The complete test comprises 155 items and can take up to 60 minutes or more to complete depending on subject stamina.

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