What is the MA2?
Melbourne Assessment 2 (MA2) is a
valid and reliable criterion-referenced test for evaluating four elements of
upper limb movement quality in children with a neurological impairment aged 2.5
to 15 years: (i) Range of movement, (ii) Accuracy of reach and placement, (iii)
Dexterity of grasp, release and manipulation and (iv) Fluency of
full test comprises 14 test items which require a child to reach to, grasp,
release and manipulate simple objects. Each child's test performance is video
recorded for subsequent scoring.
is completed across the 30 score items using a three, four or five point scale
and individually defined scoring criteria. Item scores relating to each element
of movement measured are summed within the corresponding sub-scale. A child’s
final score on the MA2 is reported as four separate scores, one for each
element of movement quality measured.
the test items and scoring criteria on the MA2 aim to be representative of the
most important components of upper limb function.
How was the MA2 developed?
MA2 was developed following further investigation of the original Melbourne
Assessment published in 1999. Further Investigations were undertaken to:
validity of the original tool for use with younger children.
lower age limit of 5 years set in development of the original Melbourne
Assessment limited the clinical and research application of the tool for
children across a broad age range and excluded younger children who are
frequently targeted to receive early intervention. The original tool had
established evidence of validity and reliability and was being reported in an
increasing number of outcome studies. Thus it was deemed of
value to investigate if a modified version of the original tool could be used
with younger children. A study was undertaken to review the tool, and
investigate face and content validity of the modified tool for use with
children aged 2 to 4 years (Randall, 2012).
measurement properties of the original scale.
Specifically the scale properties of the assessment
were investigated using methods of Rasch Analysis. Refinements to the test items
and scaling system identified the tool comprised four distinctive scales, each
measuring a separate element of upper limb movement quality (Randall, 2014).
The incorporation of modifications to extend the
original tool for use with younger children and scaling refinements have
produced the MA2.
Who can be assessed using the MA2?
MA2 can be used with children aged 2.5 to 15 years who have either a congenital
(for example, cerebral palsy) or an acquired neurological condition. The MA2 has been developed for children with a range of different movement
disorders including spasticity, dystonia, choreoathetosis and ataxia.
For children with bilateral involvement, it may be that only one upper limb is
assessed. If both upper limbs are to be assessed, each upper limb is assessed
and scored separately.
of dominant versus non-dominant limb.
For most children with congenital unilateral involvement their
non-dominant limb will be assessed. For children with unilateral involvement
resulting from an acquired neurological condition it may be either their
dominant or non-dominant limb.
NB: The test administration guidelines note
the special circumstances for excluding Item 4: Drawing Grasp for cases where
the upper limb to be assessed is the child's non-dominant limb. The score sheet
also notes to adjust the total possible score for the dexterity sub-scale when
item 4 is not completed.
What information does the MA2 provide?
elements of a child's movement to target for intervention, such as limitations
in active range of movement (ROM) or identification of muscles for surgical
one child's performance to another over time or following a specific treatment
a quantitative measure for supporting applications for funding assistance or
justification for therapy intervention
changes in an individual's performance pre- and post-intervention (such as
therapeutic, surgical, neurological and mechanical interventions)
information to parents, teachers and clinical staff as to a
child's progress in a treatment program
Who can administer and score the MA2?
administrators can be occupational therapists, physiotherapists, other allied
health professionals or researchers and medical practitioners qualified in the
assessment of upper limb motor control. It is essential that test
administrators are familiar with the tool by watching the
demonstration video provided and be knowledgeable of the equipment set up
and instructions for each test item. It is also important they understand the
components of movements scored for each item before administering the test.
of the MA2 should be experienced in observing movements of children with
neurological impairment. In addition, they need to complete the online
training and 'Test Yourself' component of the training before using the MA2
in a clinical or research setting. Scorers are also advised to establish
reliable scoring of the tool as per the recommendations provided online.
How long does the MA2 take to administer and score?
MA2 takes from 10 to 30 minutes to administer depending on the child's
age, level of ability, attention to and understanding of instructions, and
co-operation. Scoring of the video record takes a further 20 to 30 minutes
depending again on the child's co-operation and type of movement disorder and
the scorer's level of familiarity with the tool.
Prior to administering the assessment, the setting up of test equipment and
marking of the positions for the placement of the video camera takes
approximately five minutes. Packing up requires about five minutes.
younger children test administration may need to be flexible. If a younger
child loses attention or chooses not to co-operate with instructions several
short assessment sessions may be needed to complete the full assessment
however, these should be carried out within a two week period. If items need
to be presented in a varied sequence to assist in engaging and maintaining the
child's attention this is allowable as it is not the child's level or
duration of attention or level of co-operation that is being assessed rather
the quality of their upper limb movement.
About the authors
Randall is a paediatric occupational therapist who
has worked with children with neurological impairment at The Royal Children’s
Hospital, Melbourne since 1985. Melinda undertook the extension and revision of
the original Melbourne Assessment for her doctoral studies. The result of her
completed studies is the development of a revised version of the tool,
titled The Melbourne Assessment 2: a test of unilateral upper limb
Johnson is a paediatric occupational therapist with
experience in clinical, research, teaching and management roles. Lindy was
involved in the initial development of the original version of The Melbourne
Assessment in 1990-91 and maintained her interest in the assessment during her
time of working at The Royal Children’s Hospital, Melbourne from 1990 till
Reddihough is a paediatrician involved in the care of
children with multiple disabilities, particularly cerebral palsy and
developmental disability. For 25 years Dinah fulfilled the position of Director
of Developmental Medicine at The Royal Children’s Hospital, Melbourne. Dinah
has also been a key person in establishing the Victorian Cerebral Palsy
Register and is an international leader and researcher in the field of cerebral
authors would like to acknowledge the vision of the original group of
Melbourne-based clinicians who sought to construct a quantitative measure of
quality of upper limb movement for children with cerebral palsy. Also
importantly, we thank the children, families and staff who made possible the
development of the original Melbourne Assessment. Revision and further
extension of the original tool was only made possible with the valuable
Leeanne Carey, Dr. Christine Imms and Associate Professor Julie Pallant who
supervised Melinda Randall's PhD studies on the Melbourne Assessment
Wallen, Helen Bourke-Taylor, Josie Duncan, Cathy Elliot and Siobhan Reid who,
along with their respective collaborators, graciously shared de-identified
copies of Melbourne Assessment data for undertaking Rasch Analysis
- The staff, children and families of the Child Care Centre, and Departments of
Occupational Therapy, Rehabilitation and Developmental Medicine at The Royal
Children's Hospital, Melbourne without who it would not have been possible to
extend the tool for use with younger children
research undertaken to develop The Melbourne Assessment 2 was supported by
grants from The Royal Children's Hospital (Clinical Award), Faculty Health
Sciences, La Trobe University (Postgraduate Award) and the Australian
Association of Occupational Therapists (Research Award). Production of The
Melbourne Assessment 2 was supported by a grant from the Lynne Quayle
Charitable Trust Fund and the William Henry Pawsey Estate as administered by
Equity Trustees Limited.
Psychometrics of the MA and MA2
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