The Fugl-Meyer, AMAT, Wolf and Chedoke have many high level manual test items like picking up a pencil and using a knife. These tasks require considerable recovery before hand function can be detected (1-3). Easy bimanual ADL tasks show clients they can recover hand function earlier than they think is possible. Why defer hand use when many ADLs do not require full arm or fingertip control? (4).
A palmar grasp is not a primitive stage infants pass through on the way to a tip pinch. Level 3 tasks below show that adults use a palmar grasp dozens of times a day. The tests above also ask clients to use their hand while sitting and lifting their arm to table top height. The struggle to lift a weak arm increases muscle tone which can make it difficult to open the hand. Instead Level 2 tasks below show that object manipulation can begin with the affected hand holding an object after doing a hand-to-hand transfer close to the body. Ignoring hand-to-hand transfers is a large omission on a test of hand function.
3. Affected hand (AH) reaches for object to hold it still so sound hand (SH) can manipulate it
Stir pot: AH reaches for/holds pot handle as SH stirs contents of pot sitting on stove
Milk: AH reaches for/holds handle of container resting on counter so PH can remove cap
Spices: AH reaches for/holds container in air so PH can remove lid and reach in with measuring
spoon to get spice
Olive oil/soy sauce: AH reaches for/holds bottle resting on counter so PH can remove lid
Food processor: AH reaches for/holds handle of food container that is propped against stomach
so SH can reach in and scoop food sticking to sides of the container
Peel carrot/cucumber: AH reaches for/holds vegetable so SH can peel it. Wrap paper towel
around vegetable if extra traction is needed.
Aluminum foil/waxed paper: AH reaches for/holds box so PH can pull out and tear off a piece
Detergent: AH reaches for/holds handle of bottle resting on dryer as SH removes cap
Vacuum: AH reaches for/holds cord to side of body with cupped hand to prevent tripping as
SH maneuvers vacuum
Water outside plants: AH reaches for/holds handle of watering can sitting on ground so PH can
use hose to fill container with water
Restaurant: Both hands reach for/hold sides of tray to carry it to table. Put drink in center at
edge that is closest to stomach. To keep tray from bouncing while walking, prop tray
2. AH receives object from SH and holds it close to the body as SH manipulates object
Shower sitting on chair: SH places nozzle of shower hose in AH hand which holds it near crotch
so SH can soap and rinse the nooks and crannies
Shower with nylon poof and shower gel: SH places poof in AH so it can soap up sound arm
Deodorant: SH puts in AH which holds bottle resting on thigh so SH can remove cap
Hair dryer: Sitting on close lid of toilet, SH places handle of hair dryer in AH which has wrist
resting on thigh. Client leans over as SH lifts and fluffs hair
Pill bottle with "easy-off" cap: In sitting SH puts bottle in AH which holds bottle resting on
thigh as SH removes cap
Door: SH places cane in AH which holds cane next to body so SH can close bathroom door
Banana: SH places banana is AH which repeatedly holds and lets go so SH can pull down peel
Carry soda/water: SH places can/bottle in AH which rests it against hip while walking to table
Open soda/water: In sitting SH places can/bottle in AH which holds it still while resting on lap so
SH can remove lid
Ear bud: SH places wireless /cell phone in AH which is resting on thigh so SH can place prong
of ear bud into phone. Ear bud leaves SH free to take notes while talking on phone.
Carry phone: SH puts wireless/cell phone in AH which holds phone at side of body as SH uses
cane to walk to couch for extended talk with friends/family
Transfer photos: SH places camera in AH which is resting on thigh. AH holds camera as SH
plugs cord into port in camera and USB port in computer
1. Chae J, Labatia I, Yang G. Upper limb motor function in hemiparesis: Concurrent validity
of the Arm Motor Ability Test. American Journal of Physical Medicine. 2003;82(1):1-8.
2. Gustafsson L, Turnpin M, Dorman C. Clinical utility of the Chedoke Arm and Hand Activity
Inventory for stroke rehabilitation. Canadian Journal of Occupational Therapy. 2010;77:167-173.
3. Rowland T, Gustafsson L, Turnpin M, Henderson R, Read S. Chedoke Arm and Hand Activity
Inventory-9 (CAHAI-9): A multi-centre investigation of clinical utility. International Journal of
Therapy and Rehabilitation. 2011;18 (5): 290-298.
4. Dutton R. My Last Degree: A Therapist Goes Home After a Stroke, 2nd ed. Bangor, Maine: