Fugl-Meyer Assessment – Lower Extremity (FMA-LE)
A 17-item scale measuring lower extremity motor recovery after stroke.
By Claire White
- Clinician-administered by a trained physical or occupational therapist.
- 17 items covering hip, knee, ankle, and foot, plus reflexes and coordination.
- Each item scored 0 (cannot perform), 1 (partial), or 2 (complete). Total 0 to 34.
- Published by the University of Gothenburg in 22 languages.
Psychometrics
Inter-rater agreement is between an expert rater and 17 trained physical therapists scoring 15 people with hemiparetic stroke (Sullivan et al., 2011). Internal consistency is Cronbach's alpha in 140 community-dwelling stroke patients (Park and Choi, 2014). Higher is better.
What does the FMA-LE measure?
The FMA-LE tests motor recovery in the hip, knee, ankle, and foot, following the same account of how movement returns after hemiplegia as the upper extremity section. Its 17 items progress from reflex activity through the flexor and extensor synergies to isolated joint control, and end with a coordination and speed test. It is usually administered alongside the FMA-UE as part of a full Fugl-Meyer assessment.
What does an FMA-LE score mean?
Total scores run from 0 to 34, where higher means more recovered movement. The literature publishes no agreed severity bands for the lower extremity score, so this page gives none. The score is read as a position on a continuum rather than a category, and its value comes from being repeated.
Change is what it is good at. In 65 people more than six months after stroke, a gain of 6 points separated those who reported a meaningful recovery from those who did not, and it did so with a sensitivity of 87 to 90 percent against both a walking classification and the person's own rating. A factor analysis of 140 community-dwelling stroke patients found the subscale measures a single thing, with no floor or ceiling effect, which is part of why it holds up across the range of impairment. The score is reference information, tracked over time.
How the FMA-LE is administered
- Administered by
- A trained physical therapist, occupational therapist, or other rehabilitation professional
- Time to administer
- About 20 minutes for the motor scale. The full Fugl-Meyer, adding sensation, balance, range of motion, and pain, takes 30 to 35 minutes.
- Equipment
- Everyday items. The full Fugl-Meyer list includes a reflex hammer, a stopwatch, a blindfold, cotton wool, a chair, and a bedside table.
- Cost
- Free to take here.
- Published by
- University of Gothenburg
- Training required
- No certification. A standardized training procedure is published and supports the reported reliability.
- Age range
- Adolescents and adults
- Available languages
- 22, from the University of Gothenburg. Permission is required for official translations.
Which conditions is the FMA-LE used for?
Related instruments
FMA-LE questions, answered
What does an FMA-LE score mean?
The lower extremity motor score runs from 0 to 34, and higher means more recovered movement. There are no agreed severity bands for it, so no cutoffs are published here. The score is read as a position on a continuum and tracked over time. In chronic post-stroke hemiparesis, a change of 6 points marked a recovery that people themselves and their walking category both registered as meaningful.
How is the FMA-LE scored?
Seventeen items, each scored 0 if the person cannot perform it, 1 if they perform it partially, and 2 if they perform it fully. The items run from reflex activity through the flexor and extensor synergies to isolated movement at the hip, knee, and ankle, and finish with a coordination and speed test. The maximum is 34.
How does the FMA-LE relate to the full Fugl-Meyer Assessment?
It is the leg part of the motor domain. The upper extremity contributes 66 points and the lower extremity 34, giving a 100-point motor score. The full assessment adds sensation, balance, joint range of motion, and joint pain.
Who administers the FMA-LE?
A trained physical therapist, occupational therapist, or other rehabilitation professional, scoring from observed performance. No certification is required. A standardized training procedure is published and supports the reliability figures on this page.
Is the FMA-LE free?
Yes. It is free to take here. The protocols themselves are published by the University of Gothenburg, which is who to approach about administering it in your own practice.
Evidence, psychometrics and provenance
Created by Axel Fugl-Meyer and colleagues in Sweden and published in 1975, the first quantitative instrument for measuring sensorimotor recovery after stroke. The lower extremity motor subscale is one part of it.
- Minimal clinically important difference
- 6 points in chronic post-stroke hemiparesis (Pandian et al., 2016)
- Dimensionality
- One factor explains 61.7 percent of the variance, with no floor or ceiling effect in community-dwelling stroke patients (Park and Choi, 2014)
- Measurement properties
- Excellent inter-rater and intra-rater reliability and construct validity across the Fugl-Meyer motor domain (Gladstone et al., 2002)
References
- 1.Fugl-Meyer AR, Jääskö 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.
- 2.Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer Assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair. 2002;16(3):232-240.
- 3.Sullivan KJ, Tilson JK, Cen SY, et al. Fugl-Meyer assessment of sensorimotor function after stroke: standardized training procedure for clinical practice and clinical trials. Stroke. 2011;42(2):427-432.
- 4.Park EY, Choi YI. Psychometric properties of the lower extremity subscale of the Fugl-Meyer Assessment for community-dwelling hemiplegic stroke patients. J Phys Ther Sci. 2014;26(11):1775-1777.
- 5.Pandian S, Arya KN, Kumar D. Minimal clinically important difference of the lower-extremity Fugl-Meyer assessment in chronic-stroke. Top Stroke Rehabil. 2016;23(4):233-239.
- 6.University of Gothenburg. Fugl-Meyer Assessment protocols and translations.
- 7.StrokEngine. Fugl-Meyer Assessment of Sensorimotor Recovery After Stroke (FMA).
This assessment uses a validated instrument and is reference information, not a diagnosis.