Chedoke-McMaster Stroke Assessment (CMSA) – Comprehensive Guide
1. Introduction
The Chedoke-McMaster Stroke Assessment (CMSA) is a clinical tool used to assess motor
impairment and functional activity in stroke survivors. It is divided into two main components:
Impairment Inventory (Motor recovery assessment)
Activity Inventory (Functional ability assessment)
2. Impairment Inventory (Motor Recovery Assessment)
This section evaluates the arm, hand, leg, foot, postural control, and shoulder pain using the
Brunnstrom Stages of Recovery (Stages 1-7).
Scoring System:
Each limb is scored separately from Stage 1 (Flaccid paralysis) to Stage 7 (Normal movement).
Stage Motor Recovery Level Interpretation
Stage 1 Flaccid paralysis No movement; severe impairment.
Stage 2 Spasticity begins Reflexive movement possible.
Stage 3 Spasticity peaks Movement only within synergy patterns.
Stage 4 Spasticity decreases Some movement out of synergy; improving control.
Stage 5 More independent movement Less reliance on synergy patterns.
Stage 6 Near-normal movement Coordination improves, minimal spasticity.
Stage 7 Normal movement Full recovery, no impairment.
Lower scores (1-3): Severe motor impairment.
Mid-range scores (4-5): Moderate recovery, improving control.
Higher scores (6-7): Mild or no motor impairment.
3. Activity Inventory (Functional Ability Assessment)
This section evaluates a stroke survivor’s ability to perform functional tasks, divided into:
Gross Motor Function (Rolling, sitting balance, standing balance, transfers)
Walking Function (Walking indoors, outdoors, stair climbing)
Scoring System:
Each task is rated on a 7-point ordinal scale.
Score Functional Ability Level Interpretation
1 Total Dependence Unable to perform the task.
2-3 Severe Dependence Requires significant assistance.
4-5 Moderate Independence Some assistance needed but improving.
6 Independent with Difficulty Can perform the task independently but with effort.
7 Full Independence Performs the task normally without assistance.
Low scores (1-3): Severe functional limitation; needs extensive rehab.
Mid-range scores (4-5): Moderate functional ability, requires therapy.
High scores (6-7): Near-normal to fully independent function.
4. Total Score Interpretation
The total CMSA score ranges from 12 (most severe impairment) to 84 (fully independent function).
Total Score Overall Stroke Severity Rehabilitation Focus
12 - 30 Severe Disability Intensive rehab required.
31 - 50 Moderate Disability Partial independence, therapy needed.
51 - 70 Mild Disability Good recovery, minor limitations.
71 - 84 Full Recovery Independent in all activities.
5. Case Study
Patient Profile:
Name: Mr. John Doe
Age: 67 years
Diagnosis: Left MCA ischemic stroke
Affected Side: Right hemiparesis
Time Since Stroke: 6 months
Initial CMSA Assessment:
Domain Score
Arm Stage 3
Hand Stage 2
Leg Stage 4
Domain Score
Foot Stage 4
Postural Control 3/7
Walking Function 3/7
Total Score 28/84 (Severe Disability)
Interpretation: Severe impairment requiring intensive rehabilitation with a focus on motor recovery
and functional independence.
Rehabilitation Plan:
Phase 1 (0-3 months) - Early Rehabilitation
Passive and Active-Assisted ROM Exercises
Neuromuscular Electrical Stimulation (NMES)
Mirror Therapy for Hand Recovery
Sit-to-Stand Balance Training
Gait Training with Assistive Devices
Phase 2 (3-6 months) - Functional Recovery
Task-Oriented Training (Reaching, Grasping, Lifting Objects)
Constraint-Induced Movement Therapy (CIMT) for Arm Recovery
Treadmill Training with Partial Weight Support
Functional Electrical Stimulation (FES) for Foot Drop
Dual-Task Training for Cognitive-Motor Integration
Phase 3 (6-12 months) - Advanced Motor and Functional Skills
Strength and Endurance Training
Balance Exercises (Single-Leg Stance, Dynamic Stepping)
Outdoor Walking and Stair Climbing Practice
Return to Work/Hobby Training (Adaptive Sports, Hand Dexterity Drills)
Follow-Up at 12 Months:
Total CMSA Score: 62/84 (Moderate Disability → Mild Disability)
Outcome: Increased independence, ability to walk without assistance, improved hand
function.
6. Summary
The Chedoke-McMaster Stroke Assessment (CMSA) is a reliable tool for evaluating motor
and functional recovery in stroke patients.
It provides quantitative scoring to track progress over time.
Used for rehabilitation planning, goal setting, and clinical research.
Scores guide therapy intensity, assistive device prescription, and patient discharge
planning.
Would you like to add more details on specific therapy interventions, alternative assessment tools,
or additional case studies? 🚀
