Letter by Murphy et al Regarding Article, “Fugl-Meyer Assessment of Sensorimotor Function After Stroke: Standardized Training Procedure for Clinical Practice and Clinical Trials”
To the Editor:
We have been reading the article on Fugl-Meyer Assessment (FMA) by Sullivan et al1 with great interest. The authors provide a detailed description of testing procedures and a manual for the FMA. They also encourage the use of this protocol in clinical practice or in future investigations. FMA is 1 of the most widely used measures of motor impairment after stroke both in research and in clinical work. The original article on FMA by Fugl-Meyer et al2 was performed at our department at the University of Gothenburg, and to our knowledge, there is no established version of modifications made to the original FMA. We, and probably many others, appreciate that Sullivan et al provided the protocol of FMA used in their studies. We agree that the procedure manuals are time-consuming to develop and are seldom published.1 We noticed, however, that the presented protocol includes some modifications from the original FMA. This remark is very important because the published protocol is now easily accessed, and it will probably be used by other researchers and clinicians. Sullivan et al state that the procedures for FMA were based on the original source by Fugl-Meyer et al.
We list here the specific modifications we have noticed on the manual by Sullivan et al.
Margit Alt Murphy, MSc, RPT
Anna Danielsson, PhD, RPT
Katharina Stibrant Sunnerhagen, MD, PhD
Institute of Neuroscience and Physiology, Rehabilitation Medicine
University of Gothenburg
5. “…, the patient should be activating the elbow at 90° tests and activating the elbow extensors during the elbow at 0° tests.
Original: “If the elbow cannot by volitional muscle actively be brought to and kept in the required position, the examiner may assist the patient.”
I. Reflex activity. The knee flexor reflexes are omitted. IIB. Sidelying.
Original: supine. IV. Starting position. … knee is flexed, and the patient's toes are touching the floor slightly behind.
Original: 0 degrees hip flexion, foot on the floor. V. This item is only included if patient achieves a maximum score on all previous lower extremity items.
Original: this item is only included if patient achieves a maximum score (6 points) on the previous part (IV). VI. Coordination. Eyes open.
I. Reflex activity. The finger flexor reflexes are omitted. IV. 4b. Patient is sitting with hand resting on the lap.
Original: extended arm at the side. V. 5b. The patient is sitting with elbow extended, hand resting on the knee.
Original: starting position is 90 degrees flexion in shoulder and extended elbow. VI. This item is only included if patient achieves a maximum score on all previous items.
Original: V. This item is only included if patient achieves a maximum score (6 points) on the previous part (IV). VIII. 8d–g. Patient is sitting with arm on the bedside table. Instruct the patient to grasp a piece of paper/pencil/small can/tennis ball.
Original: no table, the moment of grasping an object from a table is not part of the testing, the objects are interposed to the patient. VIII. 8d. abduct the thumb.
Original: pure thumb adduction, the first carpometacarpal, metacarpophalangeal and interphalangeal joints in 0 degrees position. IX. Coordination. Eyes open.
It is important to state that the manual and test protocol provided by Sullivan et al is a modified version of the original FMA and that must be clearly stated in the publication. It may be true that those modifications can improve the FMA as an assessment measure and in this case the psychometric properties of the modified FMA should be tested as well.
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Link to the protocol of the original FMA scale: www.neurophys.gu.se/sektioner/klinisk_neurovetenskap_och_rehabilitering/neurovetenskap/rehab_med/fugl-meyer/.
- © 2011 American Heart Association, Inc.