Action Research Arm Test
Also known as: ARAT
The Action Research Arm Test (ARAT) is a 19-item performance-based assessment measuring upper limb function in four domains: grasp, grip, pinch, and gross movement. Developed by Roberta Lyle in 1989, the ARAT has become the standard functional assessment for upper limb recovery in stroke rehabilitation, providing detailed measurement of hand and arm coordination relevant to activities of daily living.
Key highlights
- Comprehensive assessment of hand and arm function across multiple dimensions (grasp, grip, pinch, reach) relevant to activities of daily living
- Performance-based observation of quality of movement captures compensatory patterns and true functional ability
- Sensitive to change in moderate impairment ranges, making it useful for tracking rehabilitation progress
- Validated for use in stroke and other neurological conditions with extensive research establishing responsiveness
Intuition
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How it works
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When to use it
The ARAT is indicated for stroke survivors with upper limb impairment, traumatic brain injury, spinal cord injury affecting upper extremities, and neuromuscular disorders. It is most sensitive for mild to moderate impairment; severely impaired individuals may score floor, while minimally impaired score ceiling. The test is appropriate for inpatient and outpatient rehabilitation settings.
Strengths & limitations
- Comprehensive assessment of hand and arm function across multiple dimensions (grasp, grip, pinch, reach) relevant to activities of daily living
- Performance-based observation of quality of movement captures compensatory patterns and true functional ability
- Sensitive to change in moderate impairment ranges, making it useful for tracking rehabilitation progress
- Validated for use in stroke and other neurological conditions with extensive research establishing responsiveness
- Requires significant upper limb function; floor effects for severely paretic arms and ceiling effects for nearly normal limbs
- Administration time (15-20 minutes) limits use in busy clinical settings and for fatigued patients
- Examiner training required for consistent scoring, especially distinguishing grades 1 and 2
- Does not assess fine motor control or speed of performance; slow completion may reflect different underlying deficits than poor quality
Common pitfalls
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Applications
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Frequently asked
What does an ARAT score of 40/57 indicate about a stroke survivor's recovery?
A score of 40 suggests moderate-to-good upper limb function with most tasks completable though some difficulty remains. This person likely can perform most ADLs independently but may have compensatory patterns or subtle deficits. Score trends (improvement or plateau) over time are more important than absolute values for prognosis.
How does ARAT differ from Fugl-Meyer Assessment upper limb score?
The Fugl-Meyer measures motor impairment (strength and coordination against resistance) on a larger scale; ARAT measures functional performance of purposeful tasks with objects. FMA is more sensitive to mild deficits; ARAT is more relevant to daily living but may have floor/ceiling effects. Both are valuable for comprehensive evaluation.
Can ARAT be reliably performed by telehealth without in-person assessment?
Emerging research suggests video telehealth ARAT can correlate with in-person assessment, though some precision is lost. For accurate scoring, especially of grades 1-2, in-person assessment remains preferred. Telehealth can screen for change but shouldn't replace formal baseline or clinical decision-making tests.
Is the ARAT sensitive enough to detect small improvements in chronic stroke survivors?
The ARAT is most sensitive in the acute and subacute phases when change is rapid. In chronic stroke (>6 months), improvements are smaller and may not be detectable on ARAT. Other instruments sensitive to small changes or tasks-specific measures (specific ADLs) may be more appropriate for chronic population.
Sources
- 1.Lyle, R. C. (1989). A performance test for assessment of upper limb function in physical rehabilitation treatment and research. International Journal of Rehabilitation Research, 12(6), 605-613.
- 2.Hsieh, C. L., Hsueh, I. P., Chiang, S. L., & Lin, C. H. (2007). Inter-rater reliability and validity of the action research arm test in stroke patients. Journal of Rehabilitation Medicine, 39(8), 654-660.
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ScholarGate. (2026, June 3). Action Research Arm Test. ScholarGate. https://scholargate.app/physical-therapy/action-research-arm-test