The Arm Motor Ability Test Mercy College Occupational Therapy Department
Introduction • Developed in 1987 by Karen L. McCulloch, PT, PhD, NCS, Edward Taub, PhD and Jean E. Crago, MSPT • Developed to be used as an outcome measure to assess gains resulting from the implementation of Constraint Induced Movement Therapy • Client performs 9 tasks replicating basic ADL’s • Within the 9 tasks, subcomponents of the task are considered when scoring.
Introduction (continued) • Tests activity limitation of the more impaired arm in hemiparesis • Tasks require use of the distal and proximal musculature of the affected arm • The unaffected arm is also utilized in some tasks, sometimes used as a stabilizer • Significant for use in research • The original version consisted of 13-tasks
When and Where to use the AMAT • Anytime you want to assess gains in function • As an outcome measure for research –alone or in conjunction with others • For initial or re-evaluations in an outpatient setting • Commonly used for clients who have suffered a stroke, but can be used for TBI, spinal cord injuries, etc.
Set up… Materials needed (see appendix for specifications) • Plastic plate and bowl • “Play-doh” (to simulate an easily cut piece of meat) • Knife, Fork, Teaspoon • Foam square (to replicate a sandwich) • Dried kidney beans • Mug with a handle • Comb with coarse teeth • Twist top jar • Shoelace on board (or large sneaker) • Push button phone • Cardigan sweater and T-shirt
Set up… • Client performs tasks while sitting at a table or desk • The chair should be at an height of 18 inches with a sturdy, straight back. • Pieces of dicem may be used to secure plate in place on table • A stopwatch is needed to time subcomponents of the task.
Administering each task • Instructions are very specific for the examiner • The AMAT includes a suggested verbal script to instruct the client • Timing is required for multiple parts of each task • Most task components are given a time limit of 1 minute – those that allow 2 minutes are indicated on the score sheet
Administering each task (cont.) • Instructions describe specific components required within the task in order to attain functional ability score • Keep materials organized in order to keep the fluidity of the assessment and to save on time • Sit side-by-side with the client and demonstrate task before asking them to perform on their own (up to 3 times) • Verbal cueing is permitted
Condensed AMAT (most recently used) 9 Items with subcomponents Task 1 – Knife and Fork • Pick up knife and fork • Cut “meat” • Fork to mouth Task 2 – Sandwich Task • Pick up foam “sandwich” • “Sandwich “ to mouth Task 3 – Feeding with a spoon • Pick up spoon • Capture 1 bean from bowl with spoon • Spoon to mouth Task 4 – Hair Combing Task • Pick up comb • Comb hair
Condensed AMAT (continued) Task 5 – Opening a Jar • Grasp jar top • Unscrew the jar top Task 6 – Shoe Lace Tie • Tie show lace Task 7 – Phone Use • Phone receiver to ear • Press phone number Task 8 – Put on a sweater • Affected arm in sleeve of sweater • Button two buttons Task 9 – Donning a T-shirt • Arms in T-shirt • Shirt over head • Straighten shirt over the body
Scoring • Scoring is based on the clinical judgment of the examiner • Timing should be unobtrusive. The client should not feel rushed • Each subcomponent of the task is scored separately • The revised AMAT utilizes a “Functional Ability Scale”
Scoring (continued) • A quantitative score (0-5) is given for each component of the task • Take into consideration if the affected hand performing the task is also the non-dominant hand • The manual provides scoring considerations for each task indicating movements that may increase or decrease the client’s score
FUNTIONAL ABILITY SCALE 0 – Does not attempt with involved arm 1 – Involved arm does not participate functionally; however, attempt is made to use the arm. In unilateral tasks that uninvolved extremity may be used to move the involved extremity 2 – Uninvolved arm is used for minor readjustments or change of position, or requires more that two attempts, or accomplishes very slowly. In bilateral tasks, involved arm is used only as a helper or stabilizer 3 – Movement is influenced to some degree by synergy or is performed very slowly and/or with effort 4 – Movement is close to normal, but slightly slower; may lack precisions, fine coordination or fluidity 5 – Movement appears normal
How would you score her performance? (go to video clip) • A score of “5” indicates motion that appears as if the injury never occurred • A score of “0” would indicate that the client was unable to perform the task or is completely flaccid • Note… • Jerky, uncoordinated movements • Muscle synergy such as increased flexion in characteristic patterns • Spasticity causing limitations in targeted movement • Velocity of movement
Validity and Reliability In 2003, Chae, et al., used the Fugl-Myer Assessment (FMA)as a reference measure to establish concurrent criterion validity of the AMAT since the FMA already has proven valid, reliable and sensitive to change.
Validity and Reliability In 1997, Kopp, et al., established reliability, validity and sensitivity for change by administering the AMAT multiple times with. • Mean scores were considered for inter-rater reliability and internal consistency. (The second examiner used a videotaped performance to time and score the assessment) • Concurrent reliability was determined by correlating AMAT results with the Motricity Index Arm assessment for motor impairment. • Improvements in AMAT scores reflected it’s sensitivity to detect changes in functional status. • Construct reliability was evident as scores changed in relation to changes in functional ability and efficiency as a result from therapeutic intervention
Advantages • The AMAT meets all 4 criteria recommend by Poole and Whitney in 2003, regarding the selection of an appropriate assessment to use in measuring impairment gains (evaluate motor function post-stroke, be quantitative, have proven reliability and/or validity, be appropriate for setting in clinic or home administration). • Documents the effectiveness of therapeutic techniques • Gives a quantitative representation of functional ability in performing a range of daily living skills • The equipment needed consists of common items, therefore one does not need to buy an expensive kit • Provides information regarding functional activities that can be helpful when considering treatment planning
Disadvantages • Takes 30 minutes to administer (depending on the progress of the patient) • Many small items are required to administer test • Requires the administrator to multi-task (timing subtasks, observing movements, setup between tasks) • Equipment must remain consistent with specifications • Requires ample workspace to perform test (may be difficult for some clinics with limited areas to treat) • Many of the tasks are too difficult for clients with limited motor recovery (may not be appropriate for this client)
Self-Efficacy Upper Extremity Scale • Conceptualization came from administration of the AMAT • Developed as an outcome measure for clients who have suffered a stroke • 15 statements regarding the patients confidence in their ability to perform tasks and recognize improvements in function • Clients are to rate statements using a Likert scale of 0-100 • Additional follow-up questions are posed to investigate further into the client’s perceptions of their affected upper extremity
Research that utilized the AMAT as an outcome measure Allin, S. and Ramanan, D. "Assessment of Post Stroke Functioning Using Machine Vision." IAPR Machine Vision and Applications (MVA), Tokyo, Japan, May 2007. Daly, J.J., Perepezko, E.M., Rogers, J.M., & Ruff, R.L. “Response To Upper Limb Functional Neuromuscular Stimulation and Robotics Following Stroke” International FES Society, Montreal, Canada, July 2005. Dunning, K., Berberich A., Albers, B., Mortellite, K., Levine, P.G., & Hill-Herman, V.A. (2008). A four-week, task-specific neuroprosthesis program for a person with not active wrist or finger movement because of chronic stroke. Physical Therapy, 88 (3), pp. 397-405. Sabari, J.S., Kane, L., Flanagan, S.R., & Steinberg, A. (2001). Constraint-induced motor relearning after Stroke: A naturalistic case report. Archives of Physical Medicine and Rehabilitation, 82 (), pp. 524-528. Levy, R., Ruland, S., Weinand, M., Lowry, D., Dafer, R., & Bakay, R. (2008). Cortical stimulation for the rehabilitation of patients with hemiparetic Stroke: A multicenter feasibility study of safety and efficacy. Journal of Neurosurgery, 108 (), pp. 707-714.
References Chae, J., Labatia, I. & Yang, G. (2003). Upper limb motor function in hemiparesis: Concurrent validity of the arm motor ability test. The American Journal of Physical Medicine and Rehabilitation, 82 (1), pp. 1-8. Kopp, B., Kunkel, A., Flor, H., Platz, T., Rose, U., & Mauritz, K.H. (1997). The Arm Motor Ability Test: Reliability, validity, and sensitivity to change of an instrument for assessing disabilities in activities of daily living. Archives of Physical Medicine and Rehabilitation, Vol. 78, pp. 615-620. Poole, J. L. & Whitney, S.L. (2001). Assessments of motor function post stroke: A review. Physical & Occupational Therapy in Geriatrics, 19 (2), pp. 1-22.