Psychometrics

Original research of 15 persons post-cerebrovascular accident (CVA) showed that the test-retest correlations ranged between r = 0.87 and 1.00, with an average correlation of 0.98, whereas inter-rater agreement was also high with a range of r = 0.89 to 0.99 (Carr, Shepherd, Nordholm, & Lynne, 1985). A study by Poole & Whitney (1988) established concurrent validity of the MAS with the Fugl-Meyer Motor Assessment (FMA) when they compared motor function in stroke patients and found high correlations between the total scores on the MAS and the FMA (r = 0.88), while between specific item scores (except sitting balance) correlations ranged from 0.28 to 0.92. A subsequent study by Malouin, Pichard, Bonneau, Durand, and Corriveau (1994) also compared the MAS and the FMA and found that the correlation coefficient for total FMA and total MAS scores was 0.96 and for selected items, correlations ranged from 0.65 to 0.93, except for sitting balance (-0.10), suggesting that the FMA sitting balance test may not be a valid measure and is responsible for the low correlation. Miller, Slade, Pallant, and Galea (2010) found that a floor effect existed upon admission to stroke rehabilitation for item 5 (walking) with participants often scoring the lowest score. Similarly, a ceiling effect on discharge existed for item 4 (sitting to standing) with persons scoring the highest. A ceiling effect on admission to and discharge from stroke rehabilitation was also noted for item 3 (balanced sitting).

Advantages

Due to its hierarchical scale and ease of administration as a clinical evaluation tool, the MAS may be preferable to other assessments such as the Wolf Motor Function Test, Action Research Arm Test, or Arm Motor Ability Test, which require extensive setup and time to complete (Sabari et al., 2014). The MAS also has the ability to test and grade gross motor abilities of low-functioning individuals as well as the ability to document meaningful change in motor ability from gross to refine during the recovery process.

Disadvantages

Sabari et al. (2014) found that problems in the scoring criteria for hand items were a negative factor that decreased the tool’s effectiveness and recommended improving the 2-hand items by clearly differentiating between movements and activities, adding criteria that would be appropriate for stroke survivors with lower levels of hand function, and providing a more valid difficulty hierarchy for behavioral criteria. Based on those findings they presented 2 amended items for assessing hand function: hand movements, consisting of 10 behavioral criteria and hand activities, consisting of 8 behavioral criteria. In addition to providing a clear differentiation between motor execution and motor control, they added easier behavioral criteria, thus allowing the items to be used with patients that demonstrate more severe impairment (Sabari et al., 2014).

Administration

The MAS is scored on the person’s ability to complete 8 specific motor tasks of increasing difficulty. A score of 0 indicates inability to achieve any of the criteria and a score of 6 indicates ability to perform all the criteria for that specific item. When administering the MAS, the clinician assigns a score (0 to 6) for each item based upon the most difficult criterion the patient was able to achieve for each task. Total MAS scores represent the sum of scores for each of the 8 task items and range from 0 to 48. The assessment requires some set up as well as several items for administration such as a low wide plinth (a sort of base), a stopwatch, polystyrene cup, a pen and pen top, a prepared sheet of paper for drawing lines with one vertical line on the right of the sheet, and a cylindrical object such as a jar.

Permissions

The MAS is located in the public domain and is an instrument that can be used in practice, research, or publication without fee. A template and instructions for administration can be downloaded from numerous websites and is wholly contained in the following journal article:

Carr, J., Shepherd, R., Nordholm, L., & Lynne, D. (1985). Investigation of a new Motor Assessment Scale for stroke patients. Physical Therapy, 65(2), 175-180.

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