Wolf Motor Function TestTM © (WMFTTM ©)

Instructions

Template
• In order to assure a standard placement of test objects, the template should be taped to the desk so
that the front edge is flush with the front edge of the desk.
• The center of the template should be at the center of the desk.
• The outline of each test object is traced on the template in the position in which it should be placed
and further identified by corresponding task item numbers.

Participant Seating
One of the following chair positions will be used for each of the task activities:

• Chair Position (Side): Chair placed sideways to the table. Position a box lengthwise at the 14 cm line,
in the Box #2 position (see template). Place the participant’s less affected forearm flat on the box, with
the wrist hanging over the edge. Height of box should be such that the patient’s hips and back are
against the back of the chair. (Note: make sure that the trunk is straight and participant is not leaning
to the side.)
o Measure position from the table edge to the side edge of the chair seat and the position of the
back of the chair seat to the end of the table.
• Chair Position (Front): Chair is facing the table. Position a box at the 20 cm line, in the Box #6 & 7
position of the template. Place the participant’s hand on the top of the box, with the heel of the
shoulder is at 90o flexion. With the arm in this functional position, place the chair so that the
participant’s hips and back are fully against the back of the chair.
o Measure this position, from the back of the seat of the chair to the edge the table
• Chair Position (Front-Close): For use with item #8 &14. Chair is facing the table. Participant is
centered to the midline of the template. Place the participant’s neutral forearm on the table, with the
wrist crease at the 40-cm line and the elbow straight. With the arm in this functional position, place
the chair so that the participant’s hips and back are fully against the back of the chair. (Note: With
larger participants, if the mass of the body does not allow for the wrist to reach the 40-cm line, the
chair position should be such that the front of the body nearly touches the table, with the hips and
back fully against the back of the chair.
o Measure this position from the back of the chair seat to the table edge.
• Note position measurements on the set-up recording form. Chair positions should be established
using the unaffected upper extremity

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 Videotaping

• Videotaping is used for standardization and/or Functional Ability Scale rating by a panel of clinicians.
• Camera height and position should allow a field of view that includes maximal clarity of the task end
position on the template. Additionally, one of the following filming positions should be used when
videotaping each task. The specific task instructions indicate which filming position to use.

Filming position (Side-Facing): - view of the whole body while participant’s side being tested is placed next to
the desk. The camera should be placed approximately 3 fee in front of and to the opposite side of the
participant being tested (camera on participant’s left side if right arm being tested) and in line with the back
edge of the desk. The camera view should include the participant’s entire body so that the full movement of
the hand from the lap to the table can be seen.

Filming position (Side-Side): - view of the whole body while participant is facing the desk: the camera should
be placed approximately 3 feet to the side of the participant and on the same side being tested (camera on
participant’s left side if left arm being tested) and in line with the back edge of the desk. The camera view
should include the participant’s entire body.

Filming position (Side-Close): - profile of expanded view of limb being tested. Camera in same position as
Side-Side, but the camera view should be zoomed in to focus on fine motor skills. The view should include the
participant’s entire upper extremity.

Filming position (Front): - the camera should be placed approximately 3 feet in front of the desk and the
camera view should include the participant’s upper body (trunk and head).

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GENERAL COMMENTS:

• For all timed tasks, participants should be told to perform the tasks as quickly as possible.

• Starting Point: the tested cues the start of the timed tasks by saying, “Ready!, Set!, Go!” This should be
said quickly and vigorously

• Start time must be coincident with “Go!” the stop time must be coincident with the event defined in
the instructions.

• If the participant performs the task incorrectly, the task should be described and demonstrated again,
and the participant is allowed one additional attempt.

• If the blinded evaluator makes a mistake with set-up or timing, the task may be repeated an additional
time.

• Blinded Evaluator clearly stated the reason when a task is repeated.

• Blinded Evaluator clearly states if task was completed correctly.

• For the grasp items, verbalize the grasp utilities (digital positions), whether it is correct or incorrect.

• Timing is carried out using a stopwatch that records in millisecond.

• Each task should be described and modeled two times by the tested at the time the instructions are
given. The first demonstration should be conducted slowly, and the second should be performed
quickly.

• Both upper extremities are to be tested. First, the less-affected upper extremity should be tested on
each task. The entire set of task should be then be repeated with the more-affected upper extremity.

• Participants should not practice the task before being tested.

• If the participant seems at all confused or has not paid attention during the demonstration, the task
should be demonstrated a third time.

• The testing room should be a minimum of 17’ x 10’ to allow adequate room for videotaping

• The chair position should be varied for participants who are substantially taller or shorted than 5’8” so
that their starting position is optimal for task performance (e.g., desk doesn’t block / restrict
movement, participant can reach objects)

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 • A step may be placed beneath the participant’s feet to achieve proper lumbar, pelvic, and hip
alignment.

• Final chair position should be established using the less affected upper extremity.

• For tasks using a box, shorter boxes may be substituted for shorted individuals. Ideally, these tasks
should not require participants to flex or abduct their shoulder past 90 degrees. Modifications should
be recorded on the pre-treatment set-up recording form and repeated during all subsequent testing of
the participant.

• Boxes with modified heights should not be used to accommodate range of motion limitations. If a
participant is unable to perform a task because of range of motion limitation, the task should be
considered unachievable for that participant and a 120+ assigned as the time score.

• Verbal encouragement may be given to participants during the task attempts to maintain motivation or
attention. The phrase “good effort, keep going, don’t give up” should be repeated in a calm, confident
voice. The phrases should be repeated approximately 12 times over the 2-minute period. (i.e. once
every 10 seconds)

• If objects are dropped on the floor during a task attempt, the tester should quickly return the object to
the starting position without interrupting the timing process. It may be helpful to have back-up items
(i.e. extra paper clip, pencil, checker, etc.) so that the item can be replaced quickly if dropped. If it
takes longer than 5 seconds to replace an item, the task should be repeated.

• If a participant appears confused or misunderstand the task, the task should be repeated. Entire verbal
instructions and demonstration are repeated 1 time per task if the participant appears confused. If the
participant performs the task incorrectly the second time, a 120+ is assigned for the time score.

• Participants wearing long sleeves should roll the sleeve up on the arm to be tested before beginning
the test. If participants are wearing a confining top and their sleeves cannot be rolled up, they should
be asked to remove it and should be given a scrub suit top.

• For each of the 17 tasks, a detailed instruction, with accompanying task demonstration is to be
provided to the participant followed by a brief instruction and accompanying task demonstration.

• For each task, the specific instructions are detailed on the following pages, along with set-up, filming,
timing and scoring instructions.

• Following the brief instruction, the participant is to be asked if he/she has any questions. If the
answer, is no, proceed with “Ready!, Set!, Go!” for all timed tasks. If the participant has a question(s),
answer it and then repeated the brief instruction prior to proceeding with “Ready!, Set!, Go!” for all
timed tasks.

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TEST ADMINISTRATION

• Begin each test by reading the following to the participant:

“Today we are going to take a look at how you are able to use your arm.
Let me tell you how we are going to go about this.
First, I will give you instructions on how to the task, and then I will show you how to do it.
I will describe and demonstrate each task 2 times.
Do not practice the task while I’m describing and demonstrating it; however, I will be happy to
clarify any confusing points.
Then I will say, “Ready!, Set!, Go!” and you will do the task as quickly as you can.
It is important that you do not start until I say “Go!”, otherwise, we will need to repeat the
entire task.
Each of the activities you will be asked to do should be carried out as rapidly as possible.
You can work on each task for up to two minutes.
Please attempt each part of the test even if you do not think that you can do it.
If you are unable to carry out a task, then we will go on to the next one.
Again, try to do each task as rapidly as possible.
Do you have any questions?”

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INDIVIDUAL TASK INSTRUCTIONS

I. Tasks (1&2) Functional ability of the shoulder of the involved upper extremity; tasks performed to
the side of the participant (i.e., away from the midsagittal plane of the participant). Shoulder
movement of abduction.

1. Forearm to table (side)

SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while

demonstrating slowly:
• Chair Position (side) Participant attempts to place
• Hips against back of chair forearm on the table (adjacent and • “Place your forearm on the
• Hands in lap parallel to front edge) by table as quickly as you can. Do
• Both feet on floor abduction at the shoulder. (Some it just like this. At the end of
• Filming Position (Side- shoulder flexion will probably also the movement, your forearm
Facing) be necessary to get arm past the and hand should be touching
edge of table.) the surface of the table. Do
this as quickly as you can.”
“Forearm” is defined as the wrist
and elbow. The palmar surface of Verbal Instructions while
the hand need not be flat. Timing demonstrating quickly:
ends when both the forearm and
hand touch the table. • “Place your forearm on the
table as fast as you can like
Timing Procedure: this.”
• “Do you have any questions?”
Starts on word “Go” and ends • “Ready!, Set!, Go!” (said
when participant’s forearm and quickly and vigorously).
hand both touch the table in the
required position. Scoring:

Measure: FA scoring should take into

account the extent to which the
The time elapsed from the starting head and trunk are maintained in
point to the moment the forearm normal alignment and the speed,
and hand touch the table in the fluidity, and precision with which
required fashion. movements are performed.

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2. Forearm to box (side)

SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while

demonstrating slowly:
• Chair Position (side) Participant attempts to place
• Hips against back of chair forearm (elbow to wrist) on the • “Place your forearm on the box
• Hand not being tested in lap box by further abduction at the as quickly as you can. Do it
• Shoulder of tested arm shoulder. (Again some shoulder just like this. At the end of the
abducted with the forearm flexion will probably also be movement, your whole
pronated and placed flat on necessary to get arm past the edge forearm should be flat and
table with radial edge of box.) At the end, the forearm touching the surface of the
adjacent and parallel to front should be flat on the box with the box, with your hand and wrist
edge of table; wrist crease at hand and wrist drooping over the drooping over the edge of the
39-cm line (front edge of box). front edge. box. Your elbow must
Palmar surface of hand need completely on the surface of
not to be flat. Timing Procedure: the box. Do this as quickly as
• Place a box of appropriate you can.”
height in the template Starts on word “Go” and ends
outlined marked Box#2. Box when participant’s forearm and Verbal Instructions while
should be wide enough that elbow are flat on the box, wrist demonstrating quickly:
participant’s entire forearm and hand are beyond the end of
and elbow can fit on the box. the box in a relaxed position. • “Place your whole forearm on
Box should be stabilized by the box as fast as you can like
evaluator during the trail. Measure: this.”
• Filming Position (Side-Facing) • “Do you have any questions?”
The time elapsed from the starting • “Ready!, Set!, Go!” (said
point to the moment the forearm quickly and vigorously).
touches the top of the box in the
required fashion with the hand Scoring:
drooping over the edge of the box.
FA scoring should take into
account the extent to which the
head and trunk are maintained in
normal alignment and the speed,
fluidity, and precision with which
movements are performed.

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 II. Tasks (3&4). Functional ability of the elbow of the involved upper extremity; movements performed
to the side of the participant (i.e. away from the midsagittal plane). Elbow movements of extension.
(A small amount of external rotation at shoulder is a necessary component of these two tasks, but
elbow extension is the primary component.)

3. Extend elbow (to the side)

SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while demonstrating slowly:

• Chair Position (side) Participant attempts to reach • “Slide your hand across the table by moving
• Hips against back of across the 40-cm line on your hand away from your body and straighten
chair template by extending the your elbow to its fullest extent; like this. Your
thumb should cross this line (point to the 40-
• Table surface elbow (to the side). Elbow can
cm line). You can raise your elbow from the
should be lightly be lifted off the table during
table if you like. Also, please keep your
dusted with the task. This may be the only
shoulders level and just move your arm; just
baby/talcum way shorter subjects can reach like this (demonstrate). Do not lean over; keep
powder 40-cm line. Shoulders should your body as straight as possible. Do this as
• Hand not being test be kept level to prevent quickly as you can.”
in lap leaning with the trunk. Some • (Note: the participant should slide his/her hand
• Shoulder of test external rotation at the across the table. Repeat the task if the hand is
arm abducted with shoulder is necessary to carry lifted off the table
forearm resting flat out this movement, but the
on table in a examiner should prevent too Verbal Instructions while demonstrating
pronated position. much of this movement. quickly:
Palmar surface of
hand need not be Timing Procedure: • “Straighten your elbow as fast as you can. Slide
flat on table. your hand across the table so your thumb
Starts on word “Go” and ends crosses this line (point to 40-cm line).”
• Forearm being
when any part of the thumb • “Do you have any questions?”
tested is resting on,
crosses the line. • “Ready!, Set!, Go!” (said quickly and
adjacent and
vigorously).
parallel to front
edge of table; Measure:
Scoring:
elbow at 14-cm
line. The time elapsed from the
starting point to the time any • FA scoring should take into account: 1) the
• Filming Position extent to which the head and trunk are
(Side-Facing) part of the thumb initially
maintained in normal alignment, 2) whether the
crosses the line. elbow is extended, 3) whether the hand
remains in contact with the table, and 4) the
speed, fluidity, and precision with which
movements are performed.
• The elbow can be lifted off the table. Also,
some shoulder external rotation and abduction
is necessary, but inadequate or excessive
motions of this type of should be noted.

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4. Extend elbow (to the side) – with weight

SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while demonstrating slowly:

• Chair Position (side) Participant attempts to push • “Push the weight across the table by moving
• Hips against back of the weight across the 40-cm your hand away from your body and straighten
chair line on template by extending your elbow to its fullest extent; like this. Your
thumb should cross this line (point to the 40-
• Table surface the elbow (to a lesser extent)
externally rotating shoulder. cm line). Your forearm should remain in
should be lightly
contact with the weight until your thumb
dusted with Elbow should be kept on the
crosses the line. Also, please keep your
baby/talcum table throughout the task shoulders level and just move your arm; just
powder (different from the previous like this (demonstrate). Do not lean over; keep
• Hand not being test task), shoulders should be your body as straight as possible. Do this as
in lap kept level to prevent leaning quickly as you can.”
• Shoulder of test with the trunk. Again, the
arm abducted with examiner needs to be aware Verbal Instructions while demonstrating
forearm resting flat of participant’s trunk leaning quickly:
on table in a and/or excessive external
pronated position. rotation at the shoulder to • “While your elbow is resting on the table,
Palmar surface of perform task (especially true straighten your arm – pushing the weight your
hand need not be for taller men). Note: the thumb crosses this line (point to 40-cm line) as
weight is to remain in contact fast as you can; like this.”
flat on table.
with the forearm throughout • “Do you have any questions?”
• Forearm being
the task. Repeat the task if • “Ready!, Set!, Go!” (said quickly and
tested is resting on, vigorously).
adjacent and the subjects swats the weight.
parallel to front Scoring:
edge of table; Timing Procedure:
elbow at 14-cm • FA scoring should take into account: 1) the
line. Starts on word “Go” and ends
extent to which the head and trunk are
• 1 lb. weight placed when any part of the thumb
maintained in normal alignment, 3) whether the
at ulnar edge of crosses the line. forearm remains in contact with the weight,
wrist; distal end of and 3) the speed, fluidity, and precision with
the weight is Measure: which movements are performed.
aligned with ulnar • Some shoulder abduction is necessary, but
styloid process. (i.e. The time elapsed from the inadequate or excessive motions of this type
the weight is only starting point to the time any shoulder be noted.
touching the part of the thumb initially • If the forearm doesn’t remain in contact with
crosses the line. the weight, a maximum score of 3 should be
forearm)
assigned.
• Filming Position • If accomplished with excessive compensatory
(Side-Facing) trunk movement and/or very limited elbow
extension, a maximum score of 2 should be
assigned

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III. Three task (5, 6, &7): Functional ability of the shoulder of the involved upper extremity performed to
the front of the participant.

5, Hand to table

SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while

demonstrating slowly:
• Chair Position (front) Participant attempts to place hand
• Hips against back of chair being tested on the table. The • “Place your hand on the table
• Both hands in lap heel of the hand must rest beyond so that the heel of your hand is
• Participant positioned so the 2 cm line. The palmar surface beyond this line (point to 2 cm
that leaning is not of the hand need not be flat. (The line). Most of your hand
necessary to uncomfortable subject should place most of the should be placed in the circle
to reach the table hand in the circle.) (demonstrate); like this. Your
• Filming Position (Side-Side) hand does not need to be flat.
Timing Procedure: Do this as quickly as you can.”

Starts on word “Go” and ends Verbal Instructions while

when the heel of the hand and demonstrating quickly:
fingers touch table beyond the 2
cm line. • “Place your hand on the table
in this circle (point to circle) as
Measure: fast as you can like this.”
• “Do you have any questions?”
The time elapsed from the starting • “Ready!, Set!, Go!” (said
point to the moment the heel of quickly and vigorously).
the hand and fingers touch table
beyond 2 cm line. Scoring:

• FA scoring should take into

account the extent to which the
head and trunk are maintained
in normal alignment and the
speed, fluidity, and precision
with which movements are
performed.
• Note: The final posture of the
hand and fingers does not
influence scoring as long as the
heel of the hand is in contact
with the table.

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6. Hand to box (front)

SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while

demonstrating slowly:
• Chair Position (front) Participant attempts to place hand
• Hips against back of chair on the box. The heel of the hand • “Lift your hand from the table
• Hand not being tested in must be placed past the front edge and place it on the box so that
lap of box. The palmar surface of the the heel of your hand goes
• Hand to be tested placed hand need not be flat. past the edge of the box; like
on table, heel of hand just this. Do this as quickly as you
beyond 2 cm line, (i.e., just Timing Procedure: can.”
past line, in circle – in final
position on last task). Starts on word “Go” and ends Verbal Instructions while
• Box centered on table; when the heel of the hand and demonstrating quickly:
front edge aligned with 20 fingers touch the box past the
cm line. Box should be front edge of box • “Place your hand on the box as
stabilized by someone fast as you can.”
during the trial. Measure: • “Do you have any questions?”
• Filming Position (Side-Side) • “Ready!, Set!, Go!” (said
The time elapsed from the starting quickly and vigorously).
point to the moment the heel of
the hand and fingers touch box Scoring:
past the edge of the box.
• FA scoring should take into
account the extent to which the
head and trunk are maintained
in normal alignment and the
speed, fluidity, and precision
with which movements are
performed.
• Note: The final posture of the
hand and fingers does not
influence scoring as long as the
heel of the hand and fingers are
in contact with the box.

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7. Weight to box

SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while

demonstrating slowly:
• Chair Position (front) Participant attempts to place
• Hips against back of chair the (weighted) hand being • “Place your hand on the box so that
• Hand not being tested in tested on the box so that the the heel of your hand is beyond the
lap heel of hand rests beyond the front edge of the box (demonstrate);
like this. Keep your back against the
• Heel of hand just beyond front edge of the box.
chair. That is very important. Take
2 cm line. Participant should not be
your time you do not need to hurry.”
• Cuff weight(s) in place permitted to lean in and use the
around forearm to be body to help lift the weight; the
Verbal Instructions while
tested; stacking of entire back should remain in
demonstrating quickly:
weights begun just distal contact with the chair (scapular
to the elbow. The weights protraction of the moving UE is
• “Lifting this weight on your arm place
should be stacked while allowed). Tester must, place
your hand on the box.”
arm to be tested is resting their fingers behind the • “Do you have any questions?”
on the table to avoid subject’s back at the top of the • “When you are ready, place your hand
fatiguing the arm. chair to determine if the on the box.”
• Participant’s hand should subject’s back moves away
be placed on the table in from the chair. In stacking the Special Considerations:
the circle on the template weights near wrist, be sure to
with the elbow off the leave enough room for weights • For the initial trial, the examiner should
table. Cuff weight should to clear the table. subjectively determine the appropriate
be unsupported. If the starting weight by resisting the
participant is unable to Timing Procedure: participant’s attempt to hold the elbow
extended, shoulder flexed to 90o. The
maintain the hand flat in
Not applicable. stronger the participant appears, the
the circle with the weight
higher the initial weight should be. If
unsupported, a lighter participant is weak, task should begin
weight should be tried Measure:
with lower initial weight. Increases in
until they are able to the amount of 2 lbs. Should continue
achieve the correct • Amount of weight until the participant’s maximum or 20
starting position, i.e. with participant is able to lift to lbs. is reached. When the participant
weight unsupported the box while keeping has reached his/her apparent
• Cuff weights with 1 lb. his/her back against the maximum, the next trial should be 1 lb.
inserts are preferable chair (not timed as previous less. If that weight can be lifted, it is
tasks). recorded as the maximum. A 2 minute
• Box centered on table;
front edge aligned with 20 • Weight amounts in the rest period should be allowed after
order attempted should be every three trials.
cm line. Box should be • For follow up evaluations, starting
stabilized by someone recorded. The maximum
weight should be the 80% of the
during the trial. amount of weight lifted
maximum weight recorded from
• Not filmed should be document on the previous evaluation.
set-up form for use at
• State amount of weight lifted for each
subsequent evaluations. trial

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IV. One, Task (8); Functional ability of the elbow of the involved upper extremity; performed to the
front of the participant.

8. Reach and retrieve

SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while demonstrating

slowly:
• Chair Position (front- Participant attempts to pull
close) 1 lb. weight across the 8 cm • “Slide the weight across the table toward
• Hips against back of line. Task object is a cuff you until it is past the 8 cm line (point to
chair weight folded so that is red line). Do the task entirely by bending
• Re-powder table. approximately 7.6 cm, (3”) your elbow and keeping your thumb
• 1 lb. weight centered on each side, and kept in facing the ceiling (demonstrate); like this.
on table and place by a velcro fastener. The weight should remain in contact with
positioned just Assign a 120+ if the your hand until it crosses this line (point to
beyond 40-cm line. participant cannot attain the red line). Do this as quickly as you can.”
• Hand not tested in lab. starting position.
• Elbow of arm to be Verbal Instructions while demonstrating
tested extended, Timing Procedure: quickly:
forearm in mid-
position of pronation Starts on word “Go” and • “Bend your elbow with your thumb facing
and supination and ends when any part of the up, sliding the weight across the table as
palm of hand in weight crosses the 8 cm line. fast as you can.”
contact with weight. • “Do you have any questions?”
• The subject must be Measure: • “Ready!, Set!, Go!” (said quickly and
able to maintain the vigorously).
starting position while The amount of time elapsed
the tester states from the starting point to Scoring:
“Ready!,Set!, Go!” the moment the leading
• Filming Position (Side- edge of the weight crosses • FA scoring should take into account: 1) the
Side) the 8 cm line. extent to which the head and trunk are
maintained in normal alignment, 2)
Whether the activity is performed by
bending the elbow as opposed to using
excessive upper arm or hand movements
(i.e. swatting the weight with the hand),
and 3)the speed, fluidity, and precision
with which movements are performed.
• If the participant’s forearm loses contact
with the weight or pronates, a maximum
FA score of 3 should be assigned.
• If the participant is unable to maintain the
starting position without physical
assistance, a zero is assigned and activity is
not attempted.
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 V. Nine Tasks (9-17), Functional ability of the arm and hand of the involved upper extremity; performed
to the front of the participant.

9. Lift Can
SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while

demonstrating slowly:
• Chair Position (front) Participant attempts to lift the can
• Hips against back of chair and bring it close to lips with a • “Lift the can to your mouth
• Hands in lap cylindrical grasp. An overhand without touching your lips; like
• Unopened 12 oz. soft drink grasp is not allowed for this task. this (demonstrate). It is very
can (392 gm) placed on Note: If the participant performs important that you use the
table at participant’s the task by lifting the can using an appropriate grasp is not
midline with front edge of overhand grasp, repeat the task allowed (demonstrate both
can just beyond 20 cm line. one more time. Assign a 120+ if grasp). Do this as quickly as
• Filming Position (Side- the task is completed with an you can.”
Close) overhand grasp.
Verbal Instructions while
Timing Procedure: demonstrating quickly:

Starts on word “Go” and ends • “Lift the can to your mouth as
when can is within approximately fast as you can.”
on inch of participant’s mouth. • “Do you have any questions?”
• “Ready!, Set!, Go!” (said
Measure: quickly and vigorously).

The time elapsed from the starting Scoring:

point to the moment the can is
within approximately on inch of • FA scoring should take into
participant’s mouth. account: 1) the extent to which
the head and trunk are
maintained in normal
alignment, 2) the directness of
the trajectory to the mouth, 3)
the speed, fluidity, and
precision with which
movements are performed.

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10. Lift Pencil

SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while

demonstrating slowly:
• Chair Position (front) Participant attempts to pick up the
• Hips against back of chair pencil using 3-jaw chuck grasp • “Pick up the pencil using your
• Hands in lap (thumb and frist two fingers). The thumb and first two fingers
• 7” pencil (with 6 flat sides) pencil should be picked up on the and hold it in the air like this
placed parallel to front table and not over the edge of the (demonstrate). The pencil
edge table, centered on table. Note: If the participant should be picked up on the
participant’s midline with performs the task by lifting the table and not over the edge of
front edge of can just pencil over the edge of the table the table. Do this as quickly as
beyond 20 cm line. once repeat the task one more you can.”
• Filming Position (Side- time. Assign a 120+ if the task is
Close) completed by bringing the pencil Verbal Instructions while
over the edge of the table. demonstrating quickly:
**Encourage the participant to use
a 3-jaw chuck grasp. • “Pick up the pencil as fast as
you can.”
Timing Procedure: • “Do you have any questions?”
• “Ready!, Set!, Go!” (said
Starts on word “Go” and ends quickly and vigorously).
when entire pencil (all surfaces) is
raised from table at least ½ inch. Scoring:
Evaluator should be positioned at
eye level with the tabletop. • FA scoring should take into
Evaluator should verbalize the account: 1) the extent to which
grasp used, whether it is correct 3- the head and trunk are
jaw chuck grasp, or another grasp. maintained in normal
alignment, 2) whether the
Measure: appropriate grasp is used (3-jaw
chuck), 3) the speed, fluidity,
The time elapsed from the starting and precision with which
point to the moment the entire movements are performed.
pencil is raised from the table. • A 3-jaw chuck grasp should be
used. If another grasp is used, a
maximum FA score of 2 should
be assigned
• Raters should take into
accounts the participant’s
control of the grasp. If the
participant immediately drops
the pencil, a maximum FA score
of 3 should be assigned.

© Copyright Emory University CRM 2011 All Rights Reserved

11. Lift paper clip

SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while

demonstrating slowly:
• Chair Position (front) Participant attempts to pick up the
• Hips against back of chair paper clip using a pincer grasp • “Pick up the paper clip using
• Hands in lap (pads of thumb and index finger). your thumb and index finger
• 2” paper clip (coated and The paper clip should be picked up and hold it in the air like this
colored) placed parallel to on the table and not over the edge (demonstrate). The paper clip
front edge table, centered of the table. Note: If the should be picked up on the
on participant’s midline participant performs the task by table and not over the edge of
with front edge of can just lifting the pencil over the edge of the table. Do this as quickly as
beyond 20 cm line; the the table once repeat the task one you can.”
winder edge of the paper more time. Assign a 120+ if the
clip should be facing task is completed by bringing the Verbal Instructions while
towards the side to be clip over the edge of the table. demonstrating quickly:
tested **Encourage the participant to use
• Filming Position (Side- a pincer grasp. • “Pick up the paper clip as fast
Close) as you can.”
Timing Procedure: • “Do you have any questions?”
• “Ready!, Set!, Go!” (said
Starts on word “Go” and ends quickly and vigorously).
when entire paper clip is raised
from table at least ½ inch. Scoring:
Evaluator should be positioned at
eye level with the tabletop. • FA scoring should take into
Evaluator should verbalize the account: 1) the extent to which
grasp used, whether it is correct the head and trunk are
pincer grasp, or another grasp. maintained in normal
alignment, 2) whether the
Measure: appropriate grasp is used
(pincer grasp), 3) the speed,
The time elapsed from the starting fluidity, and precision with
point to the moment the entire which movements are
paper clip is raised from the table. performed.
• A pincer grasp should be used.
If another grasp is used, a
maximum FA score of 2 should
be assigned
• Raters should take into
accounts the participant’s
control of the grasp. If the
participant immediately drops
the paper clip, a maximum FA
score of 3 should be assigned.
© Copyright Emory University CRM 2011 All Rights Reserved
12. Stack Checkers

SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while

demonstrating slowly:
• Chair Position (front) Participant attempts to stack the
• Hips against back of chair two end checkers onto the center • “Stack the two end checkers onto
• Hands in lap checker. The task can be executed the center checker. The checkers
do not have to be perfectly
• Three checkers are placed by picking up either checker first.
stacked, but the top two checkers
in a line parallel to front
must not touch the table surface
edge of table with front Timing Procedure:
(demonstrate incorrect method
edge of each checker just of at least one checker still
beyond 20 cm line. (See Starts on word “Go” and ends touching the table surface in the
circle outlines on template). when participant has placed the stacked position. See special
Checkers are spaced 4.5 cm third checker in required position. consideration). Do this as quickly
apart with middle checker as you can.”
at participant’s midline. Measure:
• Filming Position (Side- Verbal Instructions while
Close) The time elapsed from the starting demonstrating quickly:
point to the moment the third
checker is in place. • “Stack the two end checkers
onto the center checker as fast
as you can.”
• “Do you have any questions?”
• “Ready!, Set!, Go!” (said
quickly and vigorously).

Special Consideration
Checkers may be out of alignment,
but in order for the task to be
considered completed, the top two
checkers may not be touching the
table surface. The tested should
demonstrate what is not acceptable.

Scoring:

• FA scoring should take into

account the extent to which the
head and trunk are maintained in
normal alignment and the speed,
fluidity, and precision with which
movements are performed.
• The checkers so not need to be
perfectly aligned; therefore do not
deduct rating points based on
alignment of checkers.
© Copyright Emory University CRM 2011 All Rights Reserved
13. Flip Cards

SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while demonstrating slowly:

• Chair Position (front) Using a pincer grasp on the near • “Flip each of the cards over. You should
• Hips against back of edge of cards, participant slide the card toward you so that it goes a
chair attempts to flip each of the cards little over the edge of the table. Start with
• Hands in lap over. This task should be done the card on your (state side (R/L), to match
• Three 3” x 5” index by sliding the front edge of the
side being tested) side, then the center
cards with a black card just past the front edge of
the table with some or all of the
card, and then the card on your (state side
line at top of each
fingers and then grasping the (R/L) from above) side. The cards should
card; placed to front
line parallel to front card edge protruding past the be flipped over from side to side like this
edge of table, with edge of the table between the (demonstrate) rather than from end to end
short (3”) far edge of palmar surface of thumb and (demonstrate); not like this. You should
card facing index finger. Cards should be turn your forearm over like this (Demo
participant just flipped over from side to side supination) instead of just using your
beyond 20 cm line. (rather than from front to end). fingers to flip the card over. The cards may
Cards spaced 3 cm Evaluator should emphasized land anywhere on the table so you do not
apart with middle supination/pronation in demo. need to straighten the cards after turning
card at participant’s The cards do not have to be
them over. Do this as quickly as you can.”
midline. straightened or adjust after they
• Filming Position have been turned over. The
Verbal Instructions while demonstrating
(Side-Close) participant should first flip over
the card on side being tested, quickly:
then the center card and then
the card on the opposite side. • “Flip each of the cards over, from side to
side, as fast as you can.”
Timing Procedure: • “Do you have any questions?”
• “Ready!, Set!, Go!” (said quickly and
Starts on word “Go” and ends
vigorously).
when entire participant has
flipped all cards into a new
position. Scoring:

Measure: • FA scoring should take into account: 1) the

extent to which the head and trunk are
The time elapsed from the maintained in normal alignment, 2) the
starting point to the moment the extent the forearm supinates when turning
entire the third card has been the cards, 3) the dexterity of the fingers and
flipped over and released onto 4) the speed, fluidity, and precision with
the table. which movements are performed.
• If the participant makes more than 2
attempts on any card, a maximum FA score
of 2 should be assigned.
• If the participant fails to flip all cards side to
side, a maximum FA score of 3 should be
assigned.
© Copyright Emory University CRM 2011 All Rights Reserved
14. Grip Strength

SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while

demonstrating slowly:
• Chair Position (front-close) Participant attempts to grip the
• Hips against back of chair dynamometer with greatest grip • “Squeeze the handle as far as
• Hand not being tested on strength possible. The test should you can for at least 3 seconds
thigh be conducted 3 times with a 1- and then let go when I say
• Upper extremity to be minute rest between trails. “Release.” I will ask you to do
tested placed on table, this 3 times with a 1-minute
olecranon process at front Timing Procedure: rest between attempts.”
edge of table, forearm in (repeat instructions)
neutral position, elbow Not applicable • “Do you have any questions?”
flexed, shoulder slightly • “Ready!, Set!, Go!” (said
flexed and in 0o abduction. Measure: quickly and vigorously).
• The hand-held
dynamometer is set on the The mean of grip strength exerted
second setting position. (kg) on 3 trials
• Grip strength
dynamometer placed in
hand that is resting on the
table. The tester or an
assistant should stabilize
the dynamometer for the
participant from the front
of the participant
• Not filmed

© Copyright Emory University CRM 2011 All Rights Reserved

15. Turn Key in Lock

SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while

demonstrating slowly:
• Chair Position (front) Using a lateral pincer grasp,
• Hips against back of chair participant attempts to move • “Grasp the key between your thumb
• Hands in lap the key in the lock from the and your forefinger (demonstrate
lateral pincer grasp) like this and turn
• Lock and key board is vertical position first to the
side being test, then to the the key, first to the (state (R/L) side
stabilized at a 45 degree being tested) as far as the key will
angle, preventing board opposite side and finally back
turn, then to the (state (R/L) opposite
from moving when used by to the vertical starting side) as far as the key will turn and
participant; board held position. Tumblers of the lock finally return the key to the original
parallel to front edge of are set so that the key moves vertical position. Be sure you move
table, just beyond 8 cm line through a 180 degrees arc the key until you reach this point. Do
and centered on (only), with 90 degrees of that this as quickly as you can.”
participant’s midline. arc on either side of the
• Filming Position (Side- midline. Verbal Instructions while
Close) **encourage participant to use demonstrating quickly:
lateral pincer grasp.
• “Turn the keyin the lock, first to the
Timing Procedure: (state R/L side being tested) and then
to the (state R/L opposite side), then
Starts on word “Go” and ends back to the middle, as fast as you
can.”
when the key is in the starting
• “Do you have any questions?”
position.
• “Ready!, Set!, Go!” (said quickly and
vigorously).
Measure:
Scoring:
The time elapsed from the
starting point to the moment • FA scoring should take into account: 1)
the key is in the starting the extent to which the head and trunk
position. are maintained in normal alignment, 2)
whether the appropriate grasp is used
(lateral pincer grasp), 3) whether the
forearm moves into pronation and
supination as the key is turned, and 4)
the speed, fluidity, and precision with
which movements are performed.
• If the participant doesn’t turn the key
in the correct sequence (i.e. turn key to
side being test first), a maximum of 3
should be assigned for FA score
• If a grasp other than a lateral pincer
grasp is used, a maximum FA score of 3
should be assigned.

© Copyright Emory University CRM 2011 All Rights Reserved

16. Fold towel

SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while demonstrating

slowly:
• Chair Position (front) Participant picks up the towel
• Hips against back of chair with both hands, grasping the • “Grasp the far corners of the towel
• Hands in lap far corners of the towel. The and fold it lengthwise like this
• Towel is placed flat on table participant first folds the (demonstrate). Then fold it in half
centered on participant towel lengthwise. The across its center by using your
with front long edge of participant then folds the (state (R/L) the side being tested)
towel at 8 cm line. towel in half again across its arm. Try to get the ends of the
• Filming Position (Side- center (widthwise). The towel close together (demonstrate).
Close) second fold is done with the In order to complete the task, the
arm being tested only and is ends of the towel must be close
done from the side of the together. Do this as quickly as you
towel corresponding to the can.”
arm being tested. The folding
does not need to be exact, Verbal Instructions while
but the ends of the towel demonstrating quickly:
need to be approximately
aligned (within 1.5 inches). • “Grasp the far corners of the towel
and fold towards you, then fold in
Timing Procedure: half using your (state (R/L) side
being tested) hand as fast as you
Starts on word “Go” and ends can.”
when the towel is completely • “Do you have any questions?”
folded on the table. • “Ready!, Set!, Go!” (said quickly and
vigorously).
Measure:
Scoring:
The time elapsed from the
starting point to the moment • FA scoring should take into account:
the towel is completely folded 1) the extent to which the head and
on the table. trunk are maintained in normal
alignment, 2) the symmetry of the
arms as they fold the towel for the
first fold, 3) the speed, fluidity, and
precision with which movements are
performed.
• The ends of the towel do not need to
be exactly aligned after the second
fold, but ends of the towel need to
be approximately aligned (within 1.5
inches).

© Copyright Emory University CRM 2011 All Rights Reserved

© Copyright Emory University CRM 2011 All Rights Reserved
17. Lift Basket

SET UP TASK VERBAL INSTRUCTIONS

Starting Position: Task Description: Verbal Instructions while demonstrating

slowly:
• Participant standing and Participant attempts to
facing table pick up basket by grasping • “Pick up the basket with your (R/L)
• Bedside table is placed over handle (from underneath hand and place the basket on the table.
the desk on the the handle) and placing The far edge of the basket should go
participant’s side being the basket on far edge of past the far edge of the bedside table
tested. The table’s height is the rolling bedside table. (demonstrate); like this. Try not to
adjusted so that the The far edge of the basket move your feet while you do this task.
participant will not exceed should touch the far edge Do this as quickly as you can.”
90o abduction, when the of the table.
basket is placed on the Verbal Instructions while demonstrating
table with the desired Timing Procedure: quickly:
grasp. The bedside table
extends along the width of Starts on word “Go” and • “Pick up the basket with your (R/L)
the desk ends when any portion of hand and place the basket on the table
• Basket at 8 cm line, with the base of the basket as fast as you can.”
leading edge at 14 cm line extends beyond the far • “Do you have any questions?”
on side to be tested, edge of the bedside table. • “Ready!, Set!, Go!” (said quickly and
handles taped together and vigorously).
lined up with the center of Measure:
body. Scoring:
• Three 1 lb. weight placed in The time elapsed from the
basket starting point to the • FA scoring should take into account the
• Filming Position (Front) moment the basket has extent to which the head and trunk are
been placed on the maintained in normal alignment and the
bedside table with any speed, fluidity, and precision with which
portion of the base of the movements are performed.
basket beyond the far • If the participant moves out of the
edge of the bedside table. original foot position, a maximum FA
(Note: release of the score of 3 should be assigned.
basket is not included in • The task is demonstrated with the
the time measure). leading edge of the basked crossing the
far edge of the bedside table first. If
other portions of the basket cross the
far edge first, a maximum FA score of 3
should be assigned.
• The task is demonstrated without
rotating the trunk. If the participant
significantly rotates their trunk during
the task, a maximum FA score of 3
should be assigned.

© Copyright Emory University CRM 2011 All Rights Reserved