Clinical framework

F-MATS

Functional Movement Assessment & Treatment Strategy — a structured clinical reasoning framework for neurological and musculoskeletal rehabilitation, developed by Dr Dharam P. Pandey over more than twenty years of practice.

Why it exists

In many departments, assessment and treatment run as separate exercises. A patient is assessed thoroughly, then treated according to habit, preference or whatever equipment is available. F-MATS keeps an unbroken line between what was found and what is done, and makes progression a matter of measurement rather than intuition.

It brings together biomechanical analysis, neuroplasticity principles, functional goal-setting and evidence-based sequencing of intervention in one repeatable structure. Its organising idea is that the patient’s task — reaching for a cup, rising from a chair, walking ten metres — is the unit of assessment and of treatment, rather than an isolated muscle or joint.

The five stages

Each letter is one stage of the clinical process.

Functional assessment

Begins with real-world movement quality, measured with outcome measures rather than impairment scores alone. The question is not only which muscle is weak, but which task the patient cannot complete, and why.

Movement analysis

Kinematic and neuromuscular analysis identifies the compensatory strategies the patient has adopted. Compensation is often the nervous system’s most efficient available solution; it must be recognised before deciding whether to reinforce or retrain it.

Approach determination

Intervention is chosen on evidence, not modality preference — across manual therapy, neuroplasticity-driven exercise and technology-assisted rehabilitation. The framework constrains how the choice is justified, not which tool is used.

Targeted treatment

Treatment is built around measurable functional goals specific to the patient. Every intervention traces back to a finding in the first two stages, and forward to a goal the patient recognises as their own.

Systematic progression

Progression is data-driven, with periodic reassessment on the same measures used at baseline. The framework then re-enters at stage one rather than ending — which is what makes it usable across long neurological caseloads.

The reasoning loop

Underneath the five stages is a simple loop: assess the task, form a hypothesis about why it fails, and design a strategy that tests that hypothesis. The outcome of treatment becomes the next assessment.

In practice the loop runs through five clinical steps:

Impairment identification
Hypothesis formation
SMART goal setting
Treatment strategy design
Outcome evaluation

This makes F-MATS hypothesis-driven rather than protocol-driven: two patients with the same diagnosis may receive different treatment because their tasks fail for different reasons.

The five treatment phases

Within a session, treatment for each target task is delivered in five phases, moving from preparing the tissues to independent practice at home.

Phase	Purpose	Typical techniques
1 · Preparation	Prepare muscle and soft tissue to support movement at the target segments.	Soft tissue release, joint capsule release, muscle elongation to improve flexibility and range.
2 · Activation	Achieve good contraction and recruitment in inactive muscles.	Tactile stimulation and cueing; EMG biofeedback.
3 · Facilitation	Help the patient understand and initiate the task.	Manual guidance, tapping, verbal feedback — with assistance withdrawn as control improves.
4 · Training	Practise the task in meaningful, real-life contexts.	Task-specific repetition; progressive challenge from closed- to open-kinetic-chain and from gravity-assisted to unassisted movement.
5 · Home task	Increase repetitions and carry-over outside therapy.	Context-specific practice (e.g. brushing hair, using utensils, bed mobility), with adherence monitored and adjusted.

F-MATS and protocol-led rehabilitation

Feature	F-MATS	Protocol-led approach
Focus	Task-specific movement	Muscle- or joint-based
Strategy	Central–peripheral integration	Segmental strengthening
Clinical flow	Hypothesis-driven	Protocol-driven
Progression	Re-measured against baseline	Time- or session-based

Goals are written as SMART goals

Each target task carries a goal that is Specific, Measurable, Achievable, Relevant to the patient and Time-bound. The goal aligns the whole plan: the hypothesis explains why the task fails, the phases address it, and the outcome measure shows whether the goal was met.

Assessment tools

Four instruments put the framework into routine use.

Goal-Based Functional Outcome Measure Sheet

Three domains, five tasks each, every task scored 0–5 (25 per domain):

Upper extremity — functional reach, grasp–lift–release, targeted reach, shoulder–elbow dissociation, task-specific hand use
Gait & locomotion — 10-metre walk, affected-limb weight-bearing, terminal-stance knee extension, trunk alignment, swing-phase foot clearance
Sit-to-stand / stand-to-sit — rise without arm support, mid-rise weight shift, full extension, controlled descent, five repetitions

Clinical Case Assessment Forms

Qualitative movement analysis for three core tasks, recording the task breakdown, the impairment, the clinical hypothesis, the SMART goal and the phase-by-phase plan:

Upper extremity (reach and grasp)
Sit to stand
Gait and locomotion

Assessor guidelines accompany the outcome sheet so that scoring is applied consistently.

Score per task	Interpretation	Domain total (of 25)	Classification
5	Independent, smooth, no deviation	22–25	Normal
4	Slight deviation, no help	18–21	Mild
3	Needs cueing or mild assistance	13–17	Moderate
2	Partial assistance needed	6–12	Severe
1	Maximal physical assistance	0–5	Unable
0	Cannot initiate or complete the task	0–5	Unable

Where it is used

F-MATS is in use at Manipal Hospitals, Dwarka, at ShardaCare HealthCity, and across the rehabilitation services Dr Pandey leads. It is applied in:

StrokeSpinal cord injury Traumatic brain injuryParkinson’s disease Orthopaedic & sports rehabilitationPost-surgical recovery Paediatric neurological conditions

How it is taught

Through practice-heavy clinician workshops: core concepts, live demonstration on upper-limb reach-and-grasp and sit-to-stand, partner practice in cueing and facilitation, and group clinical-reasoning tasks. Workshops have run in Delhi, Kanpur, Lucknow, Kolkata and Malaysia.

Evidence status

What F-MATS is, and is not

F-MATS is a structured clinical framework for organising assessment and treatment. It is not yet a validated measurement instrument: reliability and validity studies of the outcome sheet have not been published. Its component principles — task-specific practice, repetition and experience-dependent neural plasticity — are drawn from the wider rehabilitation literature.¹

Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51(1):S225–39. doi:10.1044/1092-4388(2008/018) PMID 18230848

Author and disclosure. F-MATS was developed by Dr Dharam P. Pandey, who also leads the services where it is used and teaches it. This page describes the framework; it is not a substitute for individual assessment by a qualified physiotherapist. See the editorial and review policy.