Fugl-Meyer Assessment Calculator

What is the Fugl-Meyer Assessment?

The Fugl-Meyer Assessment (FMA) is a stroke-specific, performance-based impairment index originally developed by Axel Fugl-Meyer and colleagues in 1975. It is the most widely used and rigorously validated quantitative measure of sensorimotor impairment following stroke, assessing motor function, sensation, balance, joint range of motion, and pain across five domains. The Motor FMA — covering Upper Extremity (max 66) and Lower Extremity (max 34) — is the most clinically used component and is the gold standard for measuring post-stroke motor recovery in both clinical practice and research worldwide.

The Five Domains of the Full FMA

The complete Fugl-Meyer Assessment evaluates five distinct functional domains:

• Motor function — Upper extremity (max 66) and lower extremity (max 34) = 100 points total. Scored on a 3-point ordinal scale (0, 1, 2).
• Sensation — Light touch and proprioception across 8 body parts = 24 points maximum.
• Balance — Sitting and standing balance across 7 items = 14 points maximum.
• Joint range of motion — Passive ROM across 8 joints = 44 points maximum.
• Joint pain — Pain during passive ROM = 44 points maximum.

The maximum total FMA score across all 5 domains is 226 points. The Motor FMA alone (0–100) is used in most clinical and research contexts.

Upper Extremity Subscale — Item Structure

The UE Motor FMA (max 66 points) evaluates seven hierarchical movement categories based on Brunnstrom's stages of stroke recovery:

• Reflexes (4 pts) — Biceps and triceps reflex activity; scored only at initiation and resolution of recovery
• Flexor synergy (12 pts) — Shoulder retraction, elevation, abduction, external rotation; elbow flexion; forearm supination
• Extensor synergy (6 pts) — Shoulder adduction/internal rotation; elbow extension; forearm pronation
• Volitional movement (6 pts) — Hand to lumbar spine; shoulder flexion 0–90°; pronation/supination at 90° elbow flexion
• Wrist (10 pts) — Stability and flexion/extension at both 0° and 90° elbow; circumduction
• Hand (14 pts) — Mass flexion (hook grasp), lateral prehension, pincer, cylindrical, spherical grasp
• Coordination/Speed (6 pts) — Tremor, dysmetria, and speed during finger-to-nose test

Lower Extremity Subscale — Item Structure

The LE Motor FMA (max 34 points) evaluates:

• Reflexes (4 pts) — Achilles and patellar reflex
• Flexor synergy (6 pts) — Hip flexion, knee flexion, ankle dorsiflexion
• Extensor synergy (8 pts) — Hip extension/adduction, knee extension, ankle plantar flexion
• Volitional movement (8 pts) — Knee flexion and ankle dorsiflexion in sitting and standing
• Coordination/Speed (6 pts) — Tremor, dysmetria, time during heel-to-shin test
• Normal reflexes (2 pts) — Scored only if patient achieves ≥6 in volitional movement section

Psychometric Properties

• Interrater reliability: ICC = 0.97–0.99 for motor subscales (excellent)
• Test-retest reliability: ICC = 0.94–0.99 across motor subscales
• Internal consistency: Cronbach's alpha = 0.94–0.98
• MCID (UE): 9–10 points in chronic stroke; may be smaller acutely
• Content validity: Based on Brunnstrom stages — clinically meaningful progression structure

Clinical Applications

• Acute stroke — Baseline motor assessment within 72 hours of admission; predicts discharge functional outcome
• Inpatient rehabilitation — Serial assessment tracks motor recovery velocity; guides therapy intensity
• Research outcome measure — Most commonly used primary outcome in stroke motor intervention trials globally
• Neuroplasticity interventions — Benchmarks response to constraint-induced movement therapy (CIMT), robot-assisted therapy, and transcranial magnetic stimulation (TMS)
• Chronic stroke — Detects subtle gains from community-based exercise and technology-assisted rehabilitation

FMA vs Other Stroke Motor Measures

• vs FIM Score: FIM measures functional independence in ADLs (18 items, 1–7 scale); FMA measures neurological motor impairment (0–2 scale). Both are used together in stroke rehabilitation — FIM for function, FMA for impairment.
• vs Berg Balance Scale: BBS assesses balance and fall risk; FMA assesses motor recovery and synergy patterns. BBS is preferred for fall risk screening; FMA for tracking neurological recovery.
• vs Action Research Arm Test (ARAT): ARAT measures upper limb activity limitation through grasp and gross movement tasks; FMA measures impairment including synergy and reflex. ARAT is faster (15 min); FMA more comprehensive for research.
• vs Modified Ashworth Scale (MAS): MAS specifically measures spasticity; FMA assesses full motor recovery spectrum including voluntary movement, not spasticity alone.