Stroke motor recovery
Fugl-Meyer Assessment
The Fugl-Meyer Assessment measures motor impairment after stroke in detail, scoring movement, coordination, reflexes, sensation, balance and joint range separately for the upper and lower limb. It is more sensitive to change than global independence scales, which is why it is the reference measure in stroke recovery research.
What it measures
Impairment at the level of the body rather than of daily life. It grades whether specific movements are possible, partly possible or absent, in enough detail to detect change that a scale like the Barthel Index would miss entirely.
Where it fits in our programmes
We use the upper limb motor subscale for patients in robotic arm training, because arm recovery is where global scales are least informative and where families most want a number they can follow week by week.
Key facts
| Abbreviation | FMA |
|---|---|
| Number of items | 155 |
| Score range | 0–226 total; motor subscales 0–66 upper limb and 0–34 lower limb |
| Time to administer | 30–45 minutes for the full assessment |
| Training required | Yes — training improves consistency substantially |
| Cost | Free |
| Equipment | Reflex hammer · Cotton wool · Pencil · Paper · Small jar or ball · Blindfold |
| Domains | Motor function · Sensation · Balance · Joint range of motion · Joint pain |
| ICF domain | Body function |
| Age range | Adult |
| Populations | Stroke |
| Languages | Widely translated |
Psychometrics by population
The same instrument behaves differently in different conditions. A cut-off established in older adults does not transfer to Parkinson's disease, and a minimal detectable change from one study does not apply to another population.
| Population | Cut-off | MDC / MCID | Reliability | Validity |
|---|---|---|---|---|
| Stroke — upper limb | — | Clinically important difference 4.25–7.25 points on the 66-point upper limb scale in chronic stroke (Page 2012) | Excellent inter-rater and test–retest reliability with trained assessors | Considered the reference standard for motor impairment after stroke |
| Stroke — lower limbReported less often than the upper limb subscale; interpret change alongside a walking measure | — | — | — | — |
Things to be careful about
- Long to administer, which limits routine use outside research and specialist units
- Measures impairment, not activity — a patient can improve on the FMA without any change in daily function
- The motor subscales are usually reported separately rather than as a single total
Frequently asked questions
Why use the Fugl-Meyer when quicker scales exist?
Because it detects change that global scales miss entirely. It grades whether specific movements are possible, partly possible or absent, in enough detail to show progress that the Barthel Index would record as no change at all. It is considered the reference standard for motor impairment after stroke, which is why stroke recovery research is built on it.
How much change on the upper limb score is meaningful?
In chronic stroke, clinically important differences of 4.25 to 7.25 points have been estimated on the 66-point upper limb motor scale 2. We use that subscale for patients in robotic arm training, because arm recovery is where global scales are least informative and where families most want a number they can follow week by week.
Can the score improve without daily life changing?
Yes, and it is important to expect this. The Fugl-Meyer measures impairment at the level of the body, not activity — a patient can gain several points without any change in what they can do at home. Read alongside an activity measure it shows the recovery is real; read alone it can promise more than it delivers.
How long does the assessment take?
Thirty to forty-five minutes for the full 155-item assessment, which is why it is used mainly in research and specialist units rather than in routine practice. Training improves consistency substantially. The motor subscales are usually reported separately rather than combined into a single total.
Sources
- Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient: a method for evaluation of physical performance — Scandinavian Journal of Rehabilitation Medicine (1975)
- 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 — Physical Therapy (2012)
Topic
Related instruments
- Rehabilitation outcomeFunctional Independence Measure (FIM)The FIM is an 18-item scale scoring how much assistance a person needs across thirteen motor and five cognitive tasks.
- Daily livingBarthel IndexThe Barthel Index is a ten-item scale of independence in daily activities, scored from 0 to 100 in five-point increments.
- Balance and fallsBerg Balance ScaleThe Berg Balance Scale assesses static and dynamic balance through fourteen everyday tasks, each scored 0 to 4, giving a total out of 56.
