Objectives. (1) To develop two independent measurement scales for use as items assessing hand movements and hand activities within the Motor Assessment Scale (MAS), an existing instrument used for clinical assessment of motor performance in stroke survivors; (2) To examine the psychometric properties of these new measurement scales. Design. Scale development, followed by a multicenter observational study. Setting. Inpatient and outpatient occupational therapy programs in eight hospital and rehabilitation facilities in the United States and Canada. Participants. Patients receiving stroke rehabilitation following left (52%) or right (48%) cerebrovascular accident; mean age 64.2 years (sd 15); median 1 month since stroke onset. Intervention. Not applicable. Main Outcome Measures. Data were tested for unidimensionality and reliability, and behavioral criteria were ordered according to difficulty level with Rasch analysis. Results. The new scales assessing hand movements and hand activities met Rasch expectations of unidimensionality and reliability. Conclusion. Following a multistep process of test development, analysis, and refinement, we have redesigned the two scales that comprise the hand function items on the MAS. The hand movement scale contains an empirically validated 10-behavior hierarchy and the hand activities item contains an empirically validated 8-behavior hierarchy. 1. Introduction To maximize functional outcomes, occupational therapists and physical therapists assess and provide interventions related to gross mobility, sitting and standing balance, ambulation, and motor performance of the arm and hand. Rehabilitation clinicians use standardized assessment tools on a daily basis to determine patients’ baseline performance, guide treatment planning, monitor ongoing progress, establish recommendations for follow-up care after discharge, and evaluate the effectiveness of interventions. The Motor Assessment Scale (MAS)  provides rehabilitation clinicians and researchers with a single, quickly administered assessment of eight categories of poststroke motor function: supine-to-sidelying; supine-to-sitting; balanced sitting; sitting-to-standing; walking; upper arm function; hand movements; and advanced hand activities. Each category is scored on a 7-point scale (0–6), based on a person’s ability to perform specific tasks. The tasks in each category are intended to be hierarchical; that is, the ability to accomplish task 6 implies the ability to accomplish tasks 1 through 5. This arrangement reduces administration time and increases its appeal to
J. L. Poole and S. L. Whitney, “Motor assessment scale for stroke patients: concurrent validity and interrater reliability,” Archives of Physical Medicine and Rehabilitation, vol. 69, no. 3 I, pp. 195–197, 1988.
F. Malouin, L. Pichard, C. Bonneau, A. Durand, and D. Corriveau, “Evaluating motor recovery early after stroke: comparison of the Fugl-Meyer assessment and the motor assessment scale,” Archives of Physical Medicine and Rehabilitation, vol. 75, no. 11, pp. 1206–1212, 1994.
B. Langhammer, J. K. Stanghelle, and B. Lindmark, “An evaluation of two different exercise regimes during the first year following stroke: a randomised controlled trial,” Physiotherapy Theory and Practice, vol. 25, no. 2, pp. 55–68, 2009.
K. S. Hayward, R. N. Barker, S. G. Brauer, D. Lloyd, S. A. Horsley, and R. G. Carson, “SMART arm with outcome-triggered electrical stimulation: a pilot randomized clinical trial,” Topics in Stroke Rehabilitation, vol. 20, no. 4, pp. 289–298, 2013.
R. N. Barker, S. G. Brauer, and R. G. Carson, “Training of reaching in stroke survivors with severe and chronic upper limb paresis using a novel nonrobotic device: a randomized clinical trial,” Stroke, vol. 39, no. 6, pp. 1800–1807, 2008.
C. K. English, S. L. Hillier, K. R. Stiller, and A. Warden-Flood, “Circuit class therapy versus individual physiotherapy sessions during inpatient stroke rehabilitation: a controlled trial,” Archives of Physical Medicine and Rehabilitation, vol. 88, no. 8, pp. 955–963, 2007.
P. H. Katrak, D. Black, and V. Peeva, “Stroke rehabilitation in Australia in a freestanding inpatient rehabilitation unit compared with a unit located in an acute care hospital,” PM&R, vol. 3, no. 8, pp. 716–722, 2011.
J. H. Lee, S. B. Kim, K. W. Lee, and J. Y. Lee, “The effect of prolonged inpatient rehabilitation therapy in subacute stroke patients,” Annals of Rehabilitation Medicine, vol. 36, no. 1, pp. 16–21, 2012.
S. G. Brauer, P. G. Bew, S. S. Kuys, M. R. Lynch, and G. Morrison, “Prediction of discharge destination after stroke using the motor assessment scale on admission: a prospective, multisite study,” Archives of Physical Medicine and Rehabilitation, vol. 89, no. 6, pp. 1061–1065, 2008.
K. H. Kong, J. Lee, and K. S. Chua, “Occurrence and temporal evolution of upper limb spasticity in stroke patients admitted to a rehabilitation unit,” Archives of Physical Medicine and Rehabilitation, vol. 93, no. 1, pp. 143–148, 2012.
L. K. Kwah, L. A. Harvey, J. Diong, and R. D. Herbert, “Models containing age and NIHSS predict recovery of ambulation and upper limb function six months after stroke: an observational study,” Journal of Physiotherapy, vol. 59, no. 3, pp. 189–197, 2013.
S. L. Wolf, E. Lecraw, L. A. Barton, and B. B. Jann, “Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients,” Experimental Neurology, vol. 104, no. 2, pp. 125–132, 1989.
B. Kopp, A. Kunkel, H. Flor et al., “The arm motor ability test: reliability, validity, and sensitivity to change of an instrument for assessing disabilities in activities of daily living,” Archives of Physical Medicine and Rehabilitation, vol. 78, no. 6, pp. 615–620, 1997.
R. C. Lyle, “A performance test for assessment of upper limb function in physical rehabilitation treatment and research,” International Journal of Rehabilitation Research, vol. 4, no. 4, pp. 483–492, 1981.
P. W. Duncan, D. Wallace, S. M. Lai, D. Johnson, S. Embretson, and L. J. Laster, “The stroke impact scale version 2.0: evaluation of reliability, validity, and sensitivity to change,” Stroke, vol. 30, no. 10, pp. 2131–2140, 1999.
A. R. Fugl-Meyer, L. Jaasko, and I. Leyman, “The post stroke hemiplegic patient. I. A method for evaluation of physical performance,” Scandinavian Journal of Rehabilitation Medicine, vol. 7, no. 1, pp. 13–31, 1975.
M. L. Woodbury, C. A. Velozo, L. G. Richards, P. W. Duncan, S. Studenski, and S. Lai, “Dimensionality and construct validity of the Fugl-Meyer Assessment of the upper extremity,” Archives of Physical Medicine and Rehabilitation, vol. 88, no. 6, pp. 715–723, 2007.
J. A. Nugent, K. A. Schurr, and R. D. Adams, “A dose-response relationship between amount of weight-bearing exercise and walking outcome following cerebrovascular accident,” Archives of Physical Medicine and Rehabilitation, vol. 75, no. 4, pp. 399–402, 1994.
N. A. Lannin, “Reliability, validity and factor structure of the upper limb subscale of the Motor Assessment Scale (UL-MAS) in adults following stroke,” Disability and Rehabilitation, vol. 26, no. 2, pp. 109–116, 2004.
A. Khan, C. Chien, and S. G. Brauer, “Rasch-based scoring offered more precision in differentiating patient groups in measuring upper limb function,” Journal of Clinical Epidemiology, vol. 66, no. 6, pp. 681–687, 2013.
J. S. Sabari, A. L. Lim, C. A. Velozo, L. S. Lehman, O. Kieran, and J. Lai, “Assessing arm and hand function after stroke: a validity test of the hierarchical scoring system used in the motor assessment scale for stroke,” Archives of Physical Medicine and Rehabilitation, vol. 86, no. 8, pp. 1609–1615, 2005.
K. J. Miller, A. L. Slade, J. F. Pallant, and M. P. Galea, “Evaluation of the psychometric properties of the upper limb subscales of the motor assessment scale using a Rasch analysis model,” Journal of Rehabilitation Medicine, vol. 42, no. 4, pp. 315–322, 2010.
R. L. Pickering, I. J. Hubbard, K. G. Baker, and M. W. Parsons, “Assessment of the upper limb in acute stroke: the validity of hierarchal scoring for the Motor Assessment Scale,” Australian Occupational Therapy Journal, vol. 57, no. 3, pp. 174–182, 2010.