Assessing the Motor Status Score: A Scale for the Evaluation of Upper Limb Motor Outcomes in Patients after Stroke

Abstract

The Motor Status Scale (MSS) measures shoulder, elbow (maximum score = 40), wrist, hand, and finger movements (maximum score = 42), and expands the measurement of upper extremity impairment and disability provided by the Fugl-Meyer (FM) score. This work examines the interrater reliability and criterion validity of the MSS performed in patients admitted to a rehabilitation hospital 21 ± 4 days after stroke. Using the MSS and the FM, 7 occupational therapists masked to each other’s judgments, evaluated 12 consecutive patients with stroke. Two therapists evaluated 6 additional patients on consecutive days. Intraclass correlation coefficients were significant for each group of raters for the shoulder/elbow and for the wrist/hand (P < 0.0001); test-retest measures were also significant for the shoulder/elbow (Pearson correlation coefficient r = 0.99, P < 0.004) and for the wrist/hand (Pearson correlation coefficient r = 0.99, P < 0.003). The internal item consistency for the overall MSS was significant (Cronbach alpha = 0.98, P < 0.0001). Finally the correlation between the MSS and the FM (R ² = 0.964) was significant (P < 0.0001). The MSS affords a reliable and valid assessment of upper limb impairment and disability following stroke.

Keywords

Stroke Motor impairment Disability Upper limb

References

Van der Lee JH , Wagenaar RC , Lankhorst GJ , et al. Forced use of the upper extremity in chronic stroke patients. Stroke 1999;30:2369-2375.

Dromerick AW , Edwards DF , Hahn M.

Does the application of constraint-induced movement therapy during acute rehabilitation reduce arm impairment after ischemic stroke?

Stroke 2000;31(12):2984-2988.

Feys HM , De Weerdt WJ , Selz BE , et al. Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single-blind, randomized, controlled multicenter trial. Stroke 1998;29:785-792.

Kwakkel G , Wagenaar RC , Twisk JWR , Lankhorst GJ , Koetsier JC . Intensity of leg and arm training after primary middle cerebral artery stroke: a randomized trial. Lancet 1999;354:191-196.

Sunderland A , Fletcher D , Bradley L , Tinson D , Hewer RL , Wade DT . Enhanced physical therapy for arm function after stroke: a 1 year follow up study. J Neurol Neurosurg Psychiatry 1994;57:856-858.

Aisen ML , Krebs HI , Hogan N , McDowell F , Volpe BT . The effect of robot assisted therapy and rehabilitative training on motor recovery following stroke. Arch Neurol 1997;54:443-446.

Volpe BT , Krebs HI , Hogan N , Edelstein L , Diels C , Aisen M. Robot training enhanced motor outcome in patients with stroke maintained in three year follow-up. Neurology 1999;53:1874-1876.

Volpe BT , Krebs HI , Hogan N , Edelstein L , Diels C , Aisen M. A novel approach to stroke rehabilitation: robot aided sensorimotor stimulation. Neurology 2000;54:1938-1944.

Wade D. Rehabilitation therapy after stroke. Lancet 1999;354(9174):176-177.

10.

Van der Lee JH . Constraint-induced therapy for stroke: more of the same or something completely different? Curr Opin Neurol 2001;14(6):741-744.

11.

Aisen ML , Sevilla D , Edelstein L , Blass J. A double-blind placebo-controlled study of 3,4-diaminopyridine in amyotrophic lateral sclerosis patients on a rehabilitation unit. J Neurol Sci 1996;138(1-2):93-96.

12.

Aisen ML , Sevilla D , Gibson G , Kutt H , Blau A , Edelstein L , et al. 3,4-diaminopyridine as a treatment for amyotrophic lateral sclerosis. J Neurol Sci 1995;129(1):21-24.

13.

Fugl-Meyer AR , Jaasko L , Leyman I , Olsson S , Steglind S. The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med 1975;7(1):13-31.

14.

Cronbach LJ . Coefficient alpha and the internal structure of tests. Psychometrika 1951;16:297-334.

15.

Krebs HI , Volpe BT , Aisen ML , Hogan N. Increasing productivity and quality of care: robot-aided neurorehabilitation. VA J Rehabil Res Dev 2000;37: 639-652.

16.

Krebs HI , Aisen ML , Volpe BT , Hogan N. Quantization of continuous arm motion in humans with brain injury. Proceedings of the National Academy of Science; April 1999;96:4645-4649.

17.

Volpe BT , Krebs HI , Hogan N.

Is robot-aided sensorimotor training in stroke rehabilitation a realistic option?

Curr Opinion Neurol 2001;14:745-752.

18.

Volpe BT , Krebs HI , Hogan N. Robot aided sensorimotor training in stroke. In: Barnett HJM , Bogousslavsky J , Meldrum H , editors. Ischemic Stroke. Philadelphia (PA): Lippincott Williams & Wilkins. In press 2002.