Hand Evaluations

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
              against stomach.

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:
    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.