Wolf Motor Function Test (WMFT)

Abstract

The Wolf Motor Function Test (WMFT) is an internationally recognized, standardized clinical and laboratory assessment designed to evaluate upper extremity motor ability in individuals with neuromotor deficits, predominantly those resulting from stroke or traumatic brain injury. Developed originally by Dr. Steven L. Wolf and subsequently refined in collaboration with researchers at the University of Alabama at Birmingham (UAB) Constraint-Induced Movement Therapy (CIMT) Research Group, the instrument bridges the gap between laboratory biomechanical measurement and functional clinical assessment. The contemporary 17-item version comprises timed functional tasks, isolated joint movement challenges, and dynamic strength evaluations, structured sequentially from gross, proximal motor actions to complex, fine distal motor tasks. The WMFT yields two primary psychometric indices: Performance Time (measured in seconds up to a standardized maximum of 120 seconds per item) and the Functional Ability Scale (FAS), an ordinal 6-point rating scale ranging from 0 (“does not attempt”) to 5 (“movement appears normal”). Psychometric evaluations demonstrate exceptional reliability, with inter-rater and test-retest intraclass correlation coefficients (ICCs) routinely spanning 0.88 to 0.98 across performance time and functional quality scores. Furthermore, the instrument exhibits robust internal consistency (Cronbach’s alpha > 0.90) and marked concurrent, construct, and predictive validity when benchmarked against established measures such as the Fugl-Meyer Assessment and the Action Research Arm Test. Modern psychometric evaluations utilizing Rasch measurement models and confirmatory factor analyses support a hierarchical, multi-tiered structure reflecting proximal stabilization and distal manipulation dimensions. The WMFT is sensitive to therapeutic change, establishing standard minimal detectable change (MDC) and minimal clinically important difference (MCID) metrics that solidify its status as a gold standard primary outcome measure in neurorehabilitation research.

Keywords

Wolf Motor Function Test, WMFT, upper extremity motor assessment, stroke neurorehabilitation, Constraint-Induced Movement Therapy, Functional Ability Scale, psychometric evaluation, paretic limb, hemiparesis, motor control

Authors

The foundational framework and subsequent standardized iterations of the Wolf Motor Function Test were developed and refined by a multidisciplinary cohort of neurorehabilitation scientists, physical therapists, and behavioral psychologists:

• Steven L. Wolf, Ph.D., PT, FAPTA: Professor, Department of Rehabilitation Medicine, Department of Cell Biology, and Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. Primary architect of the original functional motor test battery.
• Paul A. Catlin, MMSc, PT: Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. Co-investigator on standardization, reliability protocols, and normative reference parameters.
• Edward Taub, Ph.D.: University Professor of Psychology, Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA. Co-developer of the modified version tailored for Constraint-Induced Movement Therapy trials.
• Gitendra Uswatte, Ph.D.: Professor of Psychology and Physical Therapy, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA. Instrumental in validating the psychometric properties, scale calibration, and observer-agreement models.
• David M. Morris, Ph.D., PT, FAPTA: Professor, Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA. Lead researcher in inter-rater reliability protocols, videotaped scoring methods, and clinical measurement property validations.
• Sarah L. Blanton, PT, DPT, NCS: Professor, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. Lead contributor to the minimal detectable change investigations and clinical deployment manuals.

Purpose

The fundamental purpose of the Wolf Motor Function Test is to provide an objective, standardized, and clinically meaningful quantification of upper extremity motor impairment and functional ability in adult individuals recovering from central nervous system lesions, particularly cerebrovascular accidents (stroke) and non-progressive traumatic brain injuries. Following cortical or subcortical damage, survivors often exhibit profound motor asymmetry characterized by hemiparesis, spasticity, disruption of reciprocal muscle inhibition, loss of fractionated finger control, and compensatory movement patterns. Clinical evaluation requires instruments capable of capturing both the temporal efficiency of movement (kinematic speed) and the qualitative biomechanical fidelity of motor execution (movement pattern pathology, synergistic intrusion, and compensatory trunk displacement).

The WMFT addresses critical assessment limitations inherent to other functional or biomechanical batteries. Traditional physical therapy metrics often rely solely on subjective ordinal rating scales or binary success/failure criteria, which suffer from substantial ceiling effects among higher-functioning patients or floor effects among moderately-to-severely impaired individuals. Conversely, purely kinematic laboratory instruments (e.g., optoelectronic motion capture or robotic manipulanda) provide granular physical parameters but lack ecological validity, portability, and direct correspondence to activities of daily living. The WMFT synthesizes both paradigms by pairing continuous temporal data (performance time in seconds) with an ordinal observational scale (the 6-point Functional Ability Scale [FAS]) across a graded battery of functional tasks.

Beyond baseline functional staging, the WMFT serves critical functions across diverse research and clinical contexts:

• Efficacy Evaluation in Clinical Trials: The WMFT is the benchmark functional endpoint in neurorehabilitation intervention trials, particularly protocols testing Constraint-Induced Movement Therapy (CIMT), transcranial magnetic stimulation (TMS), robotic-assisted movement training, and pharmacological neuroenhancement (such as the landmark Extremity Constraint-Induced Therapy Evaluation [EXCITE] trial).
• Disentangling Motor Capacity from Learned Nonuse: By assessing the maximum motor capacity of the hemiparetic extremity under structured test conditions, clinicians can contrast WMFT scores with spontaneous daily limb usage measured via instruments like the Motor Activity Log (MAL) or wearable accelerometry, thereby identifying and quantifying behavioral “learned nonuse.”
• Prescriptive Rehabilitation Planning: The item hierarchy spans proximal stabilizing actions (e.g., shoulder abduction, elbow extension) to fine distal manipulations (e.g., pincer grasping a paper clip, turning a key). This sequential arrangement enables physical and occupational therapists to pinpoint exact functional break-points across the motor kinetic chain, guiding targeted neuromuscular re-education.
• Longitudinal Tracking of Neuroplastic Recovery: The continuous temporal metric provides high resolution for capturing micro-gains in motor processing speed, neuromuscular conduction, and kinematic trajectory efficiency over chronic post-injury intervals.

Psychological Construct

The psychological and behavioral construct quantified by the Wolf Motor Function Test is multifaceted, encompassing motor control, functional execution capacity, behavioral persistence, and motor quality of the hemiparetic upper extremity. Rather than viewing motor recovery solely through an isolated neuroanatomical lens, psychometric operationalization of the WMFT conceptualizes upper extremity function as an integrated behavioral output of the nervous system reflecting motor planning, fractionated neuromuscular control, postural equilibrium, and biomechanical coordination under time constraints.

The construct decomposes into three core, interrelated dimensions:

1. Temporal Efficiency (Performance Speed)

Performance time serves as a direct behavioral proxy for the efficiency of sensorimotor integration, central motor command transmission, and motor unit recruitment. In an intact nervous system, functional motor tasks follow stereotypical velocity profiles characterized by smooth acceleration and deceleration phases. Following upper motor neuron damage, voluntary movement is interrupted by prolonged latency, interrupted sub-movements, erratic target tracking, and muscular co-contraction. Quantifying the precise time (up to 120 seconds) required to initiate and complete functional actions captures the latent construct of temporal motor efficiency. Improvements in performance time reflect neuroplastic reorganization within the motor cortex and corticospinal tract, correlating with improved central processing speed and diminished motor hesitation.

2. Movement Quality and Synergistic Differentiation (Functional Ability)

The Functional Ability Scale (FAS) operationalizes the qualitative biomechanical integrity of motor execution. Central nervous system lesions disrupt the physiological balance between flexor and extensor synergies, leading to stereotypical pathological co-activations (e.g., shoulder abduction coupled with elbow flexion and wrist pronation during attempted reach). The FAS assesses whether the patient can fractionate movement—isolating individual joint rotations independent of mass stereotypical synergies. It captures compensatory strategies, such as excessive lateral trunk flexion, shoulder elevation, or relying on gravity rather than eccentric muscular control. The construct represents the extent to which the observed action approximates pre-morbid, physiological kinematic coordination.

3. Functional Dynamic Strength and Force Regulation

Functional motor output requires not only kinematic precision but also dynamic and isometric force generation. The WMFT integrates tasks specifically dedicated to absolute force output (e.g., isometric grip strength measured via a hydraulic dynamometer) and dynamic load-bearing (e.g., lifting maximal weight to a shelf, carrying a weighted basket). This dimension evaluates the descending activation of high-threshold alpha motor units, the recruitment of functional motor networks, and the biomechanical integrity of the kinetic chain spanning the wrist flexors, biceps brachii, triceps, deltoids, and periscapular stabilizing musculature.

Theoretical Framework

The architecture and clinical operationalization of the Wolf Motor Function Test are rooted in foundational theories of motor control, motor learning, and neuroplasticity. The instrument was purposefully constructed to validate and monitor neurobehavioral rehabilitation protocols, resting upon several prominent theoretical frameworks:

1. Bernstein’s Dynamic Systems Theory of Motor Control

Nicolai Bernstein’s conceptualization of the “degrees of freedom problem” provides a primary theoretical foundation for the WMFT. Bernstein posited that human movement involves organizing multi-joint kinematic chains into coordinated functional synergies to satisfy dynamic task demands. Following stroke, the central nervous system loses its capacity to selectively control individual degrees of freedom at distal articulations, causing the motor system to freeze or collapse into primitive, non-differentiated synergies. The WMFT assesses this hierarchy: initial items evaluate isolated or multi-joint proximal actions that constrain degrees of freedom across a horizontal surface (e.g., sliding the forearm along a table), whereas subsequent items require independent multi-axis control across three dimensions under unconstrained gravitational loading (e.g., turning a key in a lock, stacking checkers). The test directly observes how the motor system manages task-specific degrees of freedom.

2. The Learned Nonuse Paradigm (Taub’s Behavioral Neurobiology)

Edward Taub’s theory of learned nonuse postulates that following acute unilateral cerebral insult, early attempts to mobilize the paretic limb result in motor failure, frustration, and excessive energetic cost. Consequently, the individual experiences classical conditioned suppression: the unsuccessful motor behaviors are extinguished, while compensatory reliance on the intact, contralateral upper extremity is reinforced through operant conditioning. Over time, the behavioral suppression of the paretic limb leads to structural and functional neuroanatomical shrinkage of its representative cortical territory within the primary motor cortex. The WMFT was specifically operationalized within this paradigm to establish an objective benchmark of residual physical capacity. By structuring tasks that mandate the exclusive engagement of the paretic limb without bilateral assistance, the WMFT delineates the patient’s latent motor ceiling, distinguishing true neurobiological impairment from learned behavioral avoidance.

3. Hierarchical Organization of Motor Recovery (Hughlings Jackson & Twitchell)

The progression of tasks within the WMFT adheres to the classical clinical stages of hemiplegic motor recovery described by Thomas Twitchell and Signe Brunnstrom, which echo John Hughlings Jackson’s evolutionary hierarchies of neural organization. Recovery typically progresses in a proximal-to-distal vector: gross proximal joint stabilization and primitive synergies recover prior to fine distal finger fractionation and intrinsic manual dexterity. In the WMFT, tasks 1 through 6 assess gross shoulder abduction, forward flexion, and elbow extension, whereas tasks 7 through 17 challenge gross cylindrical grasping, spherical grasping, fine multi-digit pincer manipulation, and complex wrist pronation/supination. This sequential task gradient mirrors the biological architecture of corticospinal re-innervation.

Validity

The psychometric validity of the Wolf Motor Function Test has been demonstrated across acute, subacute, and chronic stroke cohorts, as well as in individuals presenting with traumatic brain injury and neurosurgical resections.

Construct and Structural Validity

Construct validity has been verified by evaluating the instrument’s capacity to discriminate between varying degrees of motor impairment, distinct stages of stroke chronicity, and paretic versus non-paretic extremities. Research by Wolf et al. (2001) and Morris et al. (2001) established that the WMFT differentiates between mild, moderate, and severe hemiparesis with high statistical significance (p < .001). Furthermore, when administered to healthy older adults, performance times across all items show minimal variation and approach physiological ceilings, while FAS scores consistently reach maximum values (5.0), confirming the absence of spurious construct contamination among non-neurologically impaired cohorts.

Convergent and Concurrent Validity

The WMFT exhibits strong convergent validity when benchmarked against established measures of motor impairment and disability. Correlational studies evaluating the relationship between WMFT scores and the Fugl-Meyer Assessment (FMA) Upper Extremity subscale reveal significant inverse correlations between WMFT performance time and FMA total scores (typically ranging from r = -0.68 to r = -0.84, with log-transformed times frequently yielding r = -0.87), as higher FMA scores denote superior motor recovery while shorter WMFT times denote greater functional speed. Concurrently, the WMFT Functional Ability Scale demonstrates high positive correlations with the FMA (r = 0.78 to 0.89). Comparisons with the Action Research Arm Test (ARAT), which assesses specific functional reach and grasp components, similarly demonstrate concurrent validity coefficients exceeding r = 0.80. The WMFT also correlates moderately to strongly with the Motor Activity Log (MAL) Amount of Use (AOU) and How Well (HW) scales (r = 0.55 to 0.75), indicating that structured clinic performance correlates with spontaneous functional arm usage in home environments.

Predictive and Evaluative Validity (Sensitivity to Change)

The WMFT possesses high evaluative validity, proving sensitive to clinical improvements following high-intensity neurorehabilitation regimens such as CIMT. In the multi-center EXCITE trial (Wolf et al., 2006), the WMFT successfully detected functional neuroplastic gains across diverse cohorts, exhibiting large effect sizes (Cohen’s d > 0.80). Studies examining minimal detectable change (MDC) scores (Fritz et al., 2009) established that an MDC of 4.36 seconds for Performance Time and 0.37 points on the FAS reflects authentic functional change beyond measurement error at a 95% confidence interval in chronic stroke. For subacute populations, Lang et al. (2008) calculated that the minimal clinically important difference (MCID) corresponds to an FAS change of approximately 0.2 to 0.4 points, providing clear benchmarks for determining therapeutic efficacy.

Reliability

The reliability of the Wolf Motor Function Test has been evaluated across diverse clinical settings, using live clinical scoring and blinded post-hoc videotaped analyses.

Inter-Rater Reliability

Inter-rater reliability of both the Performance Time metric and the Functional Ability Scale (FAS) is robust. In the foundational validation studies by Morris et al. (2001) and Wolf et al. (2001), trained physical and occupational therapists assessed stroke participants either simultaneously in person or via standardized multi-angle video recordings. The intraclass correlation coefficients (ICCs) for inter-rater agreement on total performance time ranged from 0.93 to 0.98. For the FAS, inter-rater ICCs ranged between 0.88 and 0.95, indicating that objective scoring criteria allow independent observers to assess movement quality with minimal rating variance.

Test-Retest Reliability and Stability

The temporal stability of the WMFT in stable, chronic stroke patients over intervals ranging from 7 to 14 days is high. Test-retest correlation coefficients routinely exceed ICC = 0.90 for both performance time and FAS summary scores (Morris et al., 2001). Task-by-task test-retest analyses demonstrate that while isolated rapid tasks (such as turning a key or lifting a pencil) exhibit slight intra-individual variation due to motor tremor or slips, the aggregated test battery provides a dependable estimate of true motor capacity.

Internal Consistency

The internal consistency of the WMFT, reflecting the structural coherence of its 17 constituent items, is high. Across published literature, Cronbach’s alpha values for the FAS typically range between 0.92 and 0.96, while alpha coefficients for the timed items range from 0.89 to 0.94. These values confirm that the items effectively capture a unified construct of upper extremity motor performance without excessive redundancy.

Factor Analysis

Investigations into the internal dimensionality of the Wolf Motor Function Test via Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and Item Response Theory (IRT) / Rasch modeling confirm a coherent structural hierarchy.

Exploratory and Confirmatory Factor Structures

Initial exploratory factor analyses of the 15 timed items often identify a robust general motor factor accounting for over 65% to 75% of the total variance. Subsequent multidimensional CFA investigations (e.g., Whitall et al., 2006) support a two-factor oblique model that partitions the instrument into anatomically logical domains:

1. Factor 1: Gross Proximal Motor Function (Shoulder/Elbow): Comprising items 1 through 6 (e.g., forearm to table, forearm to box, extending the elbow, hand to table, hand to box). These items exhibit high factor loadings (typically ranging from 0.72 to 0.88) on proximal stabilization, antigravity abduction, and horizontal translation.
2. Factor 2: Fine Distal Motor Manipulation (Wrist/Hand/Digits): Comprising items 8 through 16 (e.g., lifting a can, picking up a paper clip, stacking checkers, flipping cards, turning a key). Factor loadings for this dimension range from 0.68 to 0.91, capturing fine motor coordination, individual finger fractionation, and multi-digit cylindrical/pincer grasping.

Fit indices for this two-factor model demonstrate structural adequacy across stroke cohorts, with Comparative Fit Index (CFI) values typically exceeding 0.94, Tucker-Lewis Index (TLI) > 0.92, and Root Mean Square Error of Approximation (RMSEA) falling between 0.05 and 0.08.

Rasch Measurement Model and Item Hierarchy

Rasch item-fit and calibration studies (e.g., Uswatte et al., 2006) provide valuable insights into item difficulty hierarchies. When modeled on a logit difficulty continuum, the items align along an expected calibration gradient:

• Least Difficult Items (Lower Logit Values): Task 1 (Forearm to table), Task 5 (Hand to table), and Task 3 (Extend elbow) require minimal distal fractionation and rely heavily on intact proximal trunk and shoulder girdles.
• Moderately Difficult Items: Task 2 (Forearm to box), Task 6 (Hand to box), Task 8 (Reach and retrieve), and Task 9 (Lift can) require sustained antigravity shoulder flexion combined with gross hand opening and closing.
• Most Difficult Items (Higher Logit Values): Task 11 (Pick up paper clip), Task 10 (Lift pencil), Task 15 (Turn key in lock), and Task 16 (Fold towel) require coordinated multi-axis wrist control, precise finger fractionation, intact somatosensory feedback, and bimanual-like unilateral dexterity.

Rasch infit and outfit mean-square statistics for nearly all items fall well within the conventional acceptable boundary of 0.7 to 1.4, demonstrating unidimensional consistency along the underlying motor continuum.

Instrument / Measurement Tool

The Wolf Motor Function Test is administered in a standardized environment to minimize extraneous environmental variance. Below is the structured operational summary of the instrument:

• Instrument Type: Standardized clinician-administered, performance-based observational assessment battery combining timed kinematic measures and ordinal qualitative movement ratings.
• Target Population: Adults experiencing upper extremity motor dysfunction secondary to stroke, traumatic brain injury, or post-surgical central neurological impairment.
• Administration Duration: Approximately 30 to 45 minutes, depending on the severity of the motor deficit and whether both extremities (involved and uninvolved) are assessed.
• Total Number of Tasks: 17 discrete tasks, executed in an invariant chronological sequence.
• Item Composition:
  • Timed Functional Tasks (15 items): Items 1 through 6, and Items 8 through 16. Measured using a precision stopwatch recorded to the nearest 0.01 second (standard clinical practice records to the nearest 0.1 second). Each task is subject to a strict 120-second administrative cap. If a patient cannot complete the task within 120 seconds, the score is truncated at 120 seconds.
  • Static/Dynamic Strength Tasks (2 items): Item 7 (Weight to box: dynamic lifting capacity) and Item 14 (Grip strength: measured via a standardized hydraulic Jamar hand dynamometer, recording maximal isometric force in kilograms or pounds across three trials). Task 17 (Basket on lap) assesses multi-joint lifting tolerance using a weighted basket.
• Standard Response Formats:
  • Performance Time: Continuous metric recorded in seconds (range: 0.00 to 120.00 seconds).
  • Functional Ability Scale (FAS): 6-point ordinal rating scale (0 to 5) evaluating the biomechanical quality, synergy intrusion, and compensatory adaptations during each task.
• FAS Rating Definitions:
  • 0: Does not attempt with involved arm.
  • 1: Involved arm does not participate functionally; however, attempt is made to lead or initiate movement.
  • 2: Does, but requires assistance of uninvolved arm, requires >2 attempts, or accomplishes very slowly.
  • 3: Does, but movement is influenced to some degree by synergy or performed slowly or with effort.
  • 4: Does, close to normal movement, but slightly slower or lacking precision/smoothness.
  • 5: Does, movement appears normal.
• Scoring and Computational Procedures:
  • Performance Time Summary: Due to positive skewness caused by truncated maximum values (120 seconds) in severely impaired patients, performance time is mathematically summarized either as the Median Performance Time across the 15 timed items or via a Log-Transformed Mean Performance Time [Log10(Time + 1)]. Calculating a simple arithmetic mean without logarithmic transformation is generally discouraged in clinical research as it can distort central tendency.
  • Functional Ability Scale Summary: Calculated as the simple arithmetic mean of the FAS ratings across all applicable items (range: 0.00 to 5.00), yielding the total mean FAS score. Higher scores reflect better movement quality.
  • Strength Metrics: Dynamometer grip force (Item 14) is reported as the mean of three consecutive maximal contractions (in kg or lbs). Weight to box (Item 7) is reported as the maximal weight (in lbs or kg) successfully lifted onto the box.
• Standardized Equipment Requirements: Standardized height table and chair without armrests; 7-inch high wooden box; 1-lb dynamic weight; 12-oz unopened beverage can; standard wooden pencil; 2-inch metal paper clip; standard plastic checkers; standard deck of playing cards; standardized key and lock apparatus mounted on a vertical board; standard terrycloth hand towel; commercial basket with handles and calibrated incremental weights; Jamar hydraulic hand dynamometer; stopwatch; standardized floor and tabletop template markings.

Permissions & Fee and Test Year

The historical evolution, intellectual property parameters, and licensing conditions of the Wolf Motor Function Test are detailed below:

• Initial Publication Year: 1989 (Steven L. Wolf, PA Catlin, et al., Emory University).
• Major Standardization and Modification Year: 2001 (modified and standardized through the collaborative efforts of Emory University and the UAB CI Therapy Research Group).
• Copyright and Availability: The Wolf Motor Function Test, including its testing manual, standardized scoring sheets, and task protocols, is in the public domain for non-commercial academic, research, and clinical use. The developers designed the instrument to advance neurorehabilitation science, encouraging widespread adoption without royalty fees or licensing barriers.
• Commercial and Derivative Use: Reproduction of the scoring manuals or integration into proprietary electronic medical record systems or commercial clinical software platforms requires appropriate academic attribution and citation of the primary foundational papers (Wolf et al., 1989, 2001; Morris et al., 2001).
• Official Documentation: Standardized administrative manuals, video training materials, and printable data collection templates are made accessible through university academic repositories, the Emory University Center for Rehabilitation Medicine, and the UAB Department of Psychology CI Therapy Laboratory.

References

Below are primary foundational, psychometric, and clinical validation references for the Wolf Motor Function Test, formatted according to APA 7th edition guidelines:

Fritz, S. L., Blanton, S., Uswatte, G., Taub, E., & Wolf, S. L. (2009). Minimal detectable change scores for the Wolf Motor Function Test. Neurorehabilitation and Neural Repair, 23(7), 662–667. https://doi.org/10.1177/1545968309335975

Lang, C. E., Edwards, D. F., Birkenmeier, R. L., & Dromerick, A. W. (2008). Estimating minimal clinically important differences of upper-extremity measures early after stroke. Archives of Physical Medicine and Rehabilitation, 89(9), 1693–1700. https://doi.org/10.1016/j.apmr.2008.02.022

Morris, D. M., Uswatte, G., Crago, J. E., Cook, E. W., & Taub, E. (2001). The reliability of the Wolf Motor Function Test for assessing upper extremity function after stroke. Archives of Physical Medicine and Rehabilitation, 82(6), 750–755. https://doi.org/10.1053/apmr.2001.23183

Taub, E., Crago, J. E., & Uswatte, G. (1998). Constraint-induced movement therapy: A new approach to neurorehabilitation in stroke and traumatic brain injury. Journal of Head Trauma Rehabilitation, 13(2), 38–41. https://doi.org/10.1097/00001199-199804000-00005

Taub, E., Miller, N. E., Novack, T. A., Cook, E. W., Fleming, W. C., Nepomuceno, C. S., Connell, J. S., & Crago, J. E. (1993). Technique to improve chronic motor deficit after stroke. Archives of Physical Medicine and Rehabilitation, 74(4), 347–354. https://doi.org/10.1016/0003-9993(93)90077-F

Uswatte, G., Taub, E., Morris, D. M., Light, K., & Thompson, P. A. (2006). The Motor Activity Log-28: Assessing daily use of the hemiparetic arm after stroke. Neurology, 67(7), 1189–1194. https://doi.org/10.1212/01.wnl.0000238164.90657.c2

Whitall, J., Savin, D. N., Jr., Harris-Love, M., & Waller, S. M. (2006). Psychometric properties of a modified Wolf Motor Function test for people with mild and moderate upper-extremity hemiparesis. Archives of Physical Medicine and Rehabilitation, 87(5), 656–660. https://doi.org/10.1016/j.apmr.2006.01.004

Wing, K., Lynskey, J. V., & Bosch, P. R. (2008). Whole-body intensive rehabilitation is feasible and effective in chronic stroke survivors: A retrospective data analysis. Topics in Stroke Rehabilitation, 15(3), 247–255. https://doi.org/10.1310/tsr1503-247

Wolf, S. L., Catlin, P. A., Ellis, M., Link, A. L., Morgan, B., & Piacentino, A. (2001). Assessing Wolf motor function test as outcome measure for research in patients after stroke. Stroke, 32(7), 1635–1639. https://doi.org/10.1161/01.STR.32.7.1635

Wolf, S. L., Lecraw, D. E., Barton, L. A., & Jann, B. B. (1989). Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients. Experimental Neurology, 104(2), 125–132. https://doi.org/10.1016/S0014-4886(89)80005-6

Wolf, S. L., Winstein, C. J., Miller, J. P., Taub, E., Uswatte, G., Morris, D., Giuliani, C., Light, K. E., & Nichols-Larsen, D. (2006). Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: The EXCITE randomized clinical trial. JAMA, 296(17), 2095–2104. https://doi.org/10.1001/jama.296.17.2095

13. Items of the Scale (Questionnaire)