Motor Assessment Scale

Abstract

The Motor Assessment Scale (MAS) is a widely utilized, performance-based clinical measure designed to assess functional motor recovery in patients following a stroke. Developed by J. Carr and R. Shepherd in 1985, the MAS evaluates eight areas of motor function critical for daily living, plus one measure of general muscle tone. It is distinguished by its criterion-referenced format, where patients are scored on a 7-point ordinal scale (0 to 6) based on the quality and speed of task performance, with 6 representing optimal or normal function. The MAS is highly valued in rehabilitation settings due to its practical application, demonstrated psychometric properties, and ability to track changes in motor ability over time.

Keywords

Motor Assessment Scale, MAS, Stroke, Physical Therapy, Motor Recovery, Functional Mobility, Rehabilitation Outcome Measure, Neurological Assessment, Carr and Shepherd.

Authors

J. Carr, R. Shepherd, L. Nordholm, D. Lynne

Purpose

The primary purpose of the Motor Assessment Scale is to provide a standardized, observational method for assessing and quantifying basic functional motor performance and changes in motor function in individuals, particularly those recovering from an acute or chronic stroke. It serves as both a clinical tool for guiding treatment and a research tool for measuring the effectiveness of rehabilitation interventions.

The scale focuses on assessing the patient’s ability to perform tasks related to mobility, balance, and upper and lower limb control, moving beyond simple range of motion or strength testing to evaluate functional capacity in real-world movements. High scores indicate the patient is performing activities that require coordination, speed, and minimal compensatory strategies.

Construct

The MAS measures the construct of functional motor assessment and motor control post-neurological injury. The construct is broken down into nine distinct areas, eight of which measure functional tasks (mobility, sitting balance, standing, walking, and arm/hand function) and one which measures general muscle tone (tonus). Unlike scales that simply measure impairment, the MAS emphasizes the performance of complex, goal-directed movements that reflect independence in activities of daily living (ADLs).

The hierarchical scoring system (0 to 6) is designed to capture the progression of motor recovery, moving from basic reflexive or assisted movements (scores 0-1) toward skilled, independent, and time-efficient performance (score 6). This structure ensures that the scale is sensitive to subtle but clinically meaningful improvements during the rehabilitation process.

Validity

The Motor Assessment Scale exhibits strong psychometric properties, particularly in its target population. Studies have demonstrated high concurrent validity, showing strong correlations with other established measures of motor function and disability, such as the Fugl-Meyer Assessment and the Barthel Index.

Furthermore, the MAS possesses good construct validity, as indicated by its ability to differentiate between patients at different stages of recovery post-stroke. The scale’s emphasis on functional tasks ensures that it accurately measures clinically relevant motor behaviors required for independence, supporting its use as an outcome measure in clinical practice.

Reliability

The MAS is known for its high inter-rater and intra-rater reliability, which is crucial for a performance-based observational tool. Research confirms that different clinicians administering the scale to the same patient achieve consistent scores, particularly when standardized training protocols are followed. Test-retest reliability is also reported as high, confirming the scale’s stability when used to assess patients over short intervals, assuming no significant clinical change has occurred.

The specific, criterion-referenced descriptors for each scoring point (0–6) minimize subjective interpretation, contributing significantly to its overall reliability across various clinical settings.

Factor Analysis

Factor analysis studies of the MAS typically support the scale’s multidimensional structure, often revealing distinct factors that correspond to different body functions. While the scale is administered as nine sections, factor analysis frequently separates the items into two or three primary components:

1. Lower Limb and Trunk Function: Encompassing rolling, sitting balance, sitting to standing, and walking items.

2. Upper Limb Function: Covering upper arm, hand movements, and advanced hand activities.

This factorial structure confirms that the MAS effectively captures both gross motor function and fine motor control, reflecting the complex and often differential patterns of motor impairment observed following a neurological event like a stroke.

Instrument

Test Type: Performance-based, Criterion-referenced Assessment

Format: Observational rating scale scored on an ordinal scale from 0 (lowest function) to 6 (optimal function) across nine functional domains.

Language Available: Primarily English, though translated versions are utilized globally in rehabilitation research.

Population Group: Patients with neurological deficits, primarily focusing on those recovering from stroke.

Age Group: Adult and geriatric populations.

Population Details: Originally validated for use in acute and chronic post-stroke patients. It is used by physical therapists and occupational therapists to monitor motor recovery.

Test Methodology: The MAS requires the patient to attempt specific functional tasks. Scoring is based on the highest-level criterion achieved within each section. If a patient cannot complete any part of a section, a score of zero (0) is assigned for that section. The total score is the sum of the scores from all sections, ranging from 0 to 54.

Keywords

Functional assessment, Neurological rehabilitation, Physical therapy, Motor control, Balance, Gait, Hand function, Upper extremity, Outcome measure.

Authors

Author ORCID Identifier: Not consistently provided in original documentation. Contact academic institutions for updated details.

Affiliation Email addresses: Contact the Department of Physiotherapy at the authors’ respective institutions at the time of publication (1985).

Correspondence Address: Refer to the primary publication source for contact information regarding J. Carr and R. Shepherd.

Permissions & Fee and Test Year

The Motor Assessment Scale is generally considered a public domain clinical tool available for use without specific licensing fees for clinical practice or non-commercial research. Users should reference the original publication when using the scale. The initial validation and publication year for the MAS was 1985.

The original PDF of the investigation study can be downloaded here: http://www.physther.net/content/65/2/175.full.pdf

A testing form PDF is available here: http://www.rehabmeasures.org/pdf%20library/motor%20assessment%20scale%20testing%20form.pdf

Reference’s

• Carr‚ J. H.‚ Shepherd‚ R. B.‚ Nordholm‚ L.‚ Lynne‚ D. (1985). Investigation of a new motor assessment scale for stroke patients. Phys Ther‚ 65‚ 175-180.

• Dean‚ C. M.‚ Mackey‚ F. M. (1992). Motor assessment scale scores as a measure of rehabilitation outcome following stroke. Aust J Physiother‚ 38‚ 31-35.

Items of the Motor Assessment Scale

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

If the patient cannot complete any part of a section score a zero (0) for that section. There are 9 sections in all.

Supine to Side-lying onto intact side (starting position: supine with knees straight)

1. Uses intact arm to pull body toward intact side. Uses intact leg to hook impaired leg to pull it over.

2. Actively moves impaired leg across body to roll but leaves impaired arm behind.

3. Impaired arm is lifted across body with other arm. Impaired leg moves actively & body follows as a block.

4. Actively moves impaired arm across body. The rest of the body moves as a block.

5. Actively moves impaired arm and leg rolling to intact side but overbalances.

6. Rolls to intact side in 3 seconds without use of hands.

Supine to Sitting over side of bed

1. Pt assisted to the side-lying position: Patient lifts head sideways but can’t sit up.

2. Pt may be assisted to side-lying & is assisted to sitting but has head control throughout.

3. Pt may be assisted to side-lying & is assisted with lowering LEs off bed to assume sitting.

4. Pt may be assisted to side-lying but is able to sit up without help.

5. Pt able to move from supine to sitting without help.

6. Pt able to move from supine to sitting without help in 10 seconds.

Balance Sitting

1. Pt is assisted to sitting and needs support to remain sitting.

2. Pt sits unsupported for 10 seconds with arms folded‚ knees and feet together & feet on the floor.

3. Pt sits unsupported with weight shifted forward and evenly distributed over both hips / legs. Head and thoracic spine extended.

4. Sits unsupported with feet together on the floor. Hands resting on thighs. Without moving the legs the patient turns the head and trunk to look behind the right and left shoulders.

5. Sits unsupported with feet together on the floor. Without allowing the legs or feet to move & without holding on the patient must reach forward to touch the floor (10 cm or 4 inches in front of them) The affected arm may be supported if necessary.

6. Sits on stool unsupported with feet on the floor. Pt reaches sideways without moving the legs or holding on and returns to sitting position. Support affected arm if needed.

Sitting to Standing

1. Pt assisted to standing – any method.

2. Pt assisted to standing. The patient’s weight is unevenly distributed & may use hands for support.

3. Pt stands up. The patient’s weight is evenly distributed but hips and knees are flexed – No use of hands for support.

4. Pt stands up. Remains standing for 5 seconds with hips and knees extended with weight evenly distributed.

5. Pt stands up and sits down again. When standing hips & knees are extended with weight evenly distributed

6. Pt stands up and sits down again 3 x in 10 seconds with hips & knees extended & weight evenly distributed

Walking

1. With assistance the patient stands on affected leg with the affected weight bearing hip extended and steps forward with the intact leg.

2. Walks with the assistance of one person.

3. Walks 10 feet or 3 meters without assistance but with an assistive device.

4. Walks 16 feet or 5 meters without a device or assistance in 15 seconds.

5. Walks 33 feet or 10 meters without assistance or a device. Is able to pick up a small object from the floor with either hand and walk back in 25 seconds.

6. Walks up and down 4 steps with or without a device but without holding on to a rail 3 x in 35 seconds.

Upper Arm Function

1. Supine: Therapist places affected arm in 90 degrees shoulder flexion and holds elbow in extension – hand toward ceiling. The patient protracts the affected shoulder actively.

2. Supine: Therapist places affected arm in above position. The patient must maintain the position for 2 seconds with some external rotation and with the elbow in at least 20 degrees of full extension.

3. Supine: Patient assumes above position and brings hand to forehead and extends the arm again. (flexion & extension of elbow) Therapist may assist with supination of forearm.

4. Sitting: Therapist places affected arm in 90 degrees of forward flexion. Patient must hold the affected arm in position for 2 seconds with some shoulder external rotation and forearm supination. No excessive shoulder elevation or pronation.

5. Sitting: Patient lifts affected arm to 90 degrees forward flexion – holds it there for 10 seconds and then lowers it with some shoulder external rotation and forearm supination. No pronation.

6. Standing: Have patient’s affected arm abducted to 90 degrees with palm flat against wall. Patient must maintain arm position while turning body toward the wall.

Hand Movements

1. Sitting at a table (Wrist Extension): Affected forearm resting on table. Place cylindrical object in palm of patient’s hand. Patient asked to lift object off table by extending the wrist – no elbow flexion allowed.

2. Sitting at a table (Radial Deviation of Wrist): Therapist should place forearm with ulnar side on table in mid-pronation /supination position. Thumb in line with forearm and wrist in extension. Fingers around cylindrical object. Patient is asked to lift hand off table. No wrist flexion or extension.

3. Sitting (Pronation / Supination): Affected arm on table with elbow unsupported at side. Patient asked to supinate and pronate forearm (¾ range acceptable).

4. Place a 5 inch ball on the table so that the patient has to reach forward with arms extended to reach it. Have the patient reach forward with shoulders protracted‚ elbows extended‚ wrist in neutral or extended‚ pick up the ball with both hands and put it back down in the same spot.

5. Have the patient pick up a polystyrene cup with their affected hand and put it on the table on the other side of their body without any alteration to the cup.

6. Continuous opposition of thumb to each finger 14 x in 10 seconds. Each finger in turn taps the thumb‚ starting with the index finger. Do not allow thumb to slide from one finger to the other or go backwards.

Advanced Hand Activities

1. Have the patient reach forward to pick up the top of a pen with their affected hand‚ bring the affected arm back to their side and put the pen cap down in front of them.

2. Place 8 jellybeans‚ (beans)‚ in a teacup an arms length away on the affected side. Place another teacup an arms length away on the intact side. Have the patient pick up one jellybean with their affected hand and place the jellybean in the cup on the intact side.

3. Draw a vertical line on a piece of paper. Have the patient draw horizontal lines to touch the vertical line. The goal is 10 lines in 20 seconds with at least 5 lines stopping at the vertical.

4. Have the patient pick up a pen/pencil with their affected hand‚ hold the pen as for writing‚ and position it without assistance and make rapid consecutive dots (not strokes) on a sheet of paper. Goal: at least 2 dots a second for 5 seconds.

5. Have the patient take a dessert spoon of liquid to their mouth with their affected hand without lowering the head toward the spoon or spilling.

6. Have the patient hold a comb and comb the back of their head with the affected arm in abduction and external rotation‚ forearm in supination.

General Tonus (check one – add “6” to score if tone on affected side is normal)

• ____ Flaccid‚ limp‚ no resistance when body parts are handled.

• ____Some resistance felt as body parts are moved.

• ____ Variable‚ sometimes flaccid‚ sometimes good tone‚ sometimes hypertonic.

• ____Hypertonic 50% of the time

• ____Hypertonic all of the time

• 6 = Consistently normal response