Hand Evaluations

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 homeafterastoke3@verizon.net.

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:
    Booklocker; 2013:55-65.

1 comment:

  1. A group of us [all stroke survivors] have created a stroke survivors online private website www.strokefocus.net] , primarily to connect chronic survivors to each other, and to connect survivors with researchers at our universities.