Motor Grade 0: No Movement
When extremities show no movement at all, the motor grade is 0. 1
Standardized Grading Systems
Multiple validated assessment scales consistently define complete absence of movement as grade 0:
Lower Extremity Motor Function Assessment Scale
The ACC/AHA/AATS guidelines for thoracic aortic disease provide a clear 5-point scale where:
- Grade 0 = No movement 1
- Grade 1 = Flicker of movement 1
- Grade 2 = Able to bend knee to move leg 1
- Grade 3 = Unable to perform straight leg raise against gravity, but better leg movement 1
- Grade 4 = Normal movement with expected later or demonstrated ambulation 1
Fugl-Meyer Motor Assessment
The Fugl-Meyer scales, recommended by expert panels for stroke motor function assessment, use a 3-point ordinal scale where:
This grading applies to both upper extremity (FM-UE) and lower extremity (FM-LE) assessments. 1
Clinical Application
Assessment Technique
When evaluating extremities with no movement:
- Observe for any visible muscle contraction or joint motion 1
- Look specifically for even a "flicker of movement" which would upgrade the score to grade 1 1
- Test all major muscle groups systematically (shoulder, elbow, wrist, finger for upper extremity; hip, knee, ankle for lower extremity) 1
Critical Clinical Significance
A motor grade of 0 requires immediate physician notification in postoperative settings, as it may represent early and potentially reversible paralysis, particularly after thoracic aortic procedures where spinal cord perfusion is at risk. 1
Common Pitfalls to Avoid
- Do not confuse absence of voluntary movement with flaccidity - grade 0 specifically refers to no active motion, regardless of tone 1
- Ensure the patient is attempting to move - inability to follow commands due to altered mental status or language barriers requires different assessment approaches 1
- Distinguish from sensory deficits - confirm the patient understands the command and is attempting movement 1