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Arm Motor Ability Test

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Purpose

The AMAT evaluates disabilities in upper extremity function in activities of daily living (ADL) using a quantitative and qualitative measure.

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Instrument Details

Acronym AMAT

Area of Assessment

Activities of Daily Living
Upper Extremity Function

Assessment Type

Performance Measure

Cost

Not Free

Actual Cost

$25.00

Cost Description

Cost of Equipment

Diagnosis/Conditions

  • Stroke Recovery

Populations

Key Descriptions

  • The AMAT-13 Version consists of 13 ADL activities; the AMAT-10 version consists of 10 ADL activities.
  • Each ADL activity item involves one to three component tasks or movement segments.
  • As in the case of most ADL, the components within each compound task either involve differential contributions from the two arms, or of the distal and proximal musculature of an affected arm, or are not of equal difficulty. Thus, the task components in this assessment are measured separately.
  • However, each compound task is performed continuously, as a unit, without the patient’s awareness of component parcellation.
  • One is therefore able to quantify ADL in the manner of a laboratory test without interfering with the natural flow of movement characteristic of everyday activity.
  • Each of tasks is timed and rated according to quality of movement and ability to perform each component part of a compound task. Tasks have either a 1- or 2-minute performance time limit.
  • German version available (O'Dell et al., 2011).

Number of Items

AMAT-13: 8
AMAT-10: 23

Equipment Required

  • Silverware and plate
  • Play-doh
  • Mug
  • Comb
  • Foam Sandwich
  • Towel
  • Jar
  • 2 shirts (different styles)
  • Light switch
  • Door
  • Dried beans
  • Shoe and shoelaces
  • Telephone

Time to Administer

60 minutes

AMAT-12: 31 to 60 minutes
AMAT-10: 15 to 20 minutes

Required Training

Reading an Article/Manual

Instrument Reviewers

Initially reviewed by Jane Sullivan PT, DHS, MS and the Stroke EDGE task force of the Neurology Section of the APTA. Follow-up review by Elizabeth Blaschak, OTS; Jenna Colangelo, OTS; and Katherine Kostecki, OTS from the University of Illinois at Chicago.

Body Part

Upper Extremity

ICF Domain

Activity

Measurement Domain

Activities of Daily Living

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (SCI EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 months post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

StrokEDGE

NR

R

R

Recommendations based on level of care in which the assessment is taken:

 

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

NR

R

R

R

R

Recommendations for entry-level physical therapy education and use in research:

 

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

StrokEDGE

No

Yes

Yes

Not reported

Considerations

Limitations: Very lengthy to complete. Client should have some active movement capacity in the involved arm. The AMAT has been used in post stroke UE intervention trials examining constraint induced movement therapy, electrical stimulation, and repetitive task training. Ability to follow multi-step directions verbally or through modeling is a pre-requisite (O’Dell et al., 2011). Most ADL test items have multiple sub-tasks, which could present challenges if client has severe cognitive or language limitations (O’Dell et al., 2011). Instructions can be repeated and cues provided throughout the test, as it is not a test of cognitive ability (O’Dell et al., 2011).

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Stroke

back to Populations

Minimal Detectable Change (MDC)

Stroke:

(Kopp et al, 1997; n = 33 subacute stroke inpatients with moderate to mild upper extremity motor deficit; median age = 66 years; sex = 12 females; median Motricity Index Arm Score = 89; median chronicity = 43 days)

  • In individuals with subacute stroke and mild to moderate movement deficits, the AMAT detected the difference in change occurring as a result of the passage of 1 versus 2 weeks.

Stroke: (Fulk, 2017, n=146, age=57.1 ± 10.96 years, mean time since stroke onset for participants in sample = 59.37 ± 63.22 [SD] months; 88 participants with hemiparesis affecting their right UEs; 82 participants with hemiparesis affecting their dominant UEs)

Minimal Detectable Change in AMAT Based on Therapists’ Perception of Change

  • Grasp: 0.44
  • Release: 0.42
  • Ability to move affected arm and hand: 0.42
  • Ability to perform Canadian Occupational Performance Measure tasks:  0.42
  • Overall arm and hand function: 0.42

Minimal Detectable Change in AMAT Based on Participants’ Perception of Change

  • Grasp: 0.44
  • Release: 0.42
  • Ability to move affected arm and hand: 0.40
  • Ability to perform Canadian Occupational Performance Measure tasks:  0.40
  • Overall arm and hand function: 0.40

Minimally Clinically Important Difference (MCID)

Stroke: (Fulk, 2017, n=146, age=57.1 ± 10.96 years, mean time since stroke onset for participants in sample = 59.37 ± 63.22 [SD] months; 88 participants with hemiparesis affecting their right UEs; 82 participants with hemiparesis affecting their dominant UEs)

MCID in AMAT Based on Therapists’ Perception of Change

  • Grasp: 0.34
  • Release: 0.42
  • Ability to move affected arm and hand: 0.40
  • Ability to perform Canadian Occupational Performance Measure tasks:  0.35
  • Overall arm and hand function: 0.42

 

MCID in AMAT Based on Participants’ Perception of Change

  • Grasp: 0.29
  • Release: 0.31
  • Ability to move affected arm and hand: 0.29
  • Ability to perform Canadian Occupational Performance Measure tasks:  0.30
  • Overall arm and hand function: 0.40

Cut-Off Scores

Stroke:

(O’Dell et al., 2013; n = 32 subjects prior to upper extremity robotic treatment; mean age = 56 years (SD = 12.4); age range = 35-85; gender = 72% male; ethnicity = 56% white, 28% black, 16% other; handedness = 88% right-handed; years post-stroke: mean = 4.1 (SD = 4.5; range = 0.8-25.2))

  • Low impairment (n = 10, median normalized FMA = 54.6)
  • Middle impairment (n = 8, median normalized FMA = 31.1)
  • High impairment (n = 14, median normalized FMA = 19.7)

Normative Data

Stroke: (Fulk, 2017, n=146, age=57.1 ± 10.96 years, mean time since stroke onset for participants in sample = 59.37 ± 63.22 [SD] months; 88 participants with hemiparesis affecting their right UEs; 82 participants with hemiparesis affecting their dominant UEs)

Mean score of AMAT (SD)

  • 3.0 (0.68)

Test/Retest Reliability

Stroke:

(Kopp et al, 1997)

  • Excellent test-retest reliability (ICC = 0.93 - 0.99)

Interrater/Intrarater Reliability

Stroke:

(Kopp et al, 1997)

  • Excellent interrater reliability (ICC = 0.95 - 0.99)

(Daly et al., 2005 AMAT-13; 10 subjects > 12 months post-stroke)

  • Excellent interrater reliability (ICC=0.82 for shoulder/elbow tasks; ICC=0.96 for wrist/hand tasks)
  • Excellent interrater reliability (ICC=0.94 for shoulder/elbow tasks; ICC=0.97 for wrist/hand tasks)

Internal Consistency

Stroke:

(O’Dell et al., 2013; n = 32 subjects prior to upper extremity robotic treatment; mean age = 56 years (SD = 12.4); age range = 35-85; gender = 72% male; ethnicity = 56% white, 28% black, 16% other; handedness = 88% right-handed; years post-stroke: mean = 4.1 (SD = 4.5; range = 0.8-25.2))

  • Excellent using Cronbach’s alpha (0.93)
  • Excellent with inclusion of extreme scores using Person Separation Index (0.86)
  • Excellent with exclusion of extreme scores using Person Separation Index (0.88)

Criterion Validity (Predictive/Concurrent)

Stroke:

(Kopp et al, 1997)

  • Adequate to excellent concurrent validity with the Motricity-Index-Arm (correlation coefficient = 0.45-0.61)

(Chae et al, 2003)

  • Excellent concurrent validity with the Fugl-Meyer Assessment (correlation coefficient = 0.92-0.94)

Construct Validity

Stroke:

(O’Dell et al., 2013; n = 32 subjects prior to upper extremity robotic treatment; mean age = 56 years (SD = 12.4); age range = 35-85; gender = 72% male; ethnicity = 56% white, 28% black, 16% other; handedness = 88% right-handed; years post-stroke: mean = 4.1 (SD = 4.5; range = 0.8-25.2))

  • Excellent correlation with WMFT, FMA, and ARAT (0.78-0.79)
  • Excellent correlation with FMA wrist/hand subscore (0.74)
  • Excellent correlation with FMA shoulder/elbow subscore (0.66)
  • Adequate correlation with SIS hand subscore (0.40)
  • Poor correlation with SIS communication subscore (-0.16)

(Daly et al., 2005) Participants were 12 people (21-62 years of age; 6 male and 6 female) who were 1 to 4 years post-stroke.

  • Excellent correlation with FIM self-care tasks (0.60)
  • Adequate correlation with SIS hand scale (0.59)
  • Poor correlation with FIM communication tasks (0.09)

(Kopp et al, 1997)

  • Adequate to excellent correlation with Motricity-Index-Arm (r = 0.45 – 0.61)

(Chae et al, 2003; n = 30 chronic stroke survivors)

  • Excellent correlation with Fugl-Meyer Assessment

Content Validity

Stroke:

O’Dell et al. (2013) found consistencies between the AMAT-9 and the Rasch model expectations, even with the few participants in the study.

Floor/Ceiling Effects

Stroke:

The AMAT time of performance exhibited significant ceiling and floor effects with respect to the Fugl-Meyer Assessment (Chae et al, 2003).

Responsiveness

Stroke: (Fulk, 2017, n=146, age=57.1 ± 10.96 years, mean time since stroke onset for participants in sample = 59.37 ± 63.22 [SD] months; 88 participants with hemiparesis affecting their right UEs; 82 participants with hemiparesis affecting their dominant UEs)

Sensitivity in AMAT Based on Therapists’ Perception of Change

  • Grasp: 0.64
  • Release: 0.60
  • Ability to move affected arm and hand: 0.58
  • Ability to perform Canadian Occupational Performance Measure tasks:  0.62
  • Overall arm and hand function: 0.62

Sensitivity in AMAT Based on Participants’ Perception of Change

  • Grasp: 0.67
  • Release: 0.64
  • Ability to move affected arm and hand: 0.53
  • Ability to perform Canadian Occupational Performance Measure tasks:  0.56
  • Overall arm and hand function: 0.50

 

Stroke:

In individuals with subacute stroke and mild to moderate movement deficits, the AMAT detected the difference in change occurring as a result of the passage of 1 versus 2 weeks (Kopp et al, 1997).

AMAT intermediate responsiveness = 0.98; FMA was highest at 1.26; WMFT was lowest at 0.81; ARAT SRM = 0.89 (O’Dell et al, 2013).

Bibliography

Chae, J., Labatia, I., et al. (2003). "Upper limb motor function in hemiparesis: concurrent validity of the Arm Motor Ability test." Am J Phys Med Rehabil 82(1): 1-8. Find it on PubMed

Daly, J.J., Hogan, N., Perepezko, E.M., Krebs, H.I., Rogers, J.M., Goyal, K.S., …Ruff, R.L. (2005). Response to upper-limb robotics and functional neuromuscular stimulation following stroke. Journal of Rehabilitation Research & Development, 42(6), 723-736. Find it on PubMed

Fulk G, Martin R, Page SJ. Clinically Important Difference of the Arm Motor Ability Test in Stroke Survivors. Neurorehabilitation and Neural Repair. 2017;31(3):272-279. doi:10.1177/1545968316680486

Kopp, B., Kunkel, A., et al. (1997). "The Arm Motor Ability Test: reliability, validity, and sensitivity to change of an instrument for assessing disabilities in activities of daily living." Arch Phys Med Rehabil 78(6): 615-620. Find it on PubMed

O’Dell, M.W., Kim, G., Rivera Finnen, L., Polistena, C. (2011). Clinical Implications of Using the Arm Motor Ability Test in Stroke Rehabilitation. Archives of Physical Medicine and Rehabilitation, 92, 830-836.

O’Dell, M. W., Kim, G., Rivera, L., Fieo, R., Christos, P., Polistena, C., Fitzgerald, K., . . . Delia, G. (2013). A Psychometric Evaluation of the Arm Motor Ability Test. J Rehabil Med., 45(6), 519-527. https://doi.org/10.2340/16501977-1138. Find it on PubMed

Poole, J.L., & Whitney, S.L. (2001). Assessments of motor function post stroke: A review. Physical and Occupational Therapy in Geriatrics, 19(2), 1-22.

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