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ARAT, Courtney Matuozzi and Ashley Sandefur, MSOT005
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Transcript of 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.
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
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.
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.
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.
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:
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.
Scoring
To score a 3:
Task is performed normally: defined as appropriate grasp, arm movement components, and posture
Task is performed in < 5 seconds
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.
Scoring
To score a 3:
Task is performed normally: defined as appropriate grasp, arm movement components, and posture
Task is performed in < 5 seconds
To score a 2:
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.
Scoring
To score a 3:
Task is performed normally: defined as appropriate grasp, arm movement components, and posture
Task is performed in < 5 seconds
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
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.
Scoring
To score a 3:
Task is performed normally: defined as appropriate grasp, arm movement components, and posture
Task is performed in < 5 seconds
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
To score a 1:
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.
Scoring
To score a 3:
Task is performed normally: defined as appropriate grasp, arm movement components, and posture
Task is performed in < 5 seconds
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
To score a 1:
Partially completes the task within the 60 seconds allotted
Regardless of the quality of grasp, arm movement components, or posture
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.
Scoring
To score a 3:
Task is performed normally: defined as appropriate grasp, arm movement components, and posture
Task is performed in < 5 seconds
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
To score a 1:
Partially completes the task within the 60 seconds allotted
Regardless of the quality of grasp, arm movement components, or posture
To score a 0:
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.
Scoring
To score a 3:
Task is performed normally: defined as appropriate grasp, arm movement components, and posture
Task is performed in < 5 seconds
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
To score a 1:
Partially completes the task within the 60 seconds allotted
Regardless of the quality of grasp, arm movement components, or posture
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
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.
Tasks
19 tasks across 4 domains
Grasp (6 tasks)
Grip (4 tasks)
Pinch (6 tasks)
Gross Motor (3 tasks)
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.
Important Components For Each Domain
Normal movement pattern for each task
Scoring for each task
Object positioning
Delivery of instructions
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.
Grasp
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
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.
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
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.
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
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.
Grasp Instructions “Grasp the block [ball, sharpening
stone], lift it up, and place it on top of the shelf, then let go of it.”
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 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.
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.
Examples of Normal Movement:
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.
Abnormal Movement for Grasp:
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.
Grip
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
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.
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
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.
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
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.
Grip Instructions
“Pour the water from this cup to that other cup.”
or
“Grasp this tube [washer] and place it here [onto the peg on the plank].”
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 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.
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 Grip Domain
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.
Abnormal Movement for Grip Domain
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.
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.
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.
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
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.
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
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.
Pinch Instructions
•“Grasp the ball bearing/marble [using these fingers], lift it up, and place it in the container on top of the shelf”
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 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
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.
Abnormal Movement for Pinch
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.
Gross Movement
Requires the subject to move the hand to various positions on the head and face
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.
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
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.
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
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.
Abnormal Movement
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.
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.