Fugl-Meyer Assessment – Upper Extremity (FMA-UE)

The FMA-UE assesses motor function in the upper extremity after stroke, following the sequence in which movement typically returns. Thirty of its 33 items rate movement and three rate reflexes. Items progress from reflex activity through synergy movements to isolated joint motions, wrist stability, and hand dexterity, and coordination and speed are tested at the end. The scale captures the full range from severe impairment to near-normal function.

It is one section of a larger assessment. The full Fugl-Meyer also covers the leg, sensation, balance, joint range of motion, and joint pain.

Total scores run from 0 to 66, where higher means more recovered movement. There are no agreed severity bands, so this page publishes none. The one study to derive levels empirically applied a cluster analysis to 247 people with chronic stroke and concluded that the scores support a three or four level classification, with considerable overlap between the clusters. That is a reason to treat any single cutoff with suspicion.

What the score is good for is change. Anchored against therapists' judgements of meaningful recovery, a change of 4.25 to 7.25 points marked a clinically important improvement in people with minimal to moderate impairment after chronic stroke. The range moved with which facet of arm movement was being judged. The scale is sensitive enough to serve as a primary or secondary endpoint in upper-limb stroke research, including robot-assisted therapy and brain stimulation studies. It is reference information, tracked over time.

Two limits are worth stating. The motor domain has a ceiling, so it separates people less well once recovery is near complete. And the arm is weighted more heavily than the leg, which is why the two sections are usually reported separately rather than as one total.

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. A ball, a cylinder, a scrap of paper, a pencil, a reflex hammer, cotton wool, a stopwatch, a blindfold, 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.

• Stroke→

• Fugl-Meyer Assessment, Lower Extremity (FMA-LE)The leg half of the same 100-point motor score→
• NIH Stroke Scale (NIHSS)Severity in the first hours, before recovery starts→
• Barthel IndexWhether returning movement translates into everyday independence→
• GRASSPThe same question for the arm and hand after cervical spinal cord injury→

Created by Axel Fugl-Meyer and colleagues in Sweden and published in 1975, the first quantitative instrument for measuring sensorimotor recovery after stroke. Its design follows Twitchell and Brunnstrom's account of the stages in which motor control returns after hemiplegia.

Intra-rater reliability

ICC 0.95 to 1.0 for the expert rater across motor and sensory scores (Sullivan et al., 2011)

Clinically important difference

4.25 to 7.25 points, depending on which facet of arm movement anchors the judgement (Page et al., 2012)

Measurement properties

Excellent inter-rater and intra-rater reliability and construct validity, with preliminary evidence of responsiveness (Gladstone et al., 2002)

Impairment levels

Cluster analysis in chronic stroke supports a three or four level scheme rather than fixed cutoffs (Woytowicz et al., 2017)

Known limitation

A ceiling effect at the top of the motor domain, and the arm is weighted more heavily than the leg (Gladstone et al., 2002)

References

1. 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. 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. 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. 4.Page SJ, Fulk GD, Boyne P. Clinically important differences for the upper-extremity Fugl-Meyer Scale in people with minimal to moderate impairment due to chronic stroke. Phys Ther. 2012;92(6):791-798.
5. 5.Woytowicz EJ, Rietschel JC, Goodman RN, et al. Determining levels of upper extremity movement impairment by applying a cluster analysis to the Fugl-Meyer Assessment of the upper extremity in chronic stroke. Arch Phys Med Rehabil. 2017;98(3):456-462.
6. 6.University of Gothenburg. Fugl-Meyer Assessment protocols and translations.
7. 7.StrokEngine. Fugl-Meyer Assessment of Sensorimotor Recovery After Stroke (FMA).