Motor functions

Figure: Illustration of the first item of the grasp subtest in the Action Research Arm test.

The tests assessing the patients’ upper limbs motor functions investigate the general movement abilities of the hand via the Action Research Arm test [1, 2], the grip strength [3], the dexterity via the 9-Hole Peg test [4] the shoulder flexion and wrist extension [5]. The motor abilities of the lower limbs have been examined via the combined walking index.

The Action Research Arm test [2] assesses the ability to perform purposeful movements with the upper limb extremities. Specifically, it tests the ability to grasp, grip and pinch objects of different weights and shapes, and perform gross movements with the limb.

The Jamar Dynamometer grip strength assessment investigated patients’ grip strength. The American Society of Hand Therapists’ procedure requires patients to sit on a chair with their back straight and their feet flat on the floor. The strength score is recorded in kilograms and the total score is calculated as mean kg over the three trials [6].

The patients’ dexterity has been measured via the 9-Hole Peg test [i.e. 9HPT, 7]. The test setting includes a one-piece board with a concave folded dish containing nine pegs next to a 9-holes matrix for the pegs. Patients sit on a height-custom chair with the tabletop at midchest level. The task instructions require patients to place and remove the nine pegs one at a time and in random order as quickly as possible [4, 8]. The final score is the time in seconds elapsed from when the patients touch the first peg until the last peg is placed back into the dish.

The shoulder flexion and wrist extension assessments [5] investigate patients’ movement range of the upper limb and extremity using a goniometer. During the examination for shoulder flexion, patients are asked to raise their arm against gravity as high as they can, while sitting on the chair. During the examination for wrist flexion the patients sit with their arms on the table in a resting position and with palms down. They are asked to bend back their wrist against gravity. The movement amplitude in the two tasks is recorded as angle grades of the goniometer aligned to the shoulder and wrist respectively.

Combined walking index . To assess patients’ lower limbs ability a combined walking index has been computed [9]. The walking index combines the scores of the 10-meters walking test [i.e. 10MWT] and the Functional Independence Measure [i.e. FIM, 11] to capture the variability of maximally and minimally impaired patients.

Score Info
laragrasp Left hand grasp (ARAT)
laragrip Left hand grip (ARAT)
larapinch Left hand pinch (ARAT)
lgrip Left hand grip strength 
lpegs Left hand peg replacement  
lshflex Left shoulder flexion (AROM) 
lwrext Left wrist extension (AROM) 
raragrasp Right hand grasp (ARAT)
raragrip Right hand grip (ARAT)
rarapinch Right hand pinch (ARAT)
rgrip Right hand grip strength
rpegs Right hand peg replacement 
rshflex Right shoulder flexion (AROM)
rwrext Right wrist extension (AROM)
walk_total Walking combined score

ARAT=Action Reaction Arm total test, AROM= Active Range Of Motion


1. Addis, D.R., et al., Characterizing cerebellar activity during autobiographical memory retrieval: ALE and functional connectivity investigations. Neuropsychologia, 2016. 90: p. 80-93.

2. Lyle, R.C., A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehabil Res, 1981. 4(4): p. 483-92.

3. Demeurisse, G., O. Demol, and E. Robaye, Motor evaluation in vascular hemiplegia. Eur Neurol, 1980. 19(6): p. 382-9.

4. Oxford Grice, K., et al., Adult norms for a commercially available Nine Hole Peg Test for finger dexterity. Am J Occup Ther, 2003. 57(5): p. 570-3.

5. Dreeben-Irimia, O., Physical Therapy Clinical Handbook for PTAs. 2008: Jones & Bartlett Publishers.

6. Fess, E. and C. Moran, American Society of Hand Therapists Clinical Assessment Recommendations. 1981.

7. Kellor, M., et al., Hand strength and dexterity. Am J Occup Ther, 1971. 25(2): p. 77-83.

8. Mathiowetz, V., et al., Adult norms for the Box and Block Test of manual dexterity. Am J Occup Ther, 1985. 39(6): p. 386-91.

9. Corbetta, M., et al., Common behavioral clusters and subcortical anatomy in stroke. Neuron, 2015. 85(5): p. 927-41.

10. Wade, D.T., et al., Walking after stroke. Measurement and recovery over the first 3 months. Scand J Rehabil Med, 1987. 19(1): p. 25-30.

11. Keith, R.A., et al., The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil, 1987. 1: p. 6-18.