Axel Fugl-Meyer

Biographical Timeline

• Born October 12, 1934 in Copenhagen, Denmark.
• 1962 – Received his medical degree from the University of Copenhagen and subsequently completed a PhD there
• 1967 – Moved from Denmark to Sweden and joined the newly established Department of Medical Rehabilitation at Sahlgrenska Hospital in Gothenburg.
• 1971 – Published a series of physiological studies examining respiratory-muscle paralysis and ventilatory function in patients with traumatic spinal-cord injury. Published Effects of respiratory muscle paralysis in tetraplegic and paraplegic patients in the Scandinavian Journal of Rehabilitation Medicine.
• 1972 – Published 44-page doctoral thesis, On the ventilatory function in spinal cord transection, at the University of Gothenburg. Awarded the Swedish medical doctorate or DMSc.
• 1973 – Became docent in rehabilitation medicine at the University of Gothenburg. Served as assistant chief physician at the Sahlgrenska Department of Medical Rehabilitation and qualified as a specialist in rehabilitation medicine
• 1974 – Led the development of a quantitative method for assessing motor and physical recovery following stroke. Colleagues later described the instrument as an international gold standard in stroke rehabilitation.
• 1975 – Appointed clinical director and chief physician of the Department of Rehabilitation Medicine at Norrland University Hospital in Umeå. He helped build the rehabilitation service and developed collaborations across medicine, surgery, orthopaedics, sports medicine and the allied rehabilitation professions
• 1975 – With Lise Jääskö, Inger Leyman, Solveig Olsson and Sören Steglind, published The post-stroke hemiplegic patient. I. A method for evaluation of physical performance. The paper introduced the assessment subsequently known as the Fugl-Meyer Assessment.
• 1970s–1980s – Extended his research across muscle physiology, spinal-cord injury, stroke recovery, perception, activities of daily living and the broader conceptual aims of rehabilitation.
• 1980s–1990s – Worked particularly closely with occupational therapists and was responsible for medical rehabilitation teaching within the occupational-therapy programme at Umeå.
• 1979 – Returned to Sweden after approximately one year at the University of California, Irvine, and was appointed professor of physical and rehabilitation medicine at Umeå University.
• 1980s – Became an outspoken advocate for specialised, adequately resourced and humane rehabilitation medicine. He criticised the dilution or misuse of the term rehabilitation and argued that treatment should be directed towards goals chosen by the individual rather than determined solely by professionals.
• 1988 – With his wife, Kerstin Sjögren Fugl-Meyer, developed a self-report model for assessing overall and domain-specific life satisfaction. Life satisfaction became central to his interpretation of rehabilitation outcome, and the model was subsequently incorporated into several doctoral research programmes.
• 1991 – With Kerstin Fugl-Meyer and colleagues, published research examining life satisfaction following vocational rehabilitation. This work contributed to the later development of the Life Satisfaction Checklist family of instruments.
• 1995 – Appointed professor of rehabilitation medicine at Uppsala University. He continued clinical and research work in brain injury and helped establish clinical and academic activity in sexology.
• After retirement – Sexual medicine became his principal research interest. With Kerstin Fugl-Meyer and international collaborators, he published widely on sexual function, sexual wellbeing, epidemiology and life satisfaction in people with neurological disease and other chronic conditions.
• 2002 – With Roland Melin and Kerstin Fugl-Meyer, published a population study of life satisfaction among Swedish adults using the domain-based LiSat-11 checklist.
• 2012 – Despite prolonged illness, attended the Scandinavian Society for Sexual Medicine annual meeting in Copenhagen in May. Died July 17, 2012 in Uppsala, Sweden, aged 77.

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Medical Eponyms

Fugl-Meyer Assessment of sensorimotor recovery after stroke

The Fugl-Meyer Assessment (FMA) is a clinician-administered, stroke-specific measure of impairment that evaluates motor function, sensation, balance, passive joint movement and joint pain. Its motor component is usually divided into upper- and lower-extremity domains. The original assessment used a cumulative numerical score and was designed to quantify the orderly return of motor function following hemiplegic stroke

Fugl-Meyer did not originate the concept of staged motor recovery. The theoretical foundation came principally from Twitchell and Brunnström. His achievement, with Jääskö, Leyman, Olsson and Steglind, was to transform those clinical observations into a structured, reproducible and numerically scored assessment suitable for longitudinal care and research.

1951–1954 — Thomas Twitchell (1923-2017) and Signe Brunnström (1898-1988) provided descriptions of sequential motor recovery after hemiplegia, including the progression from flaccidity through reflex and synergistic movement towards more isolated voluntary control.

Early 1970s — Fugl-Meyer worked with physiotherapist Lise Jääskö, occupational therapists Inger Leyman and Solveig Olsson, and statistician Sören Steglind to convert qualitative recovery patterns into a standardised numerical examination.

1975 — Original publication of The post-stroke hemiplegic patient. I. a method for evaluation of physical performance. The system assessed motor function, balance, selected sensory functions and joint function and followed patients from the first week after stroke for up to one year.

Fugl-Meyer published a companion epidemiological study The post-stroke hemiplegic patient. II. Incidence, mortality, and vocational return in Göteborg, Sweden with a review of the literature

Later validation and standardisation: reliability, validity, responsiveness, ceiling effects and the increasing use of the upper-extremity and lower-extremity motor subscores in rehabilitation trials. A 2002 critical review described the FMA as the first quantitative evaluative instrument specifically designed to measure sensorimotor recovery after stroke

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Key Medical Contributions

Life Satisfaction Checklist. LiSat-9 and LiSat-11

The Life Satisfaction Checklist assesses satisfaction with life as a whole and with individual domains such as vocation, finances, leisure, relationships, family life, physical health, psychological health and sexual life. Rather than measuring impairment or independence alone, it reflects Fugl-Meyer’s view that the ultimate outcome of rehabilitation was the individual’s own satisfaction with life.

Late 1980s – Fugl-Meyer, along with his wife Kerstin Sjögren Fugl-Meyer and occupational therapist Monica Eklund, developed and applied a nine-item model of global and domain-specific life satisfaction during vocational rehabilitation.

1991 – With Kerstin Fugl-Meyer and colleagues, published Vocational rehabilitation in northern Sweden. III. Aspects of life satisfaction. The study assessed satisfaction with life as a whole and eight specific life domains at entry to vocational rehabilitation and again two years later.

2002 – Fugl-Meyer, Roland Melin and Kerstin Fugl-Meyer published Swedish population reference values for the expanded LiSat-11 in Life satisfaction in 18- to 64-year-old Swedes: in relation to gender, age, partner and immigrant status. The LiSat-11 evaluated satisfaction with life as a whole and ten domains using a six-point ordinal scale.

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Vocational rehabilitation and participation

Fugl-Meyer and colleagues studied vocational rehabilitation not only through return-to-work rates but also through financial status, social participation and life satisfaction. In a northern Swedish cohort, they followed people referred for vocational rehabilitation over two years and examined both occupational outcome and the person’s own evaluation of life after rehabilitation.

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Sexual rehabilitation and sexual medicine

Later in his career, Fugl-Meyer increasingly applied rehabilitation principles to sexuality. With Kerstin Sjögren Fugl-Meyer and other collaborators, he studied sexual function, dysfunction, distress, satisfaction and quality of life in the general population and among people with neurological or chronic disease.

His work treated sexual health as multidimensional: dysfunctions rarely occurred in isolation, and their significance depended upon personal distress, relationships, health and broader satisfaction with life. The 2002 paper Sexual disabilities are not singularities exemplified this approach, while later international collaborations addressed the epidemiology and risk factors of male and female sexual dysfunction.

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Major Publications

• Fugl-Meyer AR. Effects of respiratory muscle paralysis in tetraplegic and paraplegic patients. Scand J Rehabil Med. 1971;3(4):141-50. and 168-177
• Fugl-Meyer AR, Grimby G. Ventilatory function in tetraplegic patients. Scand J Rehabil Med. 1971;3(4):151-160. and 161-167
• Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. I. a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13-31.
• Fugl-Meyer AR, Jääskö L, Norlin V. The post-stroke hemiplegic patient. II. Incidence, mortality, and vocational return in Göteborg, Sweden with a review of the literature. Scand J Rehabil Med. 1975;7(2):73-83.
• Fugl-Meyer AR. Postural muscle fibre composition. Scand J Rehabil Med Suppl. 1978;6:66-8. 
• Fugl-Meyer AR, Sjöström M, Wählby L. Human plantar flexion strength and structure. Acta Physiol Scand. 1979 Sep;107(1):47-56. 
• Fugl-Meyer AR, Jääskö L. Post-stroke hemiplegia and ADL-performance. Scand J Rehabil Med Suppl. 1980;7:140-152.
• Fugl-Meyer AR, Jääskö L. Post-stroke hemiplegia and sexual intercourse. Scand J Rehabil Med Suppl. 1980;7:158-166. 
• Sjögren K, Fugl-Meyer AR. Sexual problems in hemiplegia. Int Rehabil Med. 1981;3(1):26-31. 
• Fugl-Meyer AR, Linderholm H, Wilson AF. Restrictive ventilatory dysfunction in stroke: its relation to locomotor function. Scand J Rehabil Med Suppl. 1983;9:118-24. 
• Fugl-Meyer AR, Sjögren K, Johansson K. A vaginal temperature registration system. Arch Sex Behav. 1984 Jun;13(3):247-60.
• Fugl-Meyer AR, Eklund M, Fugl-Meyer KS. Vocational rehabilitation in northern Sweden. III. Aspects of life satisfaction. Scand J Rehabil Med. 1991;23(2):83-7.
• Fugl-Meyer AR, Lodnert G, Bränholm IB, Fugl-Meyer KS. On life satisfaction in male erectile dysfunction. Int J Impot Res. 1997 Sep;9(3):141-8.
• Fugl-Meyer AR, Melin R, Fugl-Meyer KS. Life satisfaction in 18- to 64-year-old Swedes: in relation to gender, age, partner and immigrant status. J Rehabil Med. 2002 Sep;34(5):239-46. 
• Oberg K, Fugl-Meyer AR, Fugl-Meyer KS. On categorization and quantification of women’s sexual dysfunctions: an epidemiological approach. Int J Impot Res. 2004 Jun;16(3):261-9

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References

Biography

• Grimby G, Ekholm J. Axel R Fugl-Meyer. Dagens Nyheter, 2012
• Lindström E-B. Axel R Fugl-Meyer. Dagens Nyheter, 2012
• A sad message. J Rehabil Med 2012; 44: 709
• Giraldi A. Axel Fugl-Meyer 1934–2012. The Journal of Sexual Medicine, 2012; 9: 2736-7.

Eponymous terms

• Gladstone DJ, Danells CJ, Black SE. The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair. 2002 Sep;16(3):232-40
• Busk H, Alt Murphy M, Korsman R, Skou ST, Wienecke T. Cross-cultural translation and adaptation of the Danish version of the Fugl-Meyer assessment for post stroke sensorimotor function. Disabil Rehabil. 2022 Aug;44(17):4888-4895.
• Fugl-Meyer Assessment. Institute of Neuroscience and Physiology