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physicaltherapy: 05 Feb : 06:54 pm

Is there anyone who has gone through CWT6 or type 1 evaluation with FCCPT?
If so, kindly let me know from where can the following deficiencies be fulfilled?
1. History
2. Systems Review
3. Findings that warrant referral
4. Supervision of support staff
5. Documentation

nani: 28 Sep : 04:31 am

plz pleasec tell me where to do phd in india

Nikhilphysio: 02 Jun : 03:55 am

I am working as physiotherapist in Shalby hospital ahmedabad for 4 years. I have passed out from Rajiv gandhi university of health and sciences Bangalore. I want to apply for Newzealand physiotherapy board registration so anyone there from India who got registered as physiotherapist in new zealand please help me.

Arun: 10 May : 12:36 am

Hi Priyank, welcome. Feel free to go through these forum threads returned by search [link]

Priyank: 09 May : 10:28 pm

Hi..need advice. What are the options in Australia after MPT?


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Moderators: Arun, Boopathi, Robin, Diana
Author Post
Sat Dec 01 2012, 01:00pm
Arun
May I help you?

Registered Member #1
Joined: Wed Jul 07 2004, 04:03pm
Location: Kottayam, Keralam
Posts: 726

Description:
The Fugl-Meyer Assessment (FMA) is a stroke-specific, performance-based impairment index. It is designed to assess motor functioning, balance, sensation and joint functioning in patients with post-stroke hemiplegia (Fugl-Meyer, Jaasko, Leyman, Olsson, & Steglind, 1975; Gladstone, Danells, & Black, 2002). It is applied clinically and in research to determine disease severity, describe motor recovery, and to plan and assess treatment.

Author: Lisa Zeltzer, MSc OT;

Editors: Nicol Korner-Bitensky, PhD OT; Elissa Sitcoff, BA BSc


Detailed Review

Features:

Items:
The scale is comprised of five domains and there are 155 items in total:

    Motor functioning (in the upper and lower extremities)
    Sensory functioning (evaluates light touch on two surfaces of the arm and leg, and position sense for 8 joints)
    Balance (contains 7 tests, 3 seated and 4 standing)
    Joint range of motion (8 joints)
    Joint pain

The motor domain includes items assessing movement, coordination, and reflex action of the shoulder, elbow, forearm, wrist, hand, hip, knee, and ankle. Items in the motor domain have been derived from Twitchell's 1951 description of the natural history of motor recovery following stroke and integrates Brunnstrom's stages of motor recovery (Gladstone et al. 2002; Poole & Whitney, 2001). Items of the FMA are intended to assess recovery within the context of the motor system. Functional tasks are not incorporated into the evaluation (Chae, Labatia, & Yang, 2003).

Time:
Sections of the FMA are often administered separately, however it takes approximately 30-35 minutes to administer the total FMA (Poole & Whitney, 2001). The average length of time for FMA administration of the motor, sensation and balance subscores have reported to range from 34 to 110 minutes, with a mean administration time of 58 minutes (Malouin, Pichard, Bonneau, Durand & Corriveau, 1994). When the motor scale is administered on its own, it takes approximately 20 minutes to complete.

A major criticism of the FMA is that it is a lengthy measure to administer (Gladstone et al., 2002). Sometimes it takes longer than 35 minutes to complete, such as when it is administered to aphasic or severely affected patients (Kusoffsky, Wadell, & Nilsson, 1982; Dettmann, Linder, & Sepic, 1987).

Scoring:
Scoring is based on direct observation of performance. Scale items are scored on the basis of ability to complete the item using a 3-point ordinal scale where 0=cannot perform, 1=performs partially and 2=performs fully. The total possible scale score is 226.

Points are divided among the domains as follows:

  •     Motor score: ranges from 0 (hemiplegia) to 100 points (normal motor performance).
  •     Divided into 66 points for upper extremity and 34 points for the lower extremity.
  •     Sensation: ranges from 0 to 24 points.
  •     Divided into 8 points for light touch and 16 points for position sense.
  •     Balance: ranges from 0 to 14 points.
  •     Divided into 6 points for sitting and 8 points for standing.
  •     Joint range of motion: ranges from 0 to 44 points.
  •     Joint pain: ranges from 0 to 44 points.

Classifications for impairment severity have been proposed based on FMA Total motor scores (out of 100 points):

Source: Finch, Brooks, Stratford, & Mayo, 2002

Fugl-Meyer (1980)Fugl-Meyer et al. (1975)Duncan, Goldstein, Horner,
Landsman, Samsa, & Matchar (1994)
< 50 = Severe 0-35 = Very Severe
50-84 = Marked≤ 84 = Hemiplegia36-55 = Severe
85-94 = Moderate85-95 = Hemiparesis56-79 = Moderate
95-99 = Slight96-99 = Slight motor
dyscoordination
> 79 = Mild


Each of the five FMA domains can be separated to test a specific construct. For example, to assess upper extremity function, the subsections specifically dealing with upper extremity movement, sensation, joint motion and pain can be examined without administering the rest of the scale. Scoring of the FMA will depend on the number of items included in the subsection selected for testing.

Crow et al. (2008) proposed a shortened method of administration for the upper and lower extremity portions of the FMA. Using Guttman analysis the authors determined that scale items in the upper and lower limb sections fulfill the criteria for a valid hierarchy. Clinically this means that rather than administering the entire test, a clinician may choose to begin administering at a point in the scale that appears appropriate to the observed level of patient recovery. If a patient is able to accomplish all of the remaining scale items in the section, they are awarded a full score for that section. Likewise, when the individual being tested is unable to accomplish all the scale items in a given section, a score of 0 is given for any remaining untested, more advanced, items. This method of assessment reduces the time required to perform the test. Full guidelines for hierarchical testing procedures are provided by Crow et al. (2008)

Equipment:
The FMA requires a mat or bed, a few small objects and several different tools for the assessment of sensation, reflexes, and range of motion:

Materials needed (Poole & Whitney, 2001; Sullivan et al., 2011):

  1.     Scrap of paper
  2.     Ball
  3.     Cotton ball
  4.     Pencil
  5.     Reflex hammer
  6.     Cylinder (small can or jar)
  7.     Goniometer
  8.     Stopwatch
  9.     Blindfold
  10.     Chair
  11.     Bedside table

Subscales:
There are five domains that can be assessed independently: Motor functioning; Sensory functioning; Balance; Joint range of motion; and Joint pain. Joint pain and Sensory functioning are more subjective in nature and are used less frequently (Gladstone et al., 2002). Sullivan et al. (2011) published a FMA manual of procedures, which includes training procedures for clinical practice and research trials, in an effort to standardize assessment procedures.

Training:
The FMA should be administered by a trained physical therapist, occupational therapist or other rehabilitation professional on a one-to-one basis with the patient (Gladstone et al., 2002).

Guidelines provided by Fugl-Meyer et al. (1975) suggest that the client should be instructed verbally and/or with a demonstration of the test. The evaluator is permitted to assist the patient in the testing of the wrist and hand to stabilize the arm (Fugl-Meyer et al., 1975). In patients confined to their beds, the joint range of shoulder abduction should be performed only to 90 degrees and extension of the hip to 0 degrees.

Links:
Scale - [link]

Mirror


fugl-meyer-1332679_fm-le-english.pdf

 

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