Frequently Asked Questions

The Motor Assessment Scale (MAS) is a standardized assessment developed by Janet Carr and Roberta Shepherd (1985) that uses a task-oriented approach to assess everyday motor function in stroke survivors. The original MAS evaluated eight areas of motor function and included one item on the general muscle tone of the affected side. The eight motor activity items include: supine to side-lying, supine to sitting, balanced sitting, sitting to standing, walking, upper arm function, hand movements and advanced hand activities. The item assessing muscle tone was removed by Carr and Shepherd in 1994.

The MAS is intended for use with persons recovering from a stroke. The MAS may be used in both inpatient and outpatient rehabilitation settings.

Each of the items is scored on a 7 point hierarchical difficulty scale. A score of 0 indicates the individual is unable to complete any of the tasks within a category. A score of 6 implies the individual is not only able to perform the most difficult task, but also all lower scored tasks. The patient performs each item three times, but only the best performance is recorded in the assessment. The total MAS score is the sum of the scores for each of the eight items.

Some authors have suggested that stroke patients may be assessed on the upper limb items (6, 7, 8) independent of the rest of the MAS (Lannin, 2004). The order in which the assessment is administered may also be varied to accommodate for convenience.

The MAS typically takes between 15-60 minutes to administer.

The MAS has shown to have excellent test-retest reliability (Carr et al., 1985), interrater reliability (Carr et al., 1985; Poole & Whitney, 1988) and concurrent validity with both the Fugl-Meyer Assessment and the Action Reach Arm Test (Hsueh & Hsieh, 2002; Hsieh et al., 1998).

The MAS is free. The original MAS protocol can be found at rehabmeasures.org and information about the newly recommended hand items can be found on this site's About Page.

Both occupational and physical therapists working in stroke rehabilitation are eligible to administer the MAS. Carr et al. (1985) recommend a short instruction and practice period, where the clinician administers the MAS to at least six patients prior to using the test in a formal setting. No additional training or certification is required to administer the assessment.

The Fugl-Meyer Assessment (FMA) is generally accepted as the gold standard in post-stroke assessment (http://www.strokengine.ca/assess/fma/). The FMA has excellent reliability and validity. However, it is lengthy to administer with over 155 test items. Unlike the MAS, the Fugl-Meyer Assessment evaluates movement patterns post stroke, but does not address impairments in functional performance.

The Action Reach Arm Test (ARAT) focuses only on upper extremity function and therefore is not as comprehensive in evaluating overall motor function following stroke. Additionally, the assessment requires the purchase of a costly kit. The ARAT is not specific to the stroke population; it can be used for patients with traumatic brain injuries and multiple sclerosis.

Similar to the Action Reach Arm Test, the Wolf Motor Function Test evaluates only the upper extremities. It also requires an extensive set-up and has a lengthy administration time making it difficult to use in the clinic on a regular basis. It has been used effectively to document outcomes following constraint-induced movement therapy (CIMT) (Wolf et al., 2006).

The MAS is beneficial for evaluating stroke patients because it focuses on an individual's ability to perform functional movements related to daily activities rather than qualitative measures like general movement patterns as with the Fugl-Meyer Assessment (FMA). In evaluating eight areas of motor behavior the MAS provides a holistic assessment of a patient post-stroke as compared to other assessments that focus only on one to two areas of motor function. Since the MAS is divided into eight areas of motor behavior, it allows clinicians to easily focus their treatment goals and interventions to the areas their clients have the most difficulty with in functional performance. The MAS is also based on current theory of motor control and functional performance.

The MAS is free to download (public domain), easy to administer, and does not require extensive set-up or specialized equipment. Clinicians who wish to administer the MAS are not required to acquire additional training or certification. The scoring system for each item allows quicker administration of the assessment. Based on a hierarchical difficulty scale, if a patient is able to complete a task with a score of 6, it is assumed the patient will be able to perform tasks 1-5 without issue. This scoring system makes the MAS quick to administer and provides a quantifiable way to document progress during rehabilitation and motor abilities in terms of function (Poole & Whitney, 1998).

Several studies (Sabari et al., 2005 and Aamodt, Kjendahl & Jahnsen, 2006; Pickering et al., 2010) identified concerns with the hierarchical scoring system of the MAS for the areas of hand movements and advanced hand activities. Sabari et al. (2005) found that patients able to perform tasks graded as more difficult were unable to perform easier tasks. Results from the study showed the hierarchy for the two hand items established by Carr and Shepherd did not correspond to the level of difficulty experienced by stroke survivors. Some of the hand movement tasks were found to be on a similar level of difficulty even though the tasks were assigned scores on opposite sides of the hierarchy scale. Based on these issues Sabari et al. proposed a redesigned scoring scale for the two hand items, based on extensive pilot studies and based on Rasch analysis of data collected from 332 stroke survivors (Sabari, Woodbury, Velozo, 2014).

• The newly recommended items that assess hand function make a clearer distinction between items 7 and 8, adopting the name hand activities (item 8) instead of advanced hand activities. This name change removes the implication that behaviors assessed in hand activities are more challenging to accomplish than those in hand movements.
• Items that were significantly influenced by proximal arm function to ensure a passing score in hand function were eliminated (tasks that combined hand performance with antigravity shoulder and elbow movements) such as reaching forward and moving a utensil to one's mouth, and combing hair at the back of one's head.
• The newly recommended hand activities item (Item 8) includes tasks that inherently require an individual to use different types of grasps (lateral pinch and pad to pad pinch) which were not included in the original MAS. An activity requiring cylindrical grasp was included in the research protocol; but Rasch analysis indicated that the difficulty level was not sufficiently different from other tasks to warrant inclusion on the suggested clinical measure.
• To address the "floor effects" on the original advanced hand activities item, tasks were chosen that would be easier to accomplish than picking up and putting down a pen cap. These included activation of a remote control device and moving a piece of paper on a table.
• Some additional changes were made to the original advanced hand activities items for practicality and to reduce variability in administering these task items. These included: picking up and putting down a lead pencil versus a pen, removing the task that required balancing water on a spoon and the task that required a person to pick up a jelly bean from a cup.
• Although these two hand items are still scored on a 7 point scale, the scores were adjusted to increase by increments of 0.6 and 0.75 respectively to account for the 10 hand movement tasks and 8 hand activities tasks that emerged from the Rasch analysis.
• Lastly, all movements and tasks on the newly recommended items can be successfully performed by an individual, without any hand impairments, with either the dominant or non-dominant hand.

The MAS with the newly recommended hand items can now reliably measure individuals with different levels of ability. For example, individuals who were more severely affected by the stroke can be evaluated with the addition of easier tasks like sliding the paper and the use of the remote control.

Sabari and colleagues used a multi-step process of scale development, refined the tasks and conducted Rasch analysis on data collected from 332 stroke survivors to develop these two newly recommended hand items. Their research has shown these two redesigned hand items meet specific standards for validity and reliability.

• Aamodt, G., Kjendahl, A., & Jahnsen, R. (2006). Dimensionality and scalability of the Motor Assessment Scale (MAS). Disability & Rehabilitation, 28(16), 1007-1013.
• Carr, J.H., Shepherd, R.B., Nordholm, L. & Lynne, D. (1985). Investigation of a new motor assessment scale for stroke patients. Physical Therapy, 65 (2), 175-180.
• Hsieh CL, Hsueh I-P, Chiang F-M, Lin PH. (1998). Inter-rater reliability and validity of the Action Research arm test in stroke patients. Age and Aging. 27(2),107-114.
• Hsueh IP, Hsieh CL. (2002) Responsiveness of two upper extremity function instruments for stroke inpatients receiving rehabilitation. Clinical Rehabilitation.16(6), 617-624.
• Lannin, N. A. (2004). Reliability, validity and factor structure of the upper limb subscale of the Motor Assessment Scale (UL-MAS) in adults following stroke. Disability and rehabilitation, 26(2), 109-116.
• Pickering, R.L., Hubbard, I.J., Baker, K.G. & Parsons, M.W. (2010). Assessment of the upper limb in acute stroke: The validity of hierarchical scoring for the motor assessment scale. Australian Occupational Therapy Journal, 57, 174-182.
• Poole, J.L. & Whitney S.L. (1988). Motor assessment scale for stroke patients: Concurrent validity and interrater reliability. Archives of Physical Medicine and Rehabilitation, 69, 195-197.
• Sabari J.S., Lim A.L., Velozo C.A., Lehman L., Kieran O. & Lai J.S. (2005) Assessing arm and hand function after stroke: a validity test of the hierarchical scoring system used in the motor assessment scales for stroke. Archives of Physical Medicine and Rehabilitation, 86, 1609-1615.
• Sabari, J.S., Woodbury, M. & Velozo C.A. (2014) Rasch analysis of a new hierarchical scoring system for evaluating hand function on the motor assessment scale for stroke. Stroke Research and Treatment, 2014, 1-10.
• Wolf, S. L., Winstein, C. J., Miller, J. P., Taub, E., Uswatte, G., Morris, D., … & Excite Investigators. (2006). Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. Jama, 296(17), 2095-2104.
• Zeltzer,Lisa. (2010, July 11). Fugl-Meyer Assessment of Sensorimotor Recovery After Stroke (FMA). Retrieved from http://www.strokengine.ca/assess/fma/