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  2. Melbourne Assessment of Unilateral Upper Limb Function

Melbourne Assessment of Unilateral Upper Limb Function

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Purpose

The MUUL is a discriminative and evaluative measure. It is a clinician based functional performance assessment which measures the quality of unilateral upper limb movement in children with neurological conditions aged 5 to 15 years of age.

Link to Instrument

Acronym MUUL

Cost

Not Free

Diagnosis/Conditions

  • Cerebral Palsy
  • Pediatric + Adolescent Rehabilitation

Populations

Cerebral Palsy

Key Descriptions

  • Administered using the standardized directions
  • Each child's test performance is video recorded for subsequent precise scoring
  • The child is evaluated in sitting either at a table or using their usual support (i.e. wheel-chair) with an appropriate tray or table
  • Components of upper limb movement quality measured include: range of movement, target accuracy, fluency, grasp, accuracy of release, finger dexterity and speed
  • Scoring is completed for the 37 item sub-scores using a three, four or five point scale and individually defined scoring criteria for each item
  • The maximum score is 122, the minimum score is 0
  • Reported as a percentage with higher scores reflecting greater quality of upper limb movement
  • Johnson, Randall, Reddihough, Oke, Byrt, & Bach, 1994; Appendix A provides test item descriptions. Appendix B provides examples of scoring criteria. Appendix C provides the scoring sheet
  • Bourke-Taylor, 2003; Appendix I Provides an example of Melbourne Assessment of Unilateral Upper Limb Function Score Sheet and Appendix II a scoring example

Number of Items

16

Equipment Required

  • Chair appropriate for child's size
  • Table appropriate for child's size
  • Adhesive markers
  • Video camera and memory card
  • Tripod
  • Tape measure
  • Biscuit (cookie)
  • Test kit which includes: paper, single message voice output switch, three specifically sized containers (small, medium, and large), a pellet, a 25 cm ‘magic wand’, a colored cube

Time to Administer

30 minutes

10-30 minutes
Scoring takes an additional 20-30 minutes

Required Training

Reading an Article/Manual

Instrument Reviewers

Michelle A Kiger, MHS, OTR/L

ICF Domain

Body Function
Activity

Considerations

  • Cusick et al (2005): Suggests that a protocol-based self-instruction training program would be feasible in the clinical setting. This would include readings, audiovisual presentation with commentary and demonstration of administration and scoring, self-assessment of knowledge and of scoring ability. A face-to-face facilitator directed training program is not supported by this study.
  • Bourke-Taylor (2003): The Melbourne Assessment objectively measures upper-limb function as it relates to how the child actually performs functional living skills.
  • Study populations have included children with CP. This should be taken into consideration if using with other neurologic disorders.
  • The Melbourne Assessment of Unilateral Upper Limb Function has been revised and extended from the original version to The Melbourne Assessment 2 (MA2).  The new assessment has 14 test items compared to the original 16 and 30 items are scored compared to the original 37.  A child's final score on the MA2 is reported as four separate scores, one for each element of movement quality measured compared to a single total score on the original Melbourne.  The age range was expanded to include children ages 2.5 to 15 years. Randall, Imms, Carey, and Pallant (2014) reported that further studies with larger samples were needed.  Further research to determine the MCID, SEM, SDD or the MA2 is reportedly being undertaken.  The Melbourne Assessment 2 (MA2) is now available.

Cerebral Palsy

back to Populations

Standard Error of Measurement (SEM)

Cerebral Palsy: (Cusick, Vasquez, Knowles, & Wallen, 2005; n=12 trained raters and n=12 untrained raters scoring; n=9; mean age = 8.6 (31.4) years; GMFCS level I – IV; authors used a mean and SD of overall total scores)

  • SEM for trained group = 2.56%
  • SEM for untrained group = 3.37%

(Klingels, De Cock, Desloovere, Huenaerts, Molenaers, Van Nuland, Huysmans, & Feys, 2008; n=2 raters scoring; n=21; mean age = 6 years 4 months (1 year 3 months); with hemiplegic CP, authors used a mean and SD of overall total scores)

  • SEM = 2.6%

Minimal Detectable Change (MDC)

Cerebral Palsy: (Cusick et al., 2005)

  • MDC = 7.10%

(Klingels et al., 2008)

  • SDD = 8.9%
  • MDC = 7.21% (calculation used:  MDC=1.96 x SEM x √2)

Test/Retest Reliability

Cerebral Palsy: (Randall, Carlin, Chondros, & Reddihough, 2001; n=20; mean age = 9 years 10 months (2 years, 10 months))

Estimated using the Lin concordance coefficient for 2 raters (A & B)

  • Excellent test-retest reliability for total score (CCC = 0.98 and 0.97 respectively)
  • Excellent for repeat-score mean (CCC = 0.83 and 0.79 respectively)

Interrater/Intrarater Reliability

Cerebral Palsy: (Johnson, Randall, Reddihough, Oke, Byrt, & Bach, 1994; n=2 raters scoring n=20 subjects with cerebral palsy; age range 6 years to 12 years)

  • Excellent intrarater reliability (ICC = 0.80)
  • Adequate interrater reliability (ICC = 0.68)

(Randall et al., 2001)

  • Excellent intrarater reliability (ICC = 0.97)
  • Excellent interrater reliability (ICC = 0.95)

(Cusick et al., 2005)

  • Excellent interrater reliability for trained group (ICC = 0.99)
  • Excellent interrater reliability for untrained group (ICC = 0.98)

(Klingels et al., 2008)

  • Excellent interrater reliability for total score (ICC = 0.97)

(Spirtos, O’Mahony, & Malone, 2011; n=3 raters scoring n=34; mean age = 8 years 4 months; age range = 6 years 1 month to 14 years 5 months; with hemiplegic CP)

  • Excellent interrater reliability for total score (ICC = 0.96)
  • Excellent interrater reliability for fluency category (ICC=0.90)
  • Excellent interrater reliability for range of movement category (ICC=0.87)
  • Excellent interrater reliability for target accuracy category (ICC=0.77)
  • Adequate interrater reliability for range quality of movement category  (ICC=.68)
  • Individual test items scored varied from ICC=.37 to .90

Internal Consistency

Cerebral Palsy: (Randall et al., 2001)

  • Excellent internal consistency (Cronbach’s alpha = 0.96*)

(Cusick et al., 2005)

  • Excellent internal consistency for trained group (Cronbach’s alpha = 0.99*)
  • Excellent internal consistency for untrained group (Cronbach’s alpha = 0.99*)

*Scores > 0.9 may indicate redundancy

Criterion Validity (Predictive/Concurrent)

Cerebral Palsy: (Johnson et al., 1994; n=4 raters scoring n=11 subjects with cerebral palsy; age range 6 years to 12 years)

  • Excellent criterion validity correlation between clinician score and Melbourne assessment (r=0.87)

Construct Validity

Cerebral Palsy: (Bourke-Taylor, 2003, n=18; age range = 5 years to 14 years)

Convergent validity: Associations between Melbourne Assessment of Unilateral Upper Limb Function and the Pediatric Evaluation of Disability Inventory (PEDI)

  • Excellent convergent validity related to self-care (ρ=0.94)
  • Excellent convergent validity related to mobility (ρ=0.78)
  • Adequate convergent validity related to functional skills (ρ=0.72)

(Klingels et al., 2008)

Convergent validity: Correlation between Melbourne Assessment and the Quality of Upper Extremity Skills Test (QUEST)

  • Excellent convergent validity related to the Melbourne total score (r=0.83) and QUEST score on the hemiplegic side r(=0.81)
  • Excellent convergent validity related to the QUEST dissociated movements domain  (r=0.87)
  • Excellent convergent validity related to the QUEST grasp domain  (r=0.83)
  • Adequate convergent validity related to the QUEST weight bearing domain  (r=0.50)
  • Poor convergent validity related to the QUEST protective extension domain (r=0.36)

Content Validity

Children without neurological impairments: (Randall, Imms, & Carey, 2008, n=10 children 24-35 month, n=10 children 36-47 months, n=10 children 48-59 months; modified version of the Melbourne Assessment for use with 2- to 4-year-old children)

  • Content validity was established with the help of an expert panel of occupational therapists (n = 8)

Face Validity

Children without neurological impairments

(Randall et al., 2008)

  • The Modified Melbourne Assessment has face validity in children ages 2 to 4.
    • 96.6% of the participants scored 95% or above on the assessment

Bibliography

Bourke-Taylor H. Melbourne Assessment of Unilateral Upper Limb Function: construct validity and correlation with the Pediatric Evaluation of Disability Inventory. Dev Med Child Neurol. 2003;45(2):92-96.

Cusick A, Vasquez M, Knowles L, Wallen M. Effect of rater training on reliability of Melbourne Assessment of Unilateral Upper Limb Function scores. Dev Med Child Neurol. 2005;47(1):39-45.

Hoare B, Imms C, Randall M, Carey L. Linking cerebral palsy upper limb measures to the International Classification of Functioning, Disability and Health. J Rehabil Med. 2011;43(11):987-996.

Johnson LM, Randall MJ, Reddihough DS, Oke LE, Byrt TA, Bach TM. Development of a clinical assessment of quality of movement for unilateral upper-limb function. Dev Med Child Neurol. 1994;36(11):965-973.

Klingels K, De Cock P, Desloovere K, et al. Comparison of the Melbourne Assessment of Unilateral Upper Limb Function and the Quality of Upper Extremity Skills Test in hemiplegic CP. Dev Med Child Neurol. 2008;50(12):904-909.

Randall M, Carlin JB, Chondros P, Reddihough D. Reliability of the Melbourne assessment of unilateral upper limb function. Dev Med Child Neurol. 2001;43(11):761-767.

Randall M, Imms C, Carey L. Establishing validity of a modified Melbourne Assessment for children ages 2 to 4 years. Am J Occup Ther. 2008;62(4):373-383.

Randall M, Imms C, Carey LM, Pallant JF. Rasch analysis of The Melbourne Assessment of Unilateral Upper Limb Function. Dev Med Child Neurol. 2014;56(7):665-672.

Spirtos M, O'Mahony P, Malone J. Interrater reliability of the Melbourne Assessment of Unilateral Upper Limb Function for children with hemiplegic cerebral palsy. Am J Occup Ther. 2011;65(4):378-383.

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