Summary

What it measures:

Stroke Rehabilitation Assessment of Movement Measure (STREAM) provides therapists with a quantitative measurement of motor functioning and basic mobility deficits among patients who had a stroke through the performance of 30 voluntary motor tasks of the upper extremities (UE) and lower extremities (LE). The original STREAM can also be referred to as the STREAM-30. Variations were developed, STREAM-27 and STREAM-15, which contained 27 and 15 motor tasks, respectively, in order to make this measure more clinically accessible and less timely to administer. (1)

Conditions and test variations included in this summary:

This summary contains information on how to use this test in patients or clients who have had a stroke. This test does have 2 other variations, but the following information involves only STREAM-30.

Taskforce Recommendations

The STREAM is highly recommended by the StrokEDGE task force for patients in all practice settings (acute care, inpatient rehabilitation, skilled nursing facility, outpatient rehabilitation, and home health).

The STREAM is highly recommended for use in patients with acute (6 months) acuity. (10)

Clinical Insights

The STREAM outcome measure is a relatively fast test to administer, focusing on active movements of the upper and lower extremities and basic mobility skills for patients with stroke with hemiplegia. Some items on this test may be challenging to administer for patients with significant cognitive impairments or receptive aphasia, as specific movements tested for the UE and LE movements may not be innate (ie, protracting scapula in supine). However, the test permits up to 3 repetitions of the task, allowing for some ability to reattempt if task directions were not fully comprehended at first or if performance in first repetition was not maximal performance level. Limitations of this test include the presence of significant floor and ceiling effects. Patients with poor UE or LE active movement may experience basement effect on UE and/or LE subscales; however, the mobility subscale may be used independent of limb subscale to help monitor progress over the course of rehabilitation. The test may not be ideal for measuring change in patients who are ambulatory at evaluation due to the strong potential for ceiling effect. The test is best used for patients in acute or subacute settings with some ability to follow commands and for whom changes in active motor control, standing, and/or locomotion ability are expected.