arat, courtney matuozzi and ashley sandefur, msot005

Action Research Arm Test (ARAT)

By: Ashley Sandefur & Courtney Matuozzi

Courtney Penn State University, State College

➢BS in Biobehavioral Health

Stanbridge University

➢MS Occupational Therapy

Ashley-California State University, Northridge

➢BS in Kinesiology

○ Minor Psychology

Stanbridge University

➢MS Occupational Therapy

Overview

Introduce Action Research Arm Test (ARAT)

ARAT kit (and how to make your own!)

Administering the ARAT

Positioning

Scoring

Tasks in the ARAT (Grasp, Grip, Pinch, and Gross Movement)

Scoring sheet

Object placement

Delivering instructions

Movements to assess

Normal vs. abnormal movements

ARATPurpose of Assessment: The purpose of the

Action Research Arm Test is to assess the client’s recovery of upper limb function following a cognitive impairment by observing the client perform various activities including grasp, grip, pinch, and gross movements (Lyle, 1981).

Tests arm motor status after stroke or TBI (both affected and non-affected side).

Lyle, R. C. (1981). "A performance test for assessment of upper limb function in physical rehabilitation treatment and research." Int J Rehabil Res 4(7333761): 483-492.

ARAT KitItems used:Stainless steel can4 Wood blocks: 10cm, 7.5cm, 5cm, 2.5cmCricket ballSharpening StoneLong & short dowels with threaded rodLong & short stainless steel tubingPlank with threaded receiversThreaded rods for tubesWasher2 Plastic cupsMarble2 Ball bearings

DIY ARAT Kit

Stainless steel can- ~$54 Wood blocks: 10cm, 7.5cm, 5cm, 2.5cm- ~$10Cricket ball- ~$7Sharpening Stone- ~$10Long & short dowels with threaded rod- ~$5Long & short stainless steel tubing- ~$5Plank with threaded receivers- ~$10Threaded rods for tubes- ~$5Washer- ~$52 Plastic cups- ~$6Marble- ~$52 Ball bearings- ~$5

Administering the ARATHierarchical order of difficulty for each domain:Hardest task in a domain tested first!

If perfect (score=3), then give top score (3) for all tasks in that domain

If score is 0-2, then proceed to second task, which is the easiest in the domain

If they score 0 on the second task, then score 0 for remaining tasks in that domain. If they score 1-3, continue with other tasks in that domain.

Approach allows for easy and rapid assessment of motor function.10-20 minutes total for ARAT score of both arms

Scoring

Each of 19 tasks rated on an ordinal 4-point scale (i.e. 0, 1, 2, or 3)

Maximum score is 57 on each side

Higher scores indicate better arm motor status

Each task is graded according to:

grasp involved

arm movement components

body posture

time to perform the task

Things to keep in mind...

Assess each arm separately

Demonstrate the task before the client performs it

For each of the 4 domains: score the good arm, then the affected arm, then go to next domain

Do not move on to the next task until the participant completes the task or the task exceeds 60 seconds to perform.

Positioning of the participant

Upright, standard chair with firm back, no armrests, comfortable, enough room for upper extremity mobility.

Table level approximates subject’s mid-abdomen, best is 30 cm between tabletop and chair seat.

Trunk must remain in contact with the back of the chair.

Head neutral and upright.

Legs in front of the chair; feet in contact with floor.

Both hands in pronated position on the table, except for ‘Gross Movement’ subscale, where hands on lap.Lyle, R. C. (1981). "A performance test for assessment of upper limb function in physical rehabilitation treatment and research." Int J Rehabil Res 4(7333761): 483-492.

Object positioning

Scoring

To score a 3:

Scoring

To score a 3:

Task is performed normally: defined as appropriate grasp, arm movement components, and posture

Task is performed in < 5 seconds

Scoring

To score a 3:

To score a 2:

Scoring

To score a 3:

To score a 2:

Task is completed but either “with great difficulty or abnormally long”

Great difficulty means either abnormal quality of the grasp, abnormal arm movement components, or abnormal body postures

Abnormally long means 5-60 seconds

Scoring

To score a 3:

To score a 2:

To score a 1:

Scoring

To score a 3:

To score a 2:

To score a 1:

Partially completes the task within the 60 seconds allotted

Regardless of the quality of grasp, arm movement components, or posture

Scoring

To score a 3:

To score a 2:

To score a 1:

To score a 0:

Scoring

To score a 3:

To score a 2:

To score a 1:

To score a 0:

Unable to perform any part of the task within the 60 seconds allotted

Thus, unable to grasp or complete any of the arm movement components

19 tasks across 4 domains

Grasp (6 tasks)

Grip (4 tasks)

Pinch (6 tasks)

Gross Motor (3 tasks)

Important Components For Each Domain

Normal movement pattern for each task

Scoring for each task

Object positioning

Delivery of instructions

Various objects (blocks, ball, stone) have to be lifted off the table up to the top of the shelf

Subject is asked to grasp, lift up, place, and release each object

6 tasks, thus 6 objects, but same instructions and scoring system

Grasp- Scoring Sheet

Start with most difficult task, grasping the 10cm block

If score = 3, then grasp domain score = 18; move to next domain

If the score is 0-2, continue to easiest task, grasping the 2.5cm block

If the score for the 2.5cm block = 0, then score 0 for remaining tasks in that domain; move to next domain

If the score for the 2.5cm block = 1-3, continue with scoring the rest of the tasks in grasp domain

Grasp: Object Position

Hand being tested placed lateral to the object

Examiner not allowed to stabilize objects

Cricket ball stabilized in a storage container

Sharpening stone placed on its narrow long side; if falls, reposition for up to 60 seconds

Grasp Instructions “Grasp the block [ball, sharpening

stone], lift it up, and place it on top of the shelf, then let go of it.”

Normal Arm & Hand Movements

Task 1-4:

Blocks displaced vertically to shelf

Hand voluntarily opens and adjusts to the size of the blocks using a grip that involves thumb and finger opposition.

Task 5:

Cricket ball is displaced vertically to shelf

Using a spherical grasp

Task 6:

Sharpening stone is displaced vertically to shelf

Use a lateral grip (three-jaw-chuck)

For all tasks, forearm alternated between a neutral position to pronation.The elbow is slightly flexed during grasp, then extends to place the object on the shelf. Shoulder flexion is needed to reach the top of the shelf and shoulder stabilization is needed to maintain the position as the object is released on top of the shelf.

Examples of Normal Movement:

Abnormal Movement for Grasp:

This domain requires the subject to:

Pour water from one cup to the other

Horizontally displace alloy tubes

Horizontally displace a washer to a bolt

Grip- Scoring Sheet

Start with most difficult task, pouring water

If score = 3, then grip domain score = 12; move to next domain

If the score is 0-2, continue to easiest task, displacing the 2.25cm (larger) alloy tube

If the score for the alloy tube = 0, then score 0 for remaining tasks in that domain; move to next domain

If the score for the alloy tube = 1-3, continue with scoring the rest of the tasks in grip domain

Grip- Object Position

Pouring Task:

Cups on each side of subject’s midline

Examiner/subject can stabilize receiving cup while pouring

Cup is filled with water half full

Alloy Tube Task:

Pegs placed on start and target positions

Washer Task:

Pegs/container placed on start and target positions

Grip Instructions

“Pour the water from this cup to that other cup.”

“Grasp this tube [washer] and place it here [onto the peg on the plank].”

Normal Arm & Hand MovementsTask 7:

Uses cylindrical grip around glass.

Forearm pronation to pour.

Forearm supination to return to table.

Task 8 & 9:

Use three-jaw-chuck or any grasp involving the pads of the thumb opposed with any pads of fingers.

Forearm is between neutral position and pronation.

Elbow extends to reach target,

Shoulder movement occurs in various directions and stabilizes while object is released.

Task 10:

Three-jaw-chuck grasp

Forearm is between neutral position and pronation.

Elbow extends to reach target,

Shoulder movement occurs in various directions and stabilizes while object is released.

Normal Movement for Grip Domain

Abnormal Movement for Grip Domain

PinchThis domain requires:

Participant’s ability to independently move the fingers in opposition to the thumb

Participants are asked to grasp marble or ball bearing from a container, lift, and release into target container atop shelf.

Pinch- Scoring Sheet

Start with most difficult task, ball bearing gripped with ring finger and thumb

If score = 3, then pinch domain score = 18; move to next domain

If the score is 0-2, continue to easiest task, marble gripped with index finger and thumb

If the score for the marble = 0, then score 0 for remaining tasks in that domain; move to next domain

If the score for the marble = 1-3, continue with scoring the rest of the tasks in pinch domain

Pinch- Object Positioning

Place container on top of the storage box/shelfPlace other container on tabletop halfway between midline and shoulderBall bearing/marble placed within lower containerHand being tested placed lateral to container

Pinch Instructions

•“Grasp the ball bearing/marble [using these fingers], lift it up, and place it in the container on top of the shelf”

Normal Hand & Arm Movements

Tasks 11, 13, 14:

Grasp requirements include opposition of pads of ring finger and thumb; middle finger and thumb; and index finger and thumb.

Tasks 12,15, 16:

Grasp requirements include opposition of pads of index finger and thumb; ring finger and thumb; and middle finger and thumb.

For all tasks in this domain, forearm is in neutral and pronation.The elbow first flexes when grasping the object and extends when reaching to the top of the shelf. Shoulder goes into flexion to reach the top of the shelf and shoulder stabilizes during release of the object.Lyle, R. C. (1981). "A performance test for assessment of upper limb function in physical rehabilitation treatment and research." Int J Rehabil Res 4(7333761): 483-492.

Normal Movement for Pinch

Abnormal Movement for Pinch

Gross Movement

Requires the subject to move the hand to various positions on the head and face

Gross Movement: Scoring Sheet

For gross movement, most difficult and easiest task collapsed into one: placing the hand behind the head

Start with the task of placing the hand behind the head

If score = 3 then gross movement domain score = 9; ARAT completed

If the total score for this subscale is 0, then score 0 for remaining tasks in that domain; ARAT completed

If the score is 1-2, then continue with scoring the rest of the tasks in the gross movement domain

Gross Movement: Object Position

Start with both hands, pronated on lap

Head kept in a neutral upright position

Subject to touch

Back of head (not neck) with the palmar hand

Top of the head (not forehead) with palmar hand

Mouth (not chin) with palmar hand

Fingers can be flexed if unable to extend/abduct the digitsLyle, R. C. (1981). "A performance test for assessment of upper limb function in physical rehabilitation treatment and research." Int J Rehabil Res 4(7333761): 483-492.

Normal Movement

Task 17:

Palmar side of hand contacts back (dorsal/posterior) side of head.

Task 18:

Palmar side of hand to top of head.

Task 19:

Palmar side of hand to mouth.

For all tasks,forearm alternates between supination and pronation. The elbow goes into full flexion. There is shoulder abduction, flexion, and external rotation.Lyle, R. C. (1981). "A performance test for assessment of upper limb function in physical rehabilitation treatment and research." Int J Rehabil Res 4(7333761): 483-492.

Normal Movement

Abnormal Movement

References

Lyle, R. C. (1981). "A performance test for assessment of upper limb function in physical rehabilitation treatment and research." International Journal of Rehabilitation and Research, 4(4), 483-492.

Yozbatiran, N., Der-Yeghiaian, L., & Cramer, S. C. (2008). A standardized approach to performing the action research arm test. Neurorehabilitation

And Neural Repair, 22(1), 78-90.

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