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Comprehensive Coordination Scale

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The Comprehensive Coordination Scale (CCS) assesses coordination of multiple body segments at both motor performance (endpoint movement) and quality of movement (joint rotations and interjoint coordination) levels based on observational kinematics. The CCS is composed of six different tests: the Finger-to-Nose Test, the Arm-Trunk Coordination Test, the Finger Opposition Test, the Interlimb Coordination (synchronous anti-phase forearm rotations) Test, the Lower Extremity MOtor COordination Test (LEMOCOT) and the Four-limb Coordination (Upper and lower limb movements) Test.

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Instrument Details

Acronym CCS

Area of Assessment


Assessment Type

Performance Measure

Administration Mode

Paper & Pencil



Actual Cost



Key Descriptions

  • The CCS is composed of 6 different tests: the Finger-to-Nose Test (FTN), the Arm-Trunk Coordination Test (ATC), the Finger Opposition Test (FOT), the Interlimb Coordination Test (ILC-2), the Lower Extremity MOtor COordination Test (LEMOCOT) and the Four-limb Coordination Test (ILC-4).
  • Multiple behavioral elements of each test are scored on separate rating scales ranging from 3 (normal coordination) to 0 (impaired coordination) assess different elements of motor behavior needed to perform the action.
  • The CCS includes of a total of 13 rating scales for the 6 tests.
  • The CCS score ranges from 0 to 69 points, with higher scores indicating better motor coordination. The CCS total score represents a coordination score for the whole body.
  • The CCS scores can be broken into 4 subscores: Upper limb, Lower limb, Unilateral, Bilateral.
  • Upper limb: 54 points (incudes FTN-24 points, ATC-12 points, FOT-12 points, and ILC2-6 points)
  • Lower limb: 12 points (includes LEMOCOT-12 points)
  • Unilateral: 30 points (includes FTN-12 points, ATC-6 points, FOT-6 points and LEMOCOT-6 points)
  • Bilateral: 9 points (includes ILC2-6 points and ILC4-3 points)
  • The manual describes the initial position, the instructions and the detailed scoring.
  • Administration instructions:
  • For all tests, the individual is seated in an armless chair with his/her back against the back of the chair and both feet flat on the floor or foot stool.
  • Tests are performed with eyes open, unless otherwise indicated.
  • Individuals may look at their limbs while performing the tasks, except for the ATC test.
  • Each test is demonstrated to the individual once by the examiner.
  • The individual practices each test until he/she has understood the test (up to a maximum of 5 trials).
  • Each unilateral test is performed with each side of the body.
  • For tests in which the speed and number of repetitions are assessed, two trials are needed. One trial should be used to assess speed or the number of repetitions, and the second trial should be used to score the behavioral elements.
  • Each behavioral element should be analyzed and scored independently of the other elements.
  • In the case of restricted range of motion (i.e., joint contracture), the evaluator may adapt the test. Any modifications should be noted.

Number of Items


Equipment Required

  • Chair with back support and without armrests (suggested seat height: 46 cm/18 in)
  • Foot stool (if needed)
  • Targets: One 2.54 cm-diameter sticker (FNT), One target (sphere of 2.54 cm-diameter or a cube of similar dimensions) on an adjustable height support (ATC), Two 5 cm-diameter stickers placed 30 cm (centre-to-centre) apart and attached to a cardboard (LE
  • Stopwatch/Timer
  • Table (optional, suggested height: 72 cm/28 in)
  • Pillow (optional)

Time to Administer

15 minutes

Required Training

Reading an Article/Manual

Required Training Description

The healthcare professional should read the CCS manual available on Open Science Framework: Demers, Marika, Mindy F Levin, Roni Molad, and Sandra Alouche. 2021. “Comprehensive Coordination Scale.” OSF. July 12.

Age Ranges


18 - 64


Elderly Adult

65 +


Instrument Reviewers

Sandra Alouche, PT, PhD, Professor, Universidade Cidade de Sao Paulo

Roni Molad, OT, MSc, McGill University

Marika Demers, OT, PhD, Post-doctoral research fellow, University of Southern California

Mindy F. Levin, PT, PhD, Professor, McGill University

Body Part

Upper Extremity
Lower Extremity

ICF Domain

Body Function

Measurement Domain



The CCS can be used in hospital-based settings, outpatient clinics and research studies to assess sensorimotor coordination in individuals with neurological injuries.


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Standard Error of Measurement (SEM)

Chronic Stroke (Molad et al, 2021; n=30; mean age = 65.9 (11.3) years; mean time post CVA = 34.2 (19.6) months)

•           SEM for entire group (n = 30): 1.80

Minimal Detectable Change (MDC)

Chronic Stroke (Molad et al, 2021; n=30; mean age = 65.9 (11.3) years; mean time post CVA = 34.2 (19.6) months)

•           MDC for entire group (n = 30): 4.98

Test/Retest Reliability

Chronic Stroke (Molad et al, 2021)

  • Excellent test-retest reliability (ICC = 0.97; 95% CI: 0.93-0.98)

Interrater/Intrarater Reliability

Chronic Stroke (Molad et al, 2021)

  • Excellent intrarater reliability (ICC = 0.97; 95% CI: 0.93-0.98)
  • Excellent interrater reliability (ICC = 0.98, 95% CI: 0.95-0.99)

Internal Consistency

Chronic Stroke (Molad et al, 2021)

  • Factor analysis of the whole scale revealed 2 factors with eigenvalues greater than 1 (factor 1 [PA1], eigenvalue =8; factor 2 [PA2], eigenvalue = 5) that explained 99% of the variance.
  • Excellent internal consistency: composite reliability value = 0.938

Construct Validity

Convergent validity:

Chronic Stroke (Molad et al, 2021)

  • Adequate convergent validity with FMA-Total Score (ρ=0.602; p=0.001) and FMA-Motor Score  (ρ=0.585; p<0.001)

Content Validity

Content validity of the CCS was determined by a Delphi Study followed by a panel of 8 experts (3 occupational therapists and 5 physical therapists who had more than 5 years of experience. Three participants were academic researchers and 5 were clinicians, 2 of whom also held an academic position. From the result of these steps, Alouche et al. (2021) concluded that the instrument has strong content validity (page 6).


Alouche, S.R., Molad, R., Demers, M., Levin, M.F. (2021) Development of a Comprehensive Outcome Measure for Motor Coordination; Step 1: Three-Phase Content Validity Process. Neurorehabil Neural Repair. 35(2):185-193. doi: 10.1177/1545968320981955. PMID: 33349134.

Molad, R., Alouche, S.R., Demers, M., Levin, M.F. (2021) Development of a Comprehensive Outcome Measure for Motor Coordination, Step 2: Reliability and Construct Validity in Chronic Stroke Patients. Neurorehabil Neural Repair. 35(2):194-203. doi: 10.1177/1545968320981943. PMID: 33410389.