Motor Assessment Scale

Purpose

Assesses everyday motor function in stroke patients.

Acronym MAS

Area of Assessment

Activities of Daily Living
Functional Mobility

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

Stroke Recovery

Stroke

8 items?that 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).

Number of Items

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

15 minutes

Required Training

No Training

Adult

18 - 64

years

Elderly Adult

65 +

years

ICF Domain

Activity

Measurement Domain

Activities of Daily Living
Motor

Considerations

The general tonus item may be difficult to assess because no guidelines regarding where it should be tested or how the item should be scored exist (e.g. when there is variance between leg, arm, and trunk).
This item is often omitted for these reasons (Poole & Whitney, 1988; Malouin et al, 1994; Loewen & Anderson, 1990).
Reliability has only been established in stable patients
Research suggests the Fugl-Meyer Assessment better discriminates between levels of motor recovery in the early recovery and among more disabled patients (Malouin et al, 1994).

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Normative Data

Mixed Stroke Sample: (English et al, 2006; n = 61 chronic and acute patients; mean age = 65.2 (13.1) years; mean time between admission and discharge assessments = 56.4 (38.1) days)

MAS scores at admission:

Item #	Dimension	Mean (SD)
1	Rolling	3.3 (2.0)
2	Lie to sit	4.8 (1.4)
3	Balanced sitting	5.4 (0.84)
4	Sit to stand	3.6 (1.9)
5	Walking	1.8 (1.8)
6	Upper arm function	3.2 (2.3)
7	Hand movements	2.5 (2.5)
8	Advanced hand activities	1.2 (1.5)

Test/Retest Reliability

Chronic Stroke: (Carr et al, 1985; n = 15; mean age = 70 years, range = 42 to 85)

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)

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).

Criterion Validity (Predictive/Concurrent)

Acute Stroke: (Malouin et al, 1994, n = 32, mean age = 60 years, mean time since stroke = 64.5 days)

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)

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

Floor/Ceiling Effects

Chronic & Acute Stroke: (English et al, 2006)

	Floor n (%)		Ceiling n (%)
Item	Dimension	Admission	Discharge	Admission	Discharge
1	Rolling	1 (1.6)	1 (1.6)	15 (24.6)	45 (73.8)
2	Lie to sit	0 (0)	0 (0)	27 (44.3)	53 (86.9)
3	Balanced sitting	0 (0)	0 (0)	35 (57.4)	56 (91.8)
4	Sit to stand	1 (1.6)	0 (0)	8 (13.1)	38 (62.3)
5	Walking	24 (39.3)	3 (4.9)	3 (4.9)	9 (14.8)
6	Upper arm function	11 (18.0)	3 (4.9)	12 (19.7)	25 (41.0)
7	Hand movements	25 (41.0)	17 (27.9)	11 (18.0)	22 (36.1)
8	Advanced hand activities	29 (47.5)	22 (36.1)	3 (4.9)	10 (16.4)

Responsiveness

Chronic & Acute Stroke: (English et al, 2006)

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

Bibliography

Ada, L., Canning, C., et al. (2004). "Training physiotherapy students' abilities in scoring the motor assessment scale for stroke." J Allied Health 33(4): 267-270.

Carr, J. H., Shepherd, R. B., et al. (1985). "Investigation of a new motor assessment scale for stroke patients." Phys Ther 65: 175-180.

English, C. K., Hillier, S. L., et al. (2006). "The sensitivity of three commonly used outcome measures to detect change among patients receiving inpatient rehabilitation following stroke." Clin Rehabil 20(1): 52-55.

Loewen, S. C. and Anderson, B. A. (1990). "Predictors of stroke outcome using objective measurement scales." Stroke 21: 78-81.

Malouin, F., Pichard, L., et al. (1994). "Evaluating motor recovery early after stroke: comparison of the Fugl-Meyer Assessment and the Motor Assessment Scale." Arch Phys Med Rehabil 75: 1206-1212.

Poole, J. L. and Whitney, S. L. (1988). "Motor assessment scale for stroke patients: concurrent validity and interrater reliability." Arch Phys Med Rehabil 69: 195-197.

Tyson, S. F. and DeSouza, L. H. (2004). "Reliability and validity of functional balance tests post stroke." Clin Rehabil 18(8): 916-923.

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