For example, a palmar grasp is not a stage infants pass through on the way to a tip pinch. Level 3 below shows that adults use a palmar grasp dozens of times a day. In both photos my fingertips are not touching each other or the object. The tests above also ask clients to sit and lift their hand to table top height. The struggle to lift a weak arm increases muscle tone which can make it difficult to open the hand. Level 2 below shows that object manipulation can begin with the affected hand holding an object still after a hand-to-hand transfer that is done close to the body.
3. Affected hand (AH) reaches for object to hold it still so sound hand (SH) can manipulate it
Milk: AH reaches for and holds handle of container resting on counter so SH can remove cap
Spices: AH reaches for and holds container in air so SH can remove lid and reach in with measuring spoon to get spice
Olive oil/soy sauce: AH reaches for and holds bottle resting on counter so SH can remove lid
Vacuum: AH reaches for and holds cord at side of body with cupped hand to prevent tripping as SH maneuvers vacuum
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 hose in AH hand which holds it near crotch so SH can soap/rinse nooks/crannies
Shower with nylon poof/shower gel: SH places poof in AH so it can soap up sound arm
Door: SH places cane in AH which holds cane next to body so SH can close bathroom door
Cell phone: SH puts phone in AH which holds phone at side of body as SH uses cane to walk to couch for extended talk with friends/family
To receive a list of 100+ bimanual functional tasks for Levels 1, 2, 3, and 4, e-mail me at email@example.com.
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: