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Brooke Upper Extremity Scale
Availability
Please visit this website for more information about the instrument: Brooke Upper Extremity Scale
Classification
Supplemental - Highly Recommended: Duchenne Muscular Dystrophy (DMD)
 
Supplemental: Congenital Muscular Dystrophy (CMD)
Short Description of Instrument
The Brooke Upper Extremity Scale, also known as The Brroke scale, was developed in 1981 specifically for patients with DMD. This measure is a 6-point scale that allows classification of upper extremity function and also helps document progression.
 
The scale classifies functional levels from Grade 1 (defined as the ability to abduct the arms in a full circle until they touch above the head, starting with arms at the sides) to Grade 6 (defined as the inability to raise hands to the mouth and no useful function of hands). (Gündüz et al., 2021)
Comments/Special Instructions
Additional equipment is needed to perform this test.
Scoring and Psychometric Properties
Scoring:
Functional Grades: Arms and Shoulders (Brooke et al., 1981; Jang et al., 2012)
    1. Starting with arms at the sides, the patient can abduct the arms in a full circle until they touch above the head
    2. Can raise arms above head only by flexing the elbow (shortening the circumference of the movement) or using accessory muscles
    3. Cannot raise hands above head, but can raise an 8-oz glass of water to the mouth
    4. Can raise hands to the mouth, but cannot raise an 8-oz glass of water to the mouth
    5. Cannot raise hands to the mouth, but can use hands to hold a pen or pick up pennies from the table
    6. Cannot raise hands to the mouth and has no useful function of hands
 
Psychometric Properties:
In a study by Sobierajska-Rek and colleagues (2022), there were differences among non-ambulatory DMD patients and ambulatory DMD patients. Pulmonary and Upper limb functions were within the normal range in ambulatory and low for non-ambulatory patients. Sobierajska-Rek et al. (2022) found an interdependence between the respiratory system and upper limb strength in terms of muscle strength and function in DMD patients.
 
No significant differences were found between left and right. (Houwen-van et al., 2024)
Rationale/Justification
Strengths: The scale provides easy functional classification. It is easy to assess and takes little time to complete. (Lu & Lue, 2012)
 
Weaknesses: A study by Lord et al., (1987) underlined that, "the criteria defining the functional grades of this scale do not reflect common disease stages." The Brooke scale is not as precise and detailed as other scales used to assess upper extremity function. (Bérard et al., 2005)
The Brooke scale is not appropriate for grading arm function in patients with slowly progressive DMD. (Lue et al., 2009)
"The Brooke scale provided an easy functional classification but had a limited number of grades and did not cover aspects of upper limb function that are relevant for older young males with DMD and adults." (Mayhew et al., 2013)
References
Key References:
Brooke MH, Griggs RC, Mendell JR, Fenichel GM, Shumate JB, Pellegrino RJ. Clinical trial in Duchenne dystrophy. I. The design of the protocol. Muscle Nerve. 1981;4(3):186-197.
 
Brooke MH. A Clinician's View of Neuromuscular Diseases. Baltimore, MD: Williams & Wilkins, 1977, pp. 95-109.
 
Additional References:
Bérard C, Payan C, Hodgkinson I, Fermanian J; MFM Collaborative Study Group. A motor function measure for neuromuscular diseases. Construction and validation study. Neuromuscul Disord. 2005 Jul;15(7):463-70.
 
Brooke MH, Fenichel GM, Griggs RC, Mendell JR, Moxley R, Florence J, King WM, Pandya S, Robison J, Schierbecker J, et al. Duchenne muscular dystrophy: patterns of clinical progression and effects of supportive therapy. Neurology. 1989 Apr;39(4):475-81.
 
Erdinç Gündüz N, Sertpoyraz FM, Dilek B, Şahin E, Baydan F, Tiftikcioglu Bİ, Keskin Pehlivan E, Dikici A, Zorlu Y, Akalın E, Peker Ö. The relationship between scoliosis and upper extremity functions in patients with Duchenne muscular dystrophy. Turk J Phys Med Rehabil. 2021 Mar 4;67(1):41-47.
 
Florence JM, Pandya S, King WM, Robison JD, Signore LC, Wentzell M, Province MA. Clinical trials in Duchenne dystrophy. Standardization and reliability of evaluation procedures. Phys Ther. 1984 Jan;64(1):41-5.
 
Houwen-van Opstal SLS, van der Holst M, Willemsen MAAP, Niks EH, De Groot IJM, Cup EHC. Longitudinal Course of Long Finger Flexor Shortening in Males with Duchenne Muscular Dystrophy: A Retrospective Review1. J Neuromuscul Dis. 2024;11(1):17-23.
 
Jung IY, Chae JH, Park SK, Kim JH, Kim JY, Kim SJ, Bang MS. The correlation analysis of functional factors and age with duchenne muscular dystrophy. Ann Rehabil Med. 2012 Feb;36(1):22-32.
 
Lord JP, Portwood MM, Lieberman JS, Fowler WM Jr, Berck P. Upper extremity functional rating for patients with Duchenne muscular dystrophy. Arch Phys Med Rehabil. 1987 Mar;68(3):151-4.
 
Lu Y-H & Lue Y-J. (2012). Strength and Functional Measurement for Patients with Muscular Dystrophy. In: Muscular Dystrophy. (Hedge M & Ankala A, eds.) pp. 321-30. InTech, Available from: https://cdn.intechopen.com/pdfs/36741/InTech-Strength_and_functional_measurement_for_patients_with_muscular_dystrophy.pdf
 
Lue YJ, Lin RF, Chen SS, Lu YM. Measurement of the functional status of patients with different types of muscular dystrophy. Kaohsiung J Med Sci. 2009 Jun;25(6):325-33.
 
Mayhew A, Mazzone ES, Eagle M, Duong T, Ash M, Decostre V, Vandenhauwe M, Klingels K, Florence J, Main M, Bianco F, Henrikson E, Servais L, Campion G, Vroom E, Ricotti V, Goemans N, McDonald C, Mercuri E; Performance of the Upper Limb Working Group. Development of the Performance of the Upper Limb module for Duchenne muscular dystrophy. Dev Med Child Neurol. 2013 Nov;55(11):1038-45.
 
McDonald CM, Abresch RT, Carter GT, Fowler WM Jr, Johnson ER, Kilmer DD, Sigford BJ. Profiles of neuromuscular diseases. Duchenne muscular dystrophy. Am J Phys Med Rehabil. 1995 Sep-Oct;74(5 Suppl):S70-92.
 
Servais L, Deconinck N, Moraux A, Benali M, Canal A, Van Parys F, Vereecke W, Wittevrongel S, Mayer M, Desguerre I, Maincent K, Themar-Noel C, Quijano-Roy S, Serari N, Voit T, Hogrel JY. Innovative methods to assess upper limb strength and function in non-ambulant Duchenne patients. Neuromuscul Disord. 2013 Feb;23(2):139-48.
 
Sobierajska-Rek A, Wasilewska E, Śledzińska K, Jabłońska-Brudło J, Małgorzewicz S, Wasilewski A, Szalewska D. The Association between the Respiratory System and Upper Limb Strength in Males with Duchenne Muscular Dystrophy: A New Field for Intervention? Int J Environ Res Public Health. 2022 Nov 25;19(23):15675.
 
Document last updated October 2024