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Rehab Measures: Arm Motor Ability Test

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Full AMAT Instructions 

Title of Assessment

Arm Motor Ability Test 

Acronym

AMAT

Instrument Reviewer(s)

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

Summary Date

4/19/2016 

Purpose

To evaluate disabilities in upper extremity function in activities of daily living (ADL) using a quantitative and qualitative measure.

Description

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. This, 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).

Area of Assessment

Activities of Daily Living; Upper Extremity Function 

Body Part

Upper Extremity 

ICF Domain

Activity 

Domain

ADL 

Assessment Type

Performance Measure 

Length of Test

31 to 60 Minutes 

Time to Administer

31 to 60 minutes - AMAT-13 Version

15 to 25 minutes - AMAT-10 Version (O'Dell et al., 2011).

Number of Items

8 items, including sub-tasks – AMAT-13 Version; 23 items, including sub-tasks – AMAT-10 Version 

Equipment Required

According to Poole & Whitney (2001), needed materials include:

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

In order to assure a standard placement of test objects, a laminated template is used. This can be constructed according to directions or purchased by contacting: Edward Taub, Ph.D, Department of Psychology, 415 Campbell Hall, University of Alabama at Birmingham, Birmingham, AL 35294

Training Required

Reading an article/manual

Type of training required

Reading an Article/Manual 

Cost

Not Free 

Actual Cost

$25; A test template can be obtained from the address below:
 
Edward Taub, Ph.D, Department of Psychology, 415 Campbell Hall, University of Alabama at Birmingham, Birmingham, AL 35294

Age Range

 

Administration Mode

 

Diagnosis

Stroke 

Populations Tested

Stroke

Standard Error of Measurement (SEM)

Not Established

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.

Minimally Clinically Important Difference (MCID)

Not Established

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

Not Established

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 (Convergent/Discriminant)

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.

Face Validity

Not Established

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:

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).

Professional Association Recommendations

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 (VEDGE) 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).

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

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. doi: 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.

Year published

1997 

Instrument in PDF Format

No 
Approval Status Approved 
 
Attachments
Created at 2/21/2014 12:49 PM  by Jason Raad 
Last modified at 7/14/2016 11:28 AM  by Jason Raad