Application of the Fugl-Meyer Assessment (FMA) and the Wolf Motor Function Test (WMFT) in the recovery of upper limb function in patients after chronic stroke: a literature review

Abstract

It is estimated that 45-75% of chronic adult stroke patients have difficulty in using the hemiparetic upper limb (MS) in their daily life activities (DLAs). Functional scales are used in the practice of rehabilitation, in the search for diagnoses and prognoses, and in evaluating response to treatment. The Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment (FMA) scales are the instruments most commonly mentioned in the literature. Objective: The aim of this study was to review the use of the WMFT and FMA scales in the recovery of upper limb function in patients after chronic stroke. Method: We searched the MedLine database (PubMed) for articles published from 2000 to 2013. The PICO method was adopted as the search strategy. The descriptors used for the search were: (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR thrombosis intracranial embolism) AND (Fugl-Meyer assessment OR wolf motor function test). Therapy/narrow was used as a search filter. Results: We found 181 studies, 89 of which were excluded because they did not meet the inclusion criteria or did not have a topic relevant to the review search. After selection by title and by abstract, 92 articles were fully read. Of these articles, 47 were excluded because they did not fulfil the search objective. All in all, 45 articles were reviewed. FMA is the tool most used and it was found that 80% of the studies applied this scale to evaluate responses to the different therapies. In these studies, the intervention most used was the Constrained Induced Therapy (CIT) (25%), followed by Robotics Therapy (22.2%). Although the WMFT was initially developed to assess the effects of CIT, nowadays this scale is used, after the application of other techniques, to assess the functional recovery of patients with stroke sequelae. In our survey, 44.4% of the studies used WMFT; of these, 35% assessed the effects of CIT, 15% assessed robotic therapy for the upper limbs, and 65% for different therapies. Conclusion: For randomized controlled trials, the FMA scale was more used to assess functional recovery in the upper limbs of chronic stroke patients, even after application of robotics therapy. However, we found that it is not the most appropriate scale to assess the same outcomes after CIT use. WMFT is the scale most widely used for functional assessment after application of CIT; it is more sensitive than FMA for bilateral therapy, and is highly applicable in virtual reality therapy.