Hand Evaluations

The Fugl-Meyer, AMAT, Wolf, and Chedoke have many high level test items like using a knife.  These tests require considerable distal recovery before hand function can be detected (1-3).  My NDT certification course also taught me the hand needs good shoulder control.  This is true if you want to swing a hammer without hitting your thumb.  However, many ADLs do not require this kind of precision.  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).

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 close to the body after a hand-to-hand transfer.   

 3. Affected hand (AH) reaches for object to hold it still so sound hand (SH) can manipulate it      

Stir pot: AH reaches for and holds pot handle as SH stirs contents of pot sitting on stove
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 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.