Studies on Motor Activity Log-28 and Actual Amount of Use Test, Actual Amount of Use Test Inter-rater Reliability in Healthy Individuals: Age Dependence and Handedness

연령과 손잡이에 따른 정상인들의 Motor Activity Log-28과 Actual Amount of Use Test 연구 및 Actual Amount of Use Test의 평가자간 신뢰도연구

  • Kim, Kyeong-hyeon (Dept. of Physical Therapy, College of Medical Science, Jeonju University) ;
  • Shin, Yu-mi (Dept. of Physical Therapy, College of Medical Science, Jeonju University) ;
  • Lim, Mi-yu (Dept. of Physical Therapy, College of Medical Science, Jeonju University) ;
  • Jung, Yu-chang (Dept. of Physical Therapy, College of Medical Science, Jeonju University) ;
  • Oh, Ji-eun (Dept. of Physical Therapy, College of Medical Science, Jeonju University) ;
  • Kim, Su-jin (Dept. of Physical Therapy, College of Medical Science, Jeonju University)
  • 김경현 (전주대학교 의과학대학 물리치료학과) ;
  • 신유미 (전주대학교 의과학대학 물리치료학과) ;
  • 임미유 (전주대학교 의과학대학 물리치료학과) ;
  • 정유창 (전주대학교 의과학대학 물리치료학과) ;
  • 오지은 (전주대학교 의과학대학 물리치료학과) ;
  • 김수진 (전주대학교 의과학대학 물리치료학과)
  • Received : 2019.02.28
  • Accepted : 2019.05.13
  • Published : 2019.05.21


Background: Spontaneous use of the upper extremities on the affected side of patients with stroke is a meaningful indicator of recovery and may vary by the age or dominant hand of patients. No prior study has reported changes in actual amount of use test (AAUT) and motor activity log (MAL)-28 according to age and handedness in healthy adults, and AAUT inter-rater reliability for assessment of healthy adults. Objects: This study aimed to (1) research the differences in AAUT and MAL-28 according to age and handedness in healthy adults, and (2) determine the inter-rater reliability of the AAUT. Methods: Seventy healthy adults participated in this study. The MAL-28 was assessed by dividing 61 subjects into young right-handed ($n_1=20$), young left-handed ($n_2=21$), and older right-handed ($n_3=20$) groups. The AAUT was assessed by dividing 63 subjects into young right-handed ($n_1=25$), young left-handed ($n_2=18$), and older right-handed ($n_3=20$) groups. Student's t-test and the Wilcoxon signedrank test were used for statistical analysis. Results: The Amount of Use (AOU) scale values for each group showed no significant differences between age groups and handedness groups in the MAL-28 (p>.05). The AAUT AOU scale value showed significant differences regarding dominant handedness in the AAUT (p<.05), but no significant differences according to age (p>.05). (2) Inter-rater reliability of the AAUT was excellent, except few items (item 9, 11, and 12). Conclusion: Although both the MAL-28 and the AAUT measured how much participants used their dominant arms in healthy subjects, the AAUT only showed significantly higher dominant arm use in left hander than the right hander. In addition, the inter-rater reliability of the AAUT was excellent. Current results can be utilized as a basic information when clinicians develop rehabilitation strategies, and AAUT was shown to be a reliable evaluation tool for measurement of upper extremity use in Korean adults, based on the reliability demonstrated by this study.


  1. Bard G, Hirschberg GG. Recovery of voluntary motion in upper extremity following hemiplegia. Arch Phys Med Rehabil. 1965;46(46):567-572.
  2. Barker RN, Brauer SG. Upper limb recovery after stroke: The stroke survivors' perspective. Disabil Rehabil. 2005;27(20):1213-1223.
  3. Barker RN, Gill TJ, Brauer SG. Factors contributing to upper limb recovery after stroke: A survey of stroke survivors in Queensland Australia. Disabil Rehabil. 2007;29(13):981-989.
  4. Chen S, Wolf SL, Zhang Q, et al. Minimal detectable change of the actual amount of use test and the motor activity log: The excite trial. Neurorehabil Neural Repair. 2012;26(5):507-514.
  5. Haaland KY, Mutha PK, Rinehart JK, et al. Relationship between arm usage and instrumental activities of daily living after unilateral stroke. Arch Phys Med Rehabil. 2012;93(11):1957-1962.
  6. Han CE, Kim S, Chen S, et al. Quantifying arm nonuse in individuals poststroke. Neurorehabil Neural Repair. 2013;27(5):439-447.
  7. Kalisch T, Willimzig C, Kleibel N, et al. Age-related attenuation of dominant hand superiority. PLoS One. 2006;1(1):e90.
  8. Kim S, Park H, Han CE, et al. Measuring habitual arm use post-stroke with a bilateral time-constrained reaching task. Front Neurol. 2018;9:883.
  9. Lang CE, Edwards DF, Birkenmeier RL, et al. Estimating minimal clinically important differences of upper extremity measures early after stroke. Arch Phys Med Rehabil. 2008;89(9):1693-1700.
  10. Lemmens RJM, Timmermans AAA, Janssen-Potten YJM, et al. Valid and reliable instruments for arm-hand assessment at ICF activity level in persons with hemiplegia: A systematic review. BMC Neurol. 2012;12.
  11. Mayo NE, Wood-Dauphinee S, Cote R, et al. Activity, participation, and quality of life 6 months poststroke. Arch Phys Med Rehabil. 2002;83(8):1035-1042.
  12. Morris DM, Taub E, Macrina DM, et al. A method for standardizing procedures in rehabilitation: use in the extremity constraint induced therapy evaluation multisite randomized controlled trial. Arch Phys Med Rehabil. 2009;90(4):663-668.
  13. Olsen TS. Arm and leg paresis as outcome predictors in stroke rehabilitation. Stroke. 1990;21(2):247-251.
  14. Park SW, Wolf SL, Blanton S, et al. The EXCITE trial: Predicting a clinically meaningful motor activity log outcome. Neurorehabil Neural Repair. 2008;22(5):486-493.
  15. Parker VM, Wade DT, Hewer RL. Loss of arm function after stroke: Measurement, frequency, and recovery. Disabil Rehabil. 1986;8(2):69-73.
  16. Propper RE, Christman SD. Mixed- versus strong right-handedness is associated with biases towards "remember" versus "know" judgements in recognition memory: Role of interhemispheric interaction. Memory. 2004;12(6):707-714.
  17. Rand D, Eng JJ. Arm-hand use in healthy older adults. Am J Occup Ther. 2010;64(6):877-885.
  18. Rinehart JK, Singleton RD, Adair JC, et al. Arm use after left or right hemiparesis is influenced by hand preference. Stroke. 2009;40(2):545-550.
  19. Seitz RJ, Hildebold T, Simeria K. Spontaneous arm movement activity assessed by accelerometry is a marker for early recovery after stroke. J Neurol. 2011;258(3):457-63.
  20. Sterr A, Freivogel S, Schmalohr D. Neurobehavioral aspects of recovery: Assessment of the learned nonuse phenomenon in hemiparetic adolescents. Arch Phys Med Rehabil. 2002;83(12):1726-1731.
  21. Sunderland A, Tuke A. Neuroplasticity, learning and recovery after stroke: A critical evaluation of constraint-induced therapy. Neuropsychol Rehabil. 2005;15(2):81-96.
  22. Taub E, McCulloch K, Uswatte G, et al. The motor activity log (mal) Manual. Ther Res Gr. 2011:1-18.
  23. Taub E, Miller NE, Novack TA, et al. Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil. 1993;74(4):347-354.
  24. Uswatte G, Taub E, Morris D, et al. The Motor Activity Log-28: Assessing daily use of the hemiparetic arm after stroke. Neurology. 2006;67(7):1189-1194.
  25. Uswatte G, Taub E. Implications of the learned nonuse formulation for measuring rehabilitation outcomes: Lessons from constraint-induced movement therapy. Rehabil Psychol. 2005;50(1):34-42.
  26. Van Der Lee JH, Beckerman H, Knol DL, et al. Clinimetric properties of the motor activity log for the assessment of arm use in hemiparetic patients. Stroke. 2004;35(6):1410-1414.
  27. Wade DT, Langton-Hewer R, Wood VA, et al. The hemiplegic arm after stroke: Measurement and recovery. J Neurol Neurosurg Psychiatry. 1983;46(6):521-524.