The Childhood Myositis Assessment Scale (CMAS) is a tool for assessing the functional severity of muscle involvement in children with idiopathic inflammatory myopathies. It can be followed over time to evaluate the disease status and the impact of interventions. It was developed in cooperation with the Juvenile Dermatomyositis Disease Activity Collaborative Study Group.
Maneuvers:
(1) head elevation (neck flexion when lying flat)
(2) leg raise/touch object
(3) straight leg lift/duration
(4) supine to prone
(5) sit-ups
(6) supine to sit
(7) arm raise/straighten
(8) arm raise/duration: maintaining wrists above the top of head
(9) floor sit: going from a standing position to a sitting position on the floor
(10) all-fours maneuver
(11) floor rise: going from a kneeling position on the floor to a standing position
(12) chair rise
(13) stool step
(14) pick-up: picking a pencil or other object off the floor
|
Maneuver |
Finding |
Points |
|---|---|---|
|
head elevation (neck flexion) |
unable |
0 |
|
|
1 – 9 seconds |
1 |
|
|
10 – 29 seconds |
2 |
|
|
30 – 59 seconds |
3 |
|
|
60 – 119 seconds |
4 |
|
|
>= 2 minutes (>= 120 seconds) |
5 |
|
leg raise/touch object |
unable to lift leg off table |
0 |
|
|
able to clear table, but cannot touch object |
1 |
|
|
able to lift leg high enough to touch object |
2 |
|
straight leg raise/duration |
unable |
0 |
|
|
1 – 9 seconds |
1 |
|
|
10 – 29 seconds |
2 |
|
|
30 – 59 seconds |
3 |
|
|
60 – 119 seconds |
4 |
|
|
>= 2 minutes (>= 120 seconds) |
5 |
|
supine to prone |
unable; has difficulty even turning onto side; able to pull arms under torso only slightly or not at all |
0 |
|
|
turns onto side fairly easily, but cannot fully free arms and is not able to fully assume a prone position |
1 |
|
|
easily turns onto side; has some difficulty freeing arms, but fully frees them and fully assumes a prone position |
2 |
|
supine to sit |
unable by self |
0 |
|
|
much difficulty; very slow, struggles greatly; barely makes it; almost unable |
1 |
|
|
some difficulty; able but is somewhat slow; struggles some |
2 |
|
|
no difficulty |
3 |
|
arms raise/straighten |
cannot raise wrists |
0 |
|
|
can raise wrists at least up to the level of the acromioclavicular joint, but not above the top of the head |
1 |
|
|
can raise wrists above the head, but cannot raise arms straight above the head so that elbows are in full extension |
2 |
|
|
can raise arms straight above head so that the elbows are in full extension |
3 |
|
arm raise/duration |
unable |
0 |
|
|
1 – 9 seconds |
1 |
|
|
10 – 29 seconds |
2 |
|
|
30 – 59 seconds |
3 |
|
|
60 – 119 seconds |
4 |
|
|
>= 2 minutes (>= 120 seconds) |
5 |
|
floor sit |
unable; afraid to try, even if allowed to use a chair for support; child fears that he/she will collapse, fall into a sit, or harm self |
0 |
|
|
much difficulty; able but needs to hold onto a chair for support during descent; unable or unwilling to try if not able to use a chair for support |
1 |
|
|
some difficulty; can go from stand to sit without using a chair for support but has at least some difficulty during descent; descends somewhat slowly and/or apprehensively; may not have full control or balance as maneuvers into a sit |
2 |
|
|
no difficulty; requires no compensatory maneuvering |
3 |
|
all-fours maneuver |
unable to go from a prone to an all-fours position |
0 |
|
|
barely able to assume and maintain an all-fours position |
1 |
|
|
can maintain all-fours position with straight back and head raised (so as to look straight ahead); cannot creep (crawl) forward |
2 |
|
|
can maintain all-fours position, look straight ahead and creep (crawl) forward |
3 |
|
|
can maintain balance while lifting and extending a leg |
4 |
|
floor rise |
unable, even if allowed to use a chair for support |
0 |
|
|
much difficulty; able but needs to use a chair for support; unable if not allowed to use a chair |
1 |
|
|
moderate difficulty; able to get up without using a chair for support but needs to place one or both hands on thighs, knees or floor; unable without using hands |
2 |
|
|
mild difficulty; does not need to place hands on knees, thighs or floor, but has at least some difficulty during ascent |
3 |
|
|
no difficulty |
4 |
|
chair rise |
unable to rise from chair, even if allowed to place hands on sides of chair seat |
0 |
|
|
much difficulty; able but needs to place hands on the sides of seat; unable if not allowed to place hands on knees or thighs |
1 |
|
|
moderate difficulty; able, but needs to place hands on knees or thighs; does not need to place hands on side of seat |
2 |
|
|
mild difficulty; able; does not need to use hands at all, but has at least some difficulty |
3 |
|
stool step |
unable |
0 |
|
|
much difficulty; able but needs to place one hand on the exam table or examiner's hand |
1 |
|
|
some difficulty; does not need to use exam table for support but needs to use hand(s) on knee or thigh |
2 |
|
|
able; does not need to use exam table or hand(s) on knee or thigh |
3 |
|
pick up |
unable to bend over and pick up pencil off floor |
0 |
|
|
much difficulty; able but relies heavily on support gained by placing hand(s) on knees or thighs |
1 |
|
|
some difficulty; needs to at least minimally and briefly place hand(s) on knees or thighs for support and is somewhat slow |
2 |
|
|
no difficulty; no compensatory maneuver necessary |
3 |
|
Ability to Sit-Up |
Ability |
Points |
|---|---|---|
|
hands on thighs, with counterbalance |
unable |
0 |
|
|
able |
1 |
|
hands across chest, with counterbalance |
unable |
0 |
|
|
able |
1 |
|
hands behind head, with counterbalance |
unable |
0 |
|
|
able |
1 |
|
heads on thighs, without counterbalance |
unable |
0 |
|
|
able |
1 |
|
hands across chest, without counterbalance |
unable |
0 |
|
|
able |
1 |
|
hands behind head, without counterbalance |
unable |
0 |
|
|
able |
1 |
sit-up score =
= SUM(points for all 6 sit-up methods)
childhood myositis assessment scale =
= SUM(points for all 14 maneuvers)
Interpretation:
• minimum score: 0
• maximum score: 51
• The lower the score, the more severe the muscle involvement.
Specialty: Immunology/Rheumatology
