The Fugl-Meyer, AMAT, Wolf, and Chedoke have many high level test items like 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 below shows that adults use a palmar grasp dozens of times a day.
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 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
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
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
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
Door: SH places cane in AH which holds cane next to body so SH can close bathroom door
Carry soda/water: SH places can/bottle in AH which rests it against hip while walking to table
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
To receive a Power Point presentation with numerous photos of functional bimanual tasks, e-mail me at firstname.lastname@example.org.
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: