A psychometric evaluation of the Arm Motor Ability Test.

OBJECTIVE: To further examine the psychometric properties of a 9-item version of the Arm Motor Ability Test (AMAT-9) in persons with stroke. SUBJECTS: Thirty-two community-dwelling persons > 6 months post-stroke undergoing robotics treatment (mean age = 56.0 years, time post-stroke = 4.1 years, National Institutes of Health Stroke Scale score = 4.1, and AMAT-9 score = 1.22). METHODS: Construct validity (including Rasch analyses) used baseline data prior to treatment (n = 32). Standardized response mean was calculated for subjects completing the protocol (n = 29). The Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Stroke Impact Scale (SIS) were also administered. RESULTS: Spearman-rank correlation coefficients between AMAT-9 and the WMFT, FMA, and ARAT were strong (0.78-0.79, all p < 0.001). The correlation between the AMAT-9 and SIS Hand Function sub-score was stronger than that between the AMAT-9 and the Communication sub-score (0.40, p = 0.025 and -0.16, p = 0.39, respectively). Rasch analyses provided evidence for an appropriate hierarchical structure of item difficulties, unidimensionality, and good reliability. The AMAT demonstrated a comparable standardized response mean of 0.98. CONCLUSIONS: The AMAT-9 is valid and responsive among subjects scoring in the lower range of the scale. It has the advantage of assessing function and by eliminating the standing item from the previous iteration, it may be more easily used with severely impaired patients.

Use of Nintendo(®) Wii(™) in Physical Therapy of an Adult with Lower Extremity Burns.

OBJECTIVE: The purpose of this exploratory case study is to describe differences in rehabilitation outcomes for a 47-year-old male with bilateral lower extremity burns when using conventional therapy techniques alone versus such techniques in combination with Nintendo(®) Wii™ (Nintendo of America, Inc., Redmond, WA) videogames. MATERIALS AND METHODS: The patient received three series of rehabilitation therapy over 2 weeks. During the second series, the Wii was introduced for a portion of the otherwise conventional therapy. Under standardized conditions and upon completion of each series, the Limits of Stability test with a SMART Balance Master(®) (NeuroCom(®), Clackamas, OR) was used to measure reaction time (RT), maximum excursion (MXE), endpoint excursion (EPE), movement velocity, and directional control. The Timed Up and Go (TUG) test for functional mobility and a questionnaire assessing level of motivation and interest were administered at the end of each day; these results formed mean scores for each series. RESULTS: The patient performed better on RT and MXE during the series that combined conventional therapy with the Wii than during the two series using conventional therapy alone. Improvement on EPE was greater for combined therapy than for conventional therapy alone and continued to improve after combined therapy. The patient completed the TUG test faster during the combined Wii series. Additionally, the patient reported increased motivation and interest levels for the series using combined therapy. CONCLUSIONS: The Wii may be a feasible and valuable adjunct to traditional therapy. Improvements during the series with Wii were demonstrated for areas of balance and functional mobility. Trends toward improvement in motivation and interest with the Wii suggest its use may elicit increased patient engagement during burn rehabilitation.

Clinical implications of using the arm motor ability test in stroke rehabilitation.

OBJECTIVES: To identify all published studies using the Arm Motor Ability Test (AMAT), a standardized, laboratory-based measure for selected upper extremity activities of daily living (ADLs); and to summarize its current uses and provide recommendations for its future use. DATA SOURCES: An Ovid online search was performed using the terms "Arm Motor Ability Test" and "AMAT." The reference lists of all articles obtained were reviewed for additional studies not appearing in the literature search. In addition, the original manual for the use and administration of the AMAT was reviewed. STUDY SELECTION: All studies examining the psychometric properties of the AMAT or using the AMAT as an outcome measure were identified. Articles simply mentioning the AMAT without providing data and case reports or abstracts (other than those addressing a specific aspect of the scale of interest) were excluded. DATA EXTRACTION: Studies were reviewed by the primary author. No formal system of quality review was used. DATA SYNTHESIS: The AMAT has been used as an outcome measure in stroke rehabilitation research examining upper extremity robotics, functional electrical stimulation, and cortical stimulation. The most recent version contains 10 ADL tasks, each of which is composed of 1 to 3 subtasks. Of the 3 domains originally proposed, only the "functional ability" domain is routinely assessed. Psychometric studies have demonstrated good reliability and at least reasonable construct validity. The instrument's sensitivity to change over time is less well established, and no recommendation can be made regarding a minimal clinically important difference. CONCLUSIONS: We recommend that the 10-item version of the AMAT and assessment of only the functional ability domain be adopted as standard going forward. Further research should include examination of sensitivity over time, minimal clinically important change, reliability and validity in the mid and lower range of scores, and in neurologic diagnoses other than stroke.