Fugl-Meyer et al developed a protocol for physical and functional assessment of a hemiplegic patient following a stroke. The examination is divided into various sections, including an assessment of the shoulder, elbow and forearm of the upper extremity. The authors are from the University of Goteborg in Sweden.
Parameters:
(1) reflex activity of flexors
(2) reflex activity of extensors
(3) shoulder retraction
(4) shoulder elevation
(5) shoulder abduction
(6) shoulder outward rotation
(7) elbow flexion
(8) forearm supination
(9) shoulder adduction and inward rotation
(10) elbow extension
(11) forearm pronation
(12) hand to lumbar spine
(13) shoulder flexion 0 to 90°
(14) supination and pronation with elbow at 90°
(15) shoulder abduction 0 to 90°
(16) shoulder flexion 90 to 180°
(17) supination and pronation with elbow at 0°
(18) normal reflex activity (scored only if 15+16+17 = 6)
Groupings:
(A.I) 1 and 2
(A.IIa, flexor synergy) 3, 4, 5, 6, 7, 8
(A.IIb, extensor synergy): 9, 10, 11
(A.III volitional motion mixng dynamic flexor and extensor synergies) 12, 13, 14
(A.IV volintional movements with little or no synergy dependence) 15, 16, 17
(A.V) 18
|
Parameter |
Finding |
Points |
|---|---|---|
|
reflex activity of flexors |
unable to perform |
0 |
|
|
partially able |
1 |
|
|
able to perform |
2 |
|
reflex activity of extensors |
unable to perform |
0 |
|
|
partially able |
1 |
|
|
able to perform |
2 |
|
shoulder retraction |
unable to perform |
0 |
|
|
partially able |
1 |
|
|
able to perform |
2 |
|
shoulder elevation |
unable to perform |
0 |
|
|
partially able |
1 |
|
|
able to perform |
2 |
|
shoulder abduction |
unable to perform |
0 |
|
|
partially able |
1 |
|
|
able to perform |
2 |
|
shoulder outward rotation |
unable to perform |
0 |
|
|
partially able |
1 |
|
|
able to perform |
2 |
|
elbow flexion |
unable to perform |
0 |
|
|
partially able |
1 |
|
|
able to perform |
2 |
|
forearm supination |
unable to perform |
0 |
|
|
partially able |
1 |
|
|
able to perform |
2 |
|
should adduction, inward rotation |
unable to perform |
0 |
|
|
partially able |
1 |
|
|
able to perform |
2 |
|
elbow extension |
unable to perform |
0 |
|
|
partially able |
1 |
|
|
able to perform |
2 |
|
forearm pronation |
unable to perform |
0 |
|
|
partially able |
1 |
|
|
able to perform |
2 |
|
hand to lumbar spine |
unable to perform |
0 |
|
|
hand passes the anterior superior lumbar spine without any gravitational "tricks" |
1 |
|
|
able to perform |
2 |
|
shoulder flexion 0 to 90° |
unable to perform |
0 |
|
|
partially able |
1 |
|
|
able to perform |
2 |
|
supination and pronation with elbow at 90° |
unable to perform |
0 |
|
|
partially able |
1 |
|
|
able to perform |
2 |
|
shoulder abduction 0 to 90° |
unable to perform |
0 |
|
|
partially able |
1 |
|
|
able to perform |
2 |
|
shoulder flexion 90 to 180° |
unable to perform |
0 |
|
|
partially able |
1 |
|
|
able to perform |
2 |
|
supination and pronation with elbow at 0° |
unable to perform |
0 |
|
|
partially able |
1 |
|
|
able to perform |
2 |
|
normal reflex activity (only if 15+16+17 = 6) |
2 or 3 markedly hyperactive |
0 |
|
|
1 markedly hyperactive OR 2+ lively |
1 |
|
|
none markedly hyperactive AND <= 1 lively |
2 |
where:
• Active motion is compared to that seen on the unaffected side.
total score =
= SUM(points for all 18 parameters)
Interpretation:
• minimum score: 0
• maximum score: 36
Purpose: To exam the shoulder, elbow and forearm of a post-stroke hemiplegic patient as part of the protocol developed by Fugl-Meyer.
Specialty: Sports Medicine & Rehabilitation, Neurology
Objective: severity, prognosis, stage, disability and performance
ICD-10: G81, I61, I62, I63, I64,
