Hand Evaluation

Hand tests that have many high level test items like cutting with a knife require considerable recovery before hand function can be detected (1-3).  NDT teaches that hand use requires good arm 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.  Why defer hand use during ADLs that do not require full arm or fingertip control?  The photos show that fingertips do not need to touch each other or the object for the hand to be functional.

Bimanual tasks detect early recovery when the affected hand (AH) begins to function as an assisting hand (4).  Level 2 tasks only require the affected hand to open and close so it can receive and hold an object close to the body after a hand-to-hand transfer.  Level 3 tasks require a palmar grasp and the ability to reach for an object while standing.  Traditional hand tests ask clients to sit and reach up for objects at table top height.  Lifting an arm can increase muscle tone which cascades down the arm and makes it difficult to open the hand.

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 crannies
Shower with nylon poof/shower gel: SH places poof in AH so it
     can soap up sound arm

Deodorant: SH places bottle in AH which keeps bottle from 

     slipping off thigh as SH removes cap 

Door: SH places cane in AH which holds cane next to body so
     SH can close bathroom door

3. AH reaches for object to hold it still so 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

       

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:Chapter 4.  homeafterstroke.blogspot.com