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ARM MOTOR ABILITY TEST (AMAT) – MANUAL

Edward Taub*, Jean E. Crago*, and Karen L. McCulloch**

*Department of Psychology and Physical Therapy
University of Alabama at Birmingham 35294
**Division of Physical Therapy, University of North Carolina at Chapel Hill

Instructions to the Examiner

This test is designed to evaluate disabilities in upper extremity function in activities of
daily living (ADL) using a quantitative and a qualitative measure. The test consists of 13
ADL activities involving one to three component tasks or movement segments. As in the
case of most ADL, the components within each compound task either involve differential
contributions from the two arms, or of the distal and proximal musculature of an affected
arm, or are not of equal difficulty. This, the task components in this assessment are
measured separately. However, each compound task is performed continuously, as a unit,
without the patient’s awareness of component parcellation. One is therefore able to
quantify ADL in the manner of a laboratory test without interfering with the natural flow
of movement characteristic of everyday activity.

Measurement consists of timing each task component separately. In addition, each task
component is rated according to a scale that takes into consideration: the quality of
movement, ability to perform each component part of a compound task, task completion
and the time elapsed from the moment the examiner says “go”, until the patient
completes the activity as specified in the task description. The scale provides information
about aspects of movement that is difficult to assess quantitatively when studying a broad
range of tasks. In rating the movement the uninvolved arm can be used as one means of
assessing normality. For this purpose, one must also take into consideration which arm
was dominant prior to the onset of hemiparesis. If possible, task performance should be
videotaped for later scoring by a blinded clinician(s).

The patients should be instructed to perform test movements as well as they can without
considering the amount of time it takes (see patient instructions below). They should be
told there is a generous time limit for task performance. The tasks are to be timed, but
timing should be unobtrusive and should not in any way reflect an implied demand to
perform the tasks rapidly.

For timing the sequential components of a compound task, a multiple event stopwatch
with a memory is necessary. To reduce a patient’s awareness of timing it is preferable to
use a stopwatch whose operation is quiet, without a clearly discernable click at timing
points.

Stop and start points for timing is indicated in the task descriptions by double slash
marks.
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The timing point for the beginning of tasks that involve lifting objects from the test table
is always from lift off.

Most task components have a one-minute limit on performance time, with the exception
of component tasks 2, 12, 15, 21, 22, and 23 for which subjects have a two-minute time
limit. If a subject cannot perform a component of a task and subsequent components of
the compound task can be assessed. In such a case, time for each of the completed task
components should be recorded and timing should begin anew when the patient resumes
performance of the remaining component(s). Task components that cannot be completed
in the time allotted should be scored 60+ or 120+ (whichever is relevant).

If the patient is wearing long sleeves, they should be rolled up before the beginning of the
test.

To avoid laterality confusion on the part of the patient, it is preferable for the examiner,
while demonstrating many of the tasks, to sit side-by-side with the patient on the same
side of the table. The test object (but not the template) should be placed in front of the
examiner during the demonstration. The exceptions are the Comb Hair, Use Telephone
and Wipe Up Spilled Water Tasks, where the examiner should stand in front of the patient
during the demonstration.

Patients should not practice the task before being tested. In order to stop incipient
practice movements, the examiner should touch the patient on the paretic limb when
these are observed.

Each task should be modeled three times by the examiner at the time the instructions are
given. Three iterations are of value since some of the tasks have multiple components.
The patient may object to the second or third repetition of the task as being unnecessary.
Though the third repetition may not be necessary for some cognitively higher functioning
patients, many patients (often those who object the most) do need the repetitions to avoid
artifactually high performance times due to lack of understanding. In order that test
administration be standardized, the number of task repetitions must be controlled by
those who need a larger number of iterations. If the patient objects to the second or third
repetition, the examiner can pleasantly say that “This is the standard way the test is done
all over, so please be patient”. If the patient stops paying attention, his/her attention
should be drawn back to the task demonstration. Patients should be encouraged to ask
questions.

Some cognitively impaired patients may become confused during the performance of
some of the tasks. It is important that the examiner keep prompting them on what needs
to be done next, since this is a test of motor activity independent of cognitive status.

Some of the tasks are bilateral while some are unilateral. It is important that the patient
carries out all bilateral activities using (or attempting to use) dominant and nondominant
extremities in the roles in which they were usually employed prior to the onset of
hemiparesis.
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For unilateral tasks the paretic arm should be employed for task performance.

For directions for each of the compound bilateral tasks indicate which task component(s)
the paretic arm is to perform.

Four of the compound tasks have movement segments that involve predominant use of
the uninvolved arm. These occur in the Knife and Fork Task between Component Tasks
2 and 3, in the Use Telephone Task between Component Tasks 16 and 17, in the Put-on-
Sweater Task between Component Tasks 20 and 21, and in the Light Switch/Door Task
between Component Tasks 26 and 27. The movements, indicated in the instructions for
these tasks, should be timed separately with the multiple event stopwatch, as in the other
compound tasks, but this time should then be excluded from consideration (i.e., not added
to the time of the preceding or subsequent component tasks in arriving at a total task
time), nor should this segment be scored on the rating scales.

Use of the assessment to evaluate bilaterally involved patients would necessitate two
administrations of the battery.

The test objects employed in this evaluation are standard items and should be easily
available (A list of task items is attached). The same set of objects should be used for
each test administration; this is particularly important for successive tests with the same
patient.

Testing should be performed at a table that is approximately 54 in (137cm) wide, 30 in

(76cm) long and 29 in (73.5cm) high.

If videotaping is carried out, the testing room should be a minimum of 17 ft (5.2m) x 10

ft (3m), to allow adequate room for camera angles.

The subject’s chair should be positioned so that it is comfortable for the subject to
perform the tasks. The position of the chair legs should then be marked by sticky dots (or
in some other manner) so that the chair can be returned to the same position after it has
been move. In addition, if the test is to be administered more than once, the distance of
the front chair legs from the front table legs in the forward and sideways directions
should be measured so that the chair can be repositioned correctly on later test
administrations.

In order to assure a standard placement of test objects, a laminated template should be

taped to the test table so that its front edge is flush with the front edge of the table. The
outline of each test object should be traced on the template prior to lamination in the
position in which it should be placed. (A test template can be obtained from the address
below.)

Edward Taub, Ph.D.

Department of Psychology
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415 Campbell Hall

University of Alabama at Birmingham
Birmingham, AL 35294

Send $25 with the request to pay for the cost of tracing outlines, laminating and mailing.

This assessment contains one compound task (compound task 13 – Light Switch/Door),
which is performed while standing. When nonambulatory patients are evaluated using
this test, it should be omitted.

The following instructions should be given to each patient as an introduction each time
this evaluation is administered:

“Today we are going to take a look at how you are able to use your weaker arm.
Each of the activities you will be to asked do should be carried out to the best of
your ability. You can work on most tasks for up to a minute, but for a few of the
more difficult tasks you can take two minutes. I will tell you which task parts
have the longer two-minute time limit as we go along. If you are unable to
complete part of a task, I will help you to complete that part and then let you
finish the rest of the task by yourself. We ask that you attempt each part of the
test, even if you do not think that you can do it. If you are unable to carry out a
task, then we will go on to the next one. Again, try to make your movements as
good as possible.”
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TASK DESCRIPTIONS

Knife and Fork Task

(1)Pick up knife and fork
(2)Cut “meat” (Play-Doh) (two minute time limit)
(Switch fork into premorbid dominant hand, when necessary)
(3)Fork to mouth

Starting position: Patient seated in chair facing desk, hips against chair back, forearms
resting on lines drawn on test template 7.8 in (19.8cm) on either side of the template
midline (3 in; 5.1cm) on either side of a plate centered on the template, feet on floor. A
piece of Phay-Doh, 2 in x 3 in x ½ in (5.1cm x 7.6cm x 1.3cm), is placed in the center of
the plate with the 2 in (5.1cm) side closest to the patient, and parallel to the front edge of
the desk. Two 1 in (2.3cm) squares should be inscribed on the near side of the Play-Doh
rectangle (alond which the patient will be asked to make his/her cuts). The 1 in (2.5cm)
squares should be inscribed on the Play-Doh rectangle when it is formed in a mold (see
Task Object attached). Lines should be predrawn on the plate with a marker pen to act as
guides for placement of the Play-Doh. Prior to the start of testing, the patient should be
asked in which hands he/she used a knife and fork prior to the onset of arm dysfunction.
The knife and fork should be picked up in the same hands now, and the silverware should
be set accordingly. The utensils are placed on lines 5.8 in (14.7cm) on either side of the
template midline.

Tasks: Patient picks up knife and fork with the same hands he/she would have used prior
to the onset of hemiparesis (i.e., knife in premorbid dominant hand) Patient uses the
knife and fork to cut two 1 in (2.5cm) square pieces of (Play-Doh) meat along predrawn
lines. Patient switches the fork into the paretic hand to bring one piece of “meat” to
his/her mouth without touching the lips. Lift off of utensils ends Task 1 and begins Task
2 even if the utensils are later readjusted in the hands. Task 2 ends when the knife
touches the table. Timing of Task 3 begins when the paretic hand touches the fork.

Verbal Instructions: “Begin with both forearms resting on the outer lines on either side of
the plate on the table before you. When I say ‘go’, pick up the knife in your right/left
hand and the fork in your left/right hand. Then cut two pieces of the ‘meat’ on the plate
along the indicated lines. You can work on the cutting part of this task for up to two
minutes.”
Dominant arm paresis: “When you have completed cutting the ‘meat’, put the
knife down, switch the fork into your right/left hand, and use it to raise one piece of
‘meat’ to your mouth without touching your lips. Ready, set, go.”
Nondominant arm paresis: “When you have completed cutting the ‘meat’, put the
knife down and keeping the fork in your left/right hand, use it to raise one piece of ‘meat’
to your mouth without touching your lips. Ready, set, go.”

Scoring: Qualitative assessment should take into account: the ease with which the utensils
are positioned for use once picked up, the grip employed to hold the utensils, the
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difficulty and inaccuracy with which cutting is performed, the directness of the trajectory
of fork to mouth, whether the head moves downward substantially, when the fork is
brought to the mouth, and the fluidity and precision with which movements are
performed.

Foam “Sandwich” Task

(4)Pick up foam “sandwich”
(5)”Sandwich” to mouth

Starting position: Patient seated in chair facing desk, hips against chair back, forearms
resting on the outer lines drawn on template on either side of a plate centered on table,
feet on floor. Foam “sandwich” (4 in x 3 in)(10.2cm x 7.6cm) is placed in the center of
the plate before the patient, with the long (4 in) (10.2cm) side facing the patient. Lines
should be predrawn with a marker pen on the same plate used in the Knife and Fork Task
to act as guides for placement of the “sandwich”.

Tasks: Patient reaches for foam “sandwich” with paretic hand and grasps it between
thumb and four fingers (lumbrical grip). Patient lifts “sandwich”, turning it so that the
short end is brought to mouth within 1 in (2.5cm) of lower lip. Task 4 ends and Task 5
begins when “sandwich” is completely off plate.

Verbal instructions: “Begin with your forearms resting on the outer lines on either side of
the plate on the table in front of you. When I say ‘go’, reach for the foam ‘sandwich’
with your right/left hand. Hold the long side between your thumb and fingers like this,
with your thumb underneath and your fingers on top. [demonstrate lumbrical grip around
the near edge of the foam] Then bring the short end of the ‘sandwich’ to your mouth
without touching your lips. Ready, set, go.”

Scoring: Qualitative assessment should take into account the dexterity of the paretic
fingers, the extent to which the head moves downward when the ‘sandwich’ is brought to
the mouth, the directness of the trajectory of ‘sandwich’ to mouth, and the fluidity and
precision with which the movements are performed.

Eat with Spoon Task

(6)Pick up spoon
(7)Pick up bean with spoon
(8)Spoon to mouth

Starting position: Patient seated in chair facing desk, hips against chair back, forearms
resting on the outer lines drawn on template on either side of bowl, feet on floor. Bowl is
placed before the patient with three dried kidney beans on the bottom. Spoon is placed
on line 5.8 in (14.6cm) from the template midline on the paretic side.

Tasks: Patient picks up spoon with paretic hand. Patient picks up one kidney bean with
spoon. Patient raises the spoon within 1 in (2.5cm) of lower lip. Subject should be told
to continue with the task even if they drop the bean. Task 6 ends and Task 7 begins when
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the spoon is completely off table. Task 7 ends and Task 8 begins when bean is in spoon
and spoon has been shifted off surface of the bowl.

Verbal instructions: “Begin with both forearms resting on the outer lines drawn on the
table either side of the bowl. When I say ‘go’, pick up the spoon in your right/left hand.
Use the spoon to pick up one bean from the bowl and bring the spoon with the bean in it
to your mouth without touching your lips. If you have to, you may stabilize the bowl
with your left/right hand, but try no to do this. Make sure that you keep the bottom of the
bowl flat on the table as you work; don’t tip it to the side to get the bean. Ready, set, go.”

Scoring: Qualitative assessment should take into account the ease with which the spoon is
positioned in the hand once it is picked up, the nature of the grip on the spoon, the extent
to which the head moves downward when the spoon is brought to the mouth, the
diretness of the trajectory of spoon to mouth, whether the bean is spilled in transit, and
the fluidity and precision with which the movements are carried out. If the patient tips
the bowl in order to pick up the bean, subtract one rating step for Task 7. If the bean is
spilled in transit, subtract one rating step for Task 8.

Drink from Mug Task

(9)Grasp mug handle
(10)Mug to mouth

Starting position: Patient seated in chair facing desk, hips against chair back, forearms
resting on outer lines drawn on template on either side of mug, feet on floor. The mug is
centered on the table in front of the patient, with the mug handle oriented toward the
paretic side and parallel to the desk’s front edge.

Tasks: Patient grasps handle of mug with paretic hand. Patient raises mug to within 1 in
(2.5cm) of lower lip. Lift off ends Task 9 and begins Task 10, even if position of mug in
hand is later adjusted.

Verbal instructions: “Begin with both forearms resting on the outer lines drawn on the
table in front of you. When I say ‘go’, pick up the mug by the handle with your right/left
hand. Bring the mug to your mouth as if you were going to take a sip of water, but don’t
touch your lips. Ready, set, go.”

Scoring: Qualitative assessment should take into account the grip employed by the patient
to lift the mug, the extent to which the head moves downward when the mug is brought to
the mouth, the directness of the trajectory of mug to mouth, and the fluidity and precision
of the movements.

Hair Combing Task

(11)Pick up comb
(12)Comb hair (two minute time limit)
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Starting position: Patient seated in chair facing desk, hips against chair back, forearms
resting on outer lines drawn on template on either side of comb, feet on floor. Comb is
centered on table 6 in (15.6cm) from and parallel to the front edge. Between tests, the
comb should be kept in a jar submerged in a disinfectant solution. The comb should be
removed from the disinfectant solution while the patient is watching. In demonstrating
this task, the examiner should stand in front of the patient.

Tasks: Patient picks up comb from the table in front of him/her with the paretic hand.
Patient imitates combing (i.e., comb does not touch hair) his/her hair with three strokes in
the following order: affected side, back, unaffected side. The examiner should ask the
patient how he/she usually combs his/her hair and should permit him/her to make these
movements in the test; but there should be only one stroke for each of the three
designated areas of the head. Since the comb does not touch the hair, this task can be
performed by patients with wigs, toupees, baldness, or bouffant hairdo. Task 11 ends and
Task 12 begins when comb is completely off table. Task 12 ends when the third stroke is
completed.

Verbal instructions: “Begin with your forearm resting on the outer lines drawn on the
table in front of you. When I say ‘go’, pick up the comb from the table in front of you
with your right/left hand. Then imitate combing your hair as you usually do, combing the
right/left side first, then the back, then the left/right side. Don’t let the comb actually
touch your hair. Imitate combing each part of your head only once, so that you use just
three strokes. You can work on the combing part of the task for up to two minutes.
Remember imitate combing each part of your hair, right/left, back, and left/right, only
once for a total of three strokes. Ready, set, go.”

Scoring: Qualitative assessment should take into account the grip employed to pick up
the comb and the fluidity with which the patient combs his/her hair. If the paretic hand is
the premorbid nondominant hand take into consideration that for most normals combing
hair with the nondominant hand is somewhat awkward.

Open Jar Task

(13)Grasp jar top
(14)Open jar

Starting position: Patient seated in chair facing desk, hips against chair back, forearms
resting on outer lines drawn on template on either side of jar with twist top, feet on floor.

Tasks: Patient grasps jar with the uninvolved hand and grasps jar lid with the paretic
hand. While keeping jar on table, patient uses paretic hand to twist the jar lid until it is
visible off jar.

Verbal instructions: “Begin with both forearms resting on the outer lines on either side of
the jar in front of you. When I say ‘go’, grasp the jar with your left/right hand and use
your right/left hand to grip the jar lid. Then twist the jar lid off. Make sure you keep the
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jar on the table and hold it steady while you are doing this. Do not turn the jar with your
left/right hand; be sure to turn the lid with your right/left hand. Ready, set, go.”

Scoring: Qualitative assessment should take into account the grip employed to remove
the jar lid and the degree to which the jar bottom remains on the table and is not moved.
If the patient turns the jar with the uninvolved hand rather than twisting the lid with the
involved hand, the maximum rating for this task would be a 2.

Tie “Shoelace” Task

(15)Tie “Shoelace” (two minute time limit)

Starting position: Patient seated in chair facing desk, hips against chair back, forearms
resting on table on outer lines on either side of test board, feet on floor. Test board for
this task is tilted at a 45 degree angle and positioned 6 in (15.2cm) from and parallel to
the front edge of the table and centered on the midline of the table. The laces are untied
with the free ends pointing toward the patient.

Task: Patient ties the laces on the board in a bow as one would tie laces on a shoe. End
point is when patient pulls the two loops tight.

Verbal instructions: “Begin with your forearms resting on the outer lines on either side of
the test board in front of you. When I say ‘go’, use both hands to tie the laces on the
board in a bow. Do it just as you would tie a shoe. You can work on this for up to two
minutes. Ready, set, go.”

Scoring: Qualitative assessment should take into account the participation of both hands
in this activity, the accuracy, speed and fluidity of the movements, and the tightness and
precision of the bow tied in the laces.

Use Telephone Task

(16) Phone receiver to ear (switch phone to other hand – not recorded)
(17) Press phone number

Starting position: Patient seated in chair facing desk, hips against chair back, forearms
resting on outer 6 lines on either side of the telephone, feet on floor. Push-button phone
(unconnected) is placed at midline of table 6 in (15.2cm) from the front edge. Phone
receiver is oriented with the mouthpiece on the side of the paretic hand. Card containing
phone number to be dialed is placed on table just to one side of phone.

Tasks: Patient picks up the telephone receiver with the paretic hand and lifts it to his/her
ear. Patient switches receiver into the unaffected hand and places it against ear on that
side. Patient presses a well-spaced button sequence, 971-3468, using the paretic index
finger as examiner says each number and touches the correct button with the eraser end
of a pencil before patient presses it. Switching the phone into the unaffected hand should
be timed as a separate event, but that time should be excluded from tabulation. Replacing
the phone in the cradle is not part of the task. Timing of the Press Phone Number
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component should begin when the phone is switched into the unaffected hand. This task
should be demonstrated by the examiner when in front of the patient.

Verbal instructions: “Begin with your forearms resting on the outer lines drawn on either
side of the telephone in front of you. When I say ‘go’, pick up the telephone receiver
with your right/left hand and lift it to your ear. Then switch the receiver to your left/right
hand, place it against your left/right ear, and use your right/left forefinger to press the
number written on the card in front of you, which is 971-3468. I will say the numbers
and touch the correct buttons before you press them. Try to use your forefinger to do the
button pressing if you can. Try not to use your thumb or any other finger then your
forefinger. Ready, set, go.”

Scoring: Qualitative assessment should take into account the grip employed to pick up
the phone, the fluidity and precision with which the patient lifts the receiver to his/her
ear, and the accuracy and ease of the movements used to press the number. If the patient
does not use the index finger to press the phone number (i.e., uses thumb), subtract one
rating step for this task.

Wipe Up Spilled Water Task

(18) Wipe up spilled water
(19) Throw paper towel away

Starting position: Patient seated in chair facing desk, hips against chair back, arms in lap,
feet of floor. A folded paper towel is placed on the paretic side with its inner edge just
beyond the 14cm line. Seven ml of water are spilled at the center of the table in front of
the patient. A wastepaper basket is placed beside patient’s chair on the paretic side lined
up with the end of the desk nearest the patient.

Tasks: Patient uses the paretic arm to wipe up the spilled water with the paper towel.
Patient must make six wiping movements (three in one direction, three in the other)
between tow inner lines to either side of the midline (i.e., the lines for silverware
placement). Examiner audibly counts strokes for the patient. Patient places the paper
towel in the wastepaper basket using the paretic hand, which is already grasping it. This
task should be demonstrated when the examiner is in front of the subject. Task 18 is
completed at the end of the sixth wiping motion. Task 19 is completed when the paper
towel hits the trash can.

Verbal instructions: “When I say ‘go’, reach for the paper towel with your right/left hand.
Wipe up the spilled water on the table with the towel using six wiping movements like
this, staying between these two lines. (Demonstrate six wiping movements, while
counting). I’ll help you count, so you can keep track of the number of your movements.
It is not necessary to wipe up all the water. Leaving some water behind is perfectly all
right. Just make the six wiping movements and then put the wet paper towel in the trash
can beside your chair, using your right/left hand. Ready, set, go.”
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Scoring: Qualitative assessment should take into account how well the patient succeeds in
wiping up the water on the table, the accuracy and precision of the movements, and
whether the paper towel lands in the trash can.

Put On Sweater Task

(20) Affected arm in sleeve of sweater, sweater over affected shoulder
(Unaffected arm in other sleeve – not recorded)
(21) Button two buttons (two minute time limit)

Starting position: Patient seated on wheelchair-height exercise mat (19-20 in)(48.3-

50.8cm) high, feet on floor, sweater in lap. The sweater is folded in half lengthwise and
then in half again crosswise, and positioned with the neck toward the patient’s paretic
side. Patient’s hands are in lap on top of sweater. One should have both male and
female-type sweater closings (left over right and right over left, respectively) available
for testing persons of either sex. The patient should roll down his/her sleeves for this
task.

Tasks: Patient grasps sweater in unaffected hand, allows it to unfold with aid of the
paretic arm, and puts paretic arm through sleeve so that hand is fully uncovered and
sweater is correctly fitted over paretic shoulder. Patient then puts unaffected arm through
other sleeve and places sweater over other shoulder; she/he can make adjustments to
complete donning garment. This segment, which primarily involves unaffected limb
function, should be timed as a separate event, but should be excluded from tabulation; not
should this segment be scored on the rating scales. Once sweater is on, patient buttons
the two lower buttons using both hands. Identification of the correct buttons and
buttonholes is simplified for the patient by: (1) painting the correct buttons a color
contrasting with that of the sweater, and (2) stitching thread of contrasting color around
the correct buttonholes.

Verbal instructions: “When I say ‘go’, lift the sweater from your lap with your left/right
hand, unfold it with both hands, and put your right/left arm in the sleeve so that you can
see your entire hand below the bottom of the sleeve; then put the sweater over that
shoulder. Next put the sweater on the other arm and over the other shoulder. Then adjust
the sweater so that it fits correctly. When I say ‘go’ again, button the two lower buttons
on the front of the sweater. They are painted so that you can easily tell which are the
right ones. The buttonholes that match these buttons have colored stitching around them.
You can work on buttoning the buttons for up to two minutes. You should use both hands
to perform all parts of this task. Please do not try to use one hand when you should be
using two. We ask that you remain seated as you put the sweater on. Ready, set, go.”

Scoring: Qualitative assessment should take into account the degree to which both arms
participate in this activity (all components), the fluidity and precision of the movements,
the dexterity the patient demonstrates with the buttons, and how well the sweater is
aligned on the patient’s body after donning.
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Put On T-Shirt Task

(22) Arms in t-shirt sleeves (two minute time limit)
(23) Shirt over head (two minute time limit)
(24) Shirt straightened on body

Starting Position: Patient sits on wheelchair-height exercise mat, feet on floor, t-shirt in
lap. The t-shirt is folded in half lengthwise down the center and then in half again by
bringing the bottom edge to the top of the shirt. In the final position one half the neck
and no sleeves are showing. The t-shirt is positioned on patient’s lap with the neck to the
paretic side; patient’s hands are on top of the shirt. This task should be performed with
the sleeves rolled down. If the patient wears glasses, they should be removed before the
beginning of the task.

Tasks: Patient unfolds t-shirt with both hands and puts arms through sleeves of shirt
paretic arm first, till both hands are visible. Patient then lifts shirt over head and puts
head through neck hole. Patient pulls shirt down around waist and straightens shirt on
body with both hands. Alternate means of putting on T-shirt are not permitted.

Verbal instructions: “When I say ‘go’, take the shirt which is in your lap, unfold it using
both hands through the sleeves so that both hands are visible. Be sure to put the right/left
arm into a sleeve first. After both hands are through the sleeves, put your head through
the neck hole and use both hands to pull the shirt down around your waist so that it is
straightened on your body. Be sure to use both to unfold the t-shirt and to pull it down
and straighten it. Ready, set, go.”

Scoring: Qualitative assessment should consider the degree to which both arms
participate in the components of this activity, how well the patient directs the paretic limb
through the sleeve, how well she/he uses it to straighten the shirt on his/her body, and the
fluidity with which the movements are accomplished.

Prop On Extended Arm Task

(25) Prop on extended arm

Starting position: Patient sits centered above a taped mark on wheelchair-height exercise
mat, feet on floor, paretic hand placed palm down at a piece of tape six in (15.2cm)
beyond lateral border of patient’s paretic thigh. Fingers of paretic hand point toward
front edge of mat (to prevent patient from locking elbow and accomplishing task without
exerting muscular control) with the third finger over the tape marker. A 1 ½ in (3.8cm)
square block is placed on a tope marker on the mat 12 in (30.5cm) beyond the paretic
hand. If the patient is wearing long sleeves, it is particularly important in this task that
the sleeve on the paretic side is rolled up (to observe whether patient is locking the
elbow).

Task: Patient demonstrates the ability to prop on the extended paretic arm by reaching
across the body and picking up block on the paretic side of the body with the unaffected
arm. End point is when block leaves mat.
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Verbal instructions: “Begin with you left/right hand in your lap and your right/left hand in
line with this mark at your third finger. All the fingers on your right/left hand should be
pointed straight ahead like this (examiner demonstrates). When I say ‘go’, support your
weight with your right/left arm as you lean to the right/left and pick up the block on the
mat with your left/right hand. Do not move your right/left hand as you lean to the side.
Ready, set, go.”

Scoring: Qualitative assessment should take into account the amount of elbow bending as
weight is borne on the paretic arm, and the fluidity with which the movement is
accomplished.

The following three component tasks (26-28) should be deleted for nonambulatory
subjects.

Light Switch/Door Task

(26) Turn on light
(27) Open door
(28) Close door

Starting position: Patient stand in front of light switch which is in the up position, body
centered on light switch, hands at side. Light switch is positioned just to the side of the
doorknob of a door.

Tasks: Patient uses paretic hand to grasp light switch between thumb and forefinger
(lateral grasp) and flips it down. Patient uses paretic hand to turn doorknob and pulls
door 4 in (10.2cm) open; the specified point is marked on the floor. Patient closes door
using paretic arm till door shuts.

Verbal instructions: “When I say ‘go’, use the right/left fingers to grasp the light switch
and flip it on. Then place your arms and hands at your sides. Then when I say ‘go’, use
your right/left arm to turn the doorknob and open the door until it crosses this dot marked
on the floor. Then use the same arm to push the door closed. Ready, set, go.”

Scoring: Qualitative assessment should take into account the precision with which the
light switch is grasped and flipped, and the fluidity and precision with which all the
movements are accomplished.
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LISTS OF TEST OBJECTS AND RELATED ITEMS FOR AMAT

The test objects and related items for the AMAT are listed below in the order in which
they are used. Tasks 1 through 25 can be administered with the subject seated in a
standard chair or wheelchair at a table. It is helpful to have a template drawn on the desk
top or, preferably, on a large sheet of paper that is later laminated. The template would
then be taped flush to the font edge of the test table and could be removed after testing.
The template indicates standard test object placement. Tasks 20 through 24 involve the
donning of clothing and can be administered on a wheelchair-height exercise mat 19-20
in (48.3 – 50.2cm) high, which is standart equipment in most therapy departments. Tasks
25 can also be administered on such a mat. Tasks 26-28 require a door with a doorknob
and with a light switch in close proximity to the doorknob. Tasks 26-28 examine upper
limb function while a person is standing and, therefore, should be excluded from test
administration with nonambulatory patients.

Test Objects
Plate (plastic) – 9 ½ in (24.1cm) diameter; outlines drawn in center for:
1) “Play-Doh” rectangle – the 1 in (2.5cm) squares to be cut located on the 2 in
(5.1cm) edge closest to subject
2) Foam ‘sandwich’ – long edge facing subject

“Play-Doh” – a type of moldable material meant to simulate an easily cut piece of meat;
obtainable in most stores carrying children’s toys.

“Play-Doh” mold or box [2 in x 3 in x ½ in (high)] (5.1cm x 7.6cm x 1.3cm). Lines

should be drawn on the rim of the mold to indicate where examiner should inscribe lines
outlining the two 1 in (2.5cm) squares that subject should cut; these should be located
across one of the short (2 in; 5.1cm) sides of the rectangle.

Foam sponge or ‘sandwich’ – 3 in x 4 in x 1 in (7.6cm x 10.2cm x 2.5 cm)

Knife, fork, teaspoon

Bowl (plastic) – 5 ½ in (14cm) diameter

Dried kidney beans – three per test

Mug with handle – 12 oz (0.31 L)

Comb (women’s) with coarse teeth, 6 in (15.2cm) long; kept in a jar of 70% alcohol

Twist top jar – 2 ¾ in (6.9cm) diameter

 15

Shoelace on board – 40 in (101.6cm) lace, laced between two strips of canvas (as on
shoes) with three eyelets per side and left untied; the face of the board should be canted at
a 45 degree angle.

Push button phone – disconnected

Small container for water – 7ml demarcation; a stoppered 15ml test tube can be used

Paper towels (roll)

Waste paper basket (placed beside the desk on the subject’s affected side)

2 Cardigan sweaters (button front) – large, one each for men and women, long sleeved,
5/8 in (1.6cm) buttons

2 T-shirts – extra large, one each for men and women, short sleeved, crew neck

Wooden block, 1 ½ in (3.8cm) cube

Door with doorknob having a light switch in close proximity to the doorknob

Related Items
Desk of standard height (29-30 in) (73.7 – 76.2 cm)

Straight backed chair – seat 18 in (45.7cm) high without arm rests

Template to be taped to desk top to indicate test object placement (traced on a sheet of
paper and laminated)

Pieces of dicem (if available) to help secure plates in place

Multiple event stop watch with memory for at least four serial events

Exercise mat/board 19-20 in (48.3 – 50.8 cm) high

INSTRUCTIONS FOR THE BLINDED RATERS

All subjects have been videotaped while performing the test battery of 13 ADL activities.
Each activity involves from one to three components tasks. Nonambulatory patients
perform only 12 items, since one of the compound tasks (26-28) is performed while
standing.
 16

As a rater you will be asked to evaluate each of the components of the ADL activities for:
(1) functional ability, and (2) quality of movement. It is important that you not discuss
your specific rating decisions with the other raters after the initial training period because
this could create “false agreement”, which would confound our results. Each videotape
session begins with a two letter, multiple digit subject identifier. The letters will provide
you with two significant pieces of information. The first letter (R or L), at the beginning
of the number, indicates the arm that you are to evaluate in your ratings; the second letter
(R or L), at the end of the identifier, indicates the patient’s premorbid handedness. The
premorbid handedness is of particular importance for your consideration, as we ask the
patient to perform several activities with the affected hand that are typically carried out
by the dominant hand. If the affected hand was the nondominant hand premorbidly,
performance of these activities (hair combing, for example) may be awkward; this needs
to be taken into consideration in your rating.

When you begin the rating process you should have a score sheet with your own rater
number and a patient identifier already filled in. Make sure that the patient identifier
matches the one appearing on the screen at the start of the subject’s test session. Each
ADL activity will be followed by a short blank period, indicating that either the task has
been completed, the patient was unable to complete the task, or there was a second
attempt at the same task. We ask that you stop the videotape at each blank between-task
dividing period and take time to score the preceding task performance, using the rating
scale that has been provided. Rate each segment as best as you can according to the
criteria that are given. It is often helpful to view a task performance more than once
before assigning a rating. You can view a task performance as many times as you think it
helpful.

Please take your time rating each video. Do not rate more than two subjects at one time
when you first start rating, and then not more than three when you develop some
experience with the rating scale. Stay within the limits of your concentration, so that if
less rating in one sitting is preferable, do less. Please leave at least one hour between
rating sessions.

Again, check to make sure that the identification number on your score sheet is the same
as the number on the TV screen prior to the beginning of each session’s record. Take
careful note of the side you are to evaluate (the letter at the beginning of the number
sequence) and the premorbid handedness (the letter appearing after the number
sequence).

The far left hand column lists the components of each compound task. Each component
must be rated individually. Before viewing the tasks, it is important that you take note of
when the test administration protocol indicates that each task component ends and the
next begins (i.e., the timing points). Please study your copy of the test administration
protocol so that this is clear.

Some test tasks have to be retested, sometimes more than once, because of
misunderstanding or some other difficulty in patient performance not relevant to motor
 17

ability. The extra attempts have not been edited out of the videotape; therefore, it may be
necessary for you to grade the second or third attempt instead of the first performance
you see. This will be indicated in the left hand margin of the score sheet and/or in the
Comments column. Other notations may appear in the left hand margin or right hand
Comments column which must be taken into consideration when you rate the videotaped
performance.

Those patients who are not ambulatory unless they have a great deal of assistance will not
be tested on items 26-28. At times, other test items may be omitted for some reason.
These will be noted in the left hand margin or right hand Comments column of your score
sheet.

Using your copy of the description of the scale as a basis, please rate each task
component. Choose the number which appears most appropriate according to the
description, but select only one number for each of the scales applying to an item. Most
task components must be completed by the subject within a time limit of one minute.
However, for some task components the time limit is two minutes. The task compontents
with the longer time limit are indicated on the score sheet. They are: 2, 12, 15, 21, 22,
and 23.

There are several additional rating criteria that are task specific:
(7) Pick up bean in spoon
If the patient tips the bowl with the uninvolved hand in the attempt to pick up the bean,
subtract one point from the rating.
(14) Open jar
If the patient accomplishes the task objective by turning the jar with the uninvolved hand
rather than twisting the lid with the involved hand, the rating should be no higher than
two.
(18) Press phone number
If the patient does not use the index finger to press the phone number (using thumb
instead, for example), subtract one level from your rating.
 18

ARM MOTOR ABILITY TEST (AMAT) SCORE SHEET

Subject Code: Date:

Premorbid-handedness: Paretic arm:

Rater:

Comments:
 19

Task Time Functional Ability Comments

1. Pick up utensils* 0 1 2 3 4 5

2. Cut meat* 0 1 2 3 4 5

3. Fork to mouth 0 1 2 3 4 5

4. Pick up 'sandwich' 0 1 2 3 4 5

5. Sandwich to mouth 0 1 2 3 4 5

6. Pick up spoon 0 1 2 3 4 5

7. Bean in spoon 0 1 2 3 4 5

8. Spoon to mouth 0 1 2 3 4 5

9. Grasp mug handle 0 1 2 3 4 5

10. Mug to mouth 0 1 2 3 4 5

11. Pick up comb 0 1 2 3 4 5

12. Comb hair (2 min) 0 1 2 3 4 5

13. Grasp jar top* 0 1 2 3 4 5

14. Open jar* 0 1 2 3 4 5

15. Tie lace* 0 1 2 3 4 5

16. Phone to ear 0 1 2 3 4 5

17. Press phone # 0 1 2 3 4 5

18. Wipe up water 0 1 2 3 4 5

19. Throw away towel 0 1 2 3 4 5

20. Paretic arm in sleeve* 0 1 2 3 4 5

21. Button 2 buttons* 0 1 2 3 4 5

22. Arms in T-shirt*(2 min) 0 1 2 3 4 5

23. Shirt over head*(2 min) 0 1 2 3 4 5

24. Straighten shirt* 0 1 2 3 4 5

25. Prop on extended arm* 0 1 2 3 4 5

26. Turn on light 0 1 2 3 4 5

27. Open door 0 1 2 3 4 5

28. Close door 0 1 2 3 4 5

* Bilateral Task

Sum

Mean

Median
 20

FUNCTIONAL ABILITY SCALE

0 Does not attempt with involved arm.

1 Involved arm does not participate functionally; however, attempt is made to
use the arm. In unilateral tasks that uninvolved extremity may be used to
move the involved extremity.
2 Does, but requires assistance of uninvolved extremity for minor readjustments
or change of position, or requires more than two attempts to complete, or
accomplishes very slowly. In bilateral tasks the involved extremity may serve
only as a helper or stabilizer.
3 Does, but movement is influenced to some degree by synergy or is performed
slowly and/or with effort.
4 Does, movement is close to normal*, but slightly slower; may lack precision,
fine coordination or fluidity.
5 Does, movement appears to be normal.*

QUALITY OF MOVEMENT SCALE

0 No movement initiated.
1 Partial range movement accomplished, but:
a. Movement dominated by synergy, or there is gross incoordination between
limb segments, or extremity nonfunctional for weightbearing activities.
2 Movement accomplished, but:
a. Is influenced by synergy, or is accompanied by excessive compensatory
movements of trunk, head, or contralateral upper extremity, or lacks either
proximal control or fine motor ability, or movement performed very
slowly, or minimally able to perform weightbearing activities.
3 Some isolated movement, but:
a. Influenced to some degree by synergy, or movement with little influence
of synergy but performed slowly, or moderate incoordination and lack of
accuracy, or weightbearing activities are performed with difficulty, or
primitive grasp patterns are present.
4 Movement close to normal*, but:
a. Slightly slower, or lacks precision, fluidity or precise coordination of
movement, or able to perform weightbearing activities but with some
hesitancy or mild difficulty.
5 Normal movement*:
a. Fluid and coordinated activity, speed of movement appears within normal
limits.

(*) For the determination of normal the uninvolved limb can be utilized as an
available index for comparison, with premorbid limb dominance taken into
consideration.