Pediatric Performance-Based Outcome Measures for Upper Extremity Function: A Scoping Review and Linking to the International Classification of Functioning,Disability,and Health

Abstract

Background. Performance-based outcome measures (PBOMs) are objective measures that assess physical capacity or performance in specific tasks or movements. Purpose. 1) to identify which PBOMs are most frequently reported to evaluate upper extremity (UE) function in pediatric rehabilitation 2) to determine the link between constructs of the ICF and meaningful concepts extracted from each identified PBOM. Methods. Pediatric UE PBOMs were searched in four databases. The selection of outcome measures included an initial title and abstract screening, followed by full-text review of the articles to be included based on identified selection criteria. Two reviewers were appointed to link the meaningful concepts identified in the outcome measures independently and a third reviewer was consulted in case of ambiguity to make a final decision. Findings. After the initial screening, 1786 full-text articles were reviewed, 1191 met the inclusion criteria, in which 77 outcome measures were identified and 32 were included in the linking process. From the included 32 outcome measures, 538 items were extracted and linked to the ICF. The most commonly cited measures included Assisting Hand Assessment, Jebsen-Taylor Hand Function Test, Melbourne Assessment of Unilateral Upper Limb. The Activity and Participation domain represented 364 codes followed by the Body Functions domain domain which represented 174 codes. Implications. A majority of the outcome measures identified were linked with the Mobility, Fine Hand Use of the ICF. Therefore, when selecting a PBOM, careful considerations need to be made regarding which concept of health is to be assessed.

Introduction

Pediatric rehabilitation is a specialized field that aims to improve the functional outcomes of children with various health conditions (Hsu et al., 2021). Among the most common types of pediatric rehabilitation is musculoskeletal rehabilitation, which focuses on improving the physical function of children with bone, joint, and muscle disorders. In the field of rehabilitation, occupational therapists (OTs) and physical therapists (PTs) use various outcome measures to assess the effectiveness of their interventions (American Physical Therapy Association, 2014; Houtrow & Coster, 2019). These outcome measures can be either patient-reported or performance-based. Patient-reported outcome measures (PROMs) rely on self-reported information from the patient or caregiver, such as pain level or functional status. In contrast, performance-based outcome measures (PBOMs) require the patient to perform a set of movements or tasks that assess the patient's physical capacity or performance (Mayo, 2015). Scores for PBOMs can be based on either objective measurement (such as time to complete) or a qualitative assessment (such as describing task performance) that is assigned a score. PROMs and PBOMs can be either generic or condition-specific. Generic measures are designed to be applicable to a broad range of conditions and populations, while condition-specific measures are tailored to assess specific impairments or conditions for a given population. An example of a condition-specific measure for children with cerebral palsy would include the Gross Motor Performance Measure (GMPM) that seeks to evaluate gross motor performance or the Shriners Hospital Upper Extremity Evaluation (SHUEE) designed for use with hemiplegic type of cerebral palsy (Boyce et al., 1992; Davids et al., 2006).

While both types of outcome measures have their advantages and disadvantages, choosing the most appropriate measure for a specific patient and condition can be challenging. This is where the International Classification of Functioning, Disability and Health (ICF) can be a valuable framework for clinicians. The ICF provides a comprehensive and standardized system for describing health and health-related states, including body function and structure, activity, and participation (World Health Organization (WHO)., 2019). The ICF health-related states are further broken down into chapters (b=body function, s=body structure, d=activities and participation, e=environmental factors) followed by a numeric code. The number of digits which make up the code indicate the category and its level. The more digits (4^th level coding) available, the more precise description of the ICF (World Health Organization (WHO)., 2013). By using the ICF as a framework to guide their choice of outcome measures, clinicians can ensure that they are assessing the most relevant and meaningful outcomes for their patients (Houtrow & Coster, 2019). This, in turn, can help better report the effectiveness of their interventions and ultimately improve the functional outcomes and quality of life of children with musculoskeletal conditions.

A recently published scoping review (Lesher et al., 2017) identified outcome measures frequently used in occupational therapy investigating the links between the constructs of the ICF and upper extremity outcome measures. Although the journal article by Lesher et al. (2017) provides an overview of linking constructs from UE outcome measures to the ICF, it is important to note that their approach did not follow a standardized linking process. Additionally, the authors were limited to first-level codes of the ICF, providing only a superficial level of information. A deeper analysis into the content of a measure can provide a comprehensive assessment of the most relevant components of a specified construct for a target audience and context (MacDermid, 2021). Hence, there was a need to conduct a more in-depth review of PBOMs across all pediatric conditions impacting the UE function in order to accurately inform clinicians in their selection of outcome measure to better evaluate children with UE anomalies.

In order to provide a standardized method for collecting health information, Alarcos Cieza and colleagues have proposed rules for linking existing health information to the ICF. Since its development in 2002, two updated versions have been published with the latest being in 2019 (Cieza et al. 2019). The latest version includes ten linking rules, as well as a linking extraction table. By implementing a standardized linking process, health-status measures can be properly used to assess and address patients’ needs in rehabilitation.

The aims of this scoping review were twofold. The first aim was to identify which PBOMs are most frequently reported to evaluate UE function in pediatric rehabilitation. The second aim was to determine the link between constructs of the ICF and meaningful concepts extracted from each identified PBOM. The overall goal was to determine the gaps in the PBOMs to help better inform clinicians and outcome measure developers.

Methods

Design

A scoping review is a form of knowledge synthesis that addresses an exploratory research question aimed at mapping key concepts, types of evidence, and gaps in research related to a defined area or field by systematically searching, selecting, and synthesizing existing knowledge (Arksey & O’Malley, 2005). The current scoping review used Arksey and O’Malley's (2005) framework in addition to the recommendations by Levac et al. (2010) (Arksey & O’Malley, 2005; Levac et al., 2010). This framework consists of five steps: i) identifying the research question(s), ii) identifying relevant studies, iii) selecting studies, iv) charting the data and v) collating, summarizing and reporting results (Arksey & O’Malley, 2005; Levac et al., 2010).

Identifying the research question

Literature Review: The first aim was to identify which PBOMs are most frequently reported to evaluate UE function in pediatric rehabilitation. UE function was defined as UE coordination, motor function, sensation, muscle strength, and stabilization.

Linking to the ICF: The second aim was to determine the link between constructs of the ICF and meaningful concepts extracted from each identified PBOM using standardized ICF Linking Rules (Cieza et al., 2019).

Identifying relevant studies

Literature Review: A comprehensive search strategy was designed using the PRISMA extension for scoping reviews (PRISMA-ScR) (Tricco et al., 2018). In order to conduct a comprehensive search that would include UE evaluation for the pediatric population in rehabilitation, articles were searched through the following electronic databases: Medline (1950–2021), EMBASE (1980–2021), CINAHL (1990–2021), and OTseeker in July 2021. The databases were used to reach a broad-based search strategy of English and French literature. To identify relevant studies, members of the research team entered search terms that included but were not limited to “child”,“infant”,“adolescent”,“upper extremity”,“upper limb”, “fine motor skills” “agility or function” in English in varying combinations into the electronic databases. The search strategy with associated MeSH terms and/or text word search or combinations for the search strategy in Medline can be found in Table 1.

Linking to the ICF: Alarcos Cieza and colleagues have developed three iterations of linking rules, the latest being published in 2019. These were the linking rules applied during the linking process.

Selecting studies

Literature Review: The selection of UE outcome measures (Aim 1) was conducted in two phases: an initial title and abstract screening, followed by full-text review of the articles to be included using the selection criteria. Two reviewers used the Rayyan web application, which allows an independent and blinded application of the selection criteria to the process of selecting studies for inclusion (Ouzzani et al., 2016), to go through the title and abstract screening portion. A third reviewer was included to resolve any disagreements in this initial selection process. To increase consistency among reviewers, all reviewers screened the same 50 publications and discussed the results before beginning screening. Once all reviewers agreed, the two reviewers then applied the selection criteria to full-text articles. For a study to be included, it had to meet the following conditions: 1) be specific to the pediatric population (0–18 years) with any health status or health condition, 2) purpose of the PBOM included UE function, 3) outcome measure must be performance-based (PBOM), and 4) be published in English or French. If an outcome was a self-reported or proxy completed measure it was excluded. The selection criteria can be found in Table 2.

Linking to the ICF: Two reviewers were appointed to link the meaningful concepts identified in the outcome measures independently and a third reviewer was consulted in case of ambiguity to make a final decision. A discussion was held to ensure consensus was reached. In addition to acquiring good knowledge of the conceptual and taxonomical fundamentals of the ICF, the three reviewers performed a mock linking session to align perspectives and ensure all had the same understanding of the linking rules. A kappa statistic was reported to determine the level of agreement for linking of meaningful concepts to the ICF. Kappa values generally range from 0 to 1 with 1 indicating perfect agreement and 0 indicating no additional agreement beyond what is expected chance alone. Kappa coefficients above 0.6 are regarded as good (Bernardelli et al., 2021). The data analysis was performed with SPSS.

Charting the data

Literature Review: The included studies were organized in an excel document which identified the name of the outcome measure, number of times it was identified in the literature search, author and year of publication, purpose, intended population, age of population, number of domains of function assessed, list of domains assessed (Table 3).

Linking to the ICF: The latest linking rules suggest using a specific linking extraction table that includes the following information: Name of outcome measure, verbatim health information, perspective adopted in information, response options, classification of response options, main meaningful concepts, additional meaningful concepts, ICF category for the main meaningful concepts, ICF category for the additional meaningful concepts, annotation (Cieza et al., 2019). This table was generated for each included outcome measure (Table 4).

Collating, summarizing and reporting results

Once the data from the measures was extracted and the items linked accordingly, the data was analyzed and synthesized. The outcome measures were organized based on the number of times they were reported in the literature. The items extracted from the outcome measures were then linked to the ICF following the linking extraction table (Table 4) (Cieza et al., 2019). Findings were reported and discussed below (Arksey & O’Malley, 2005).

Table 1

Search Strategy in Medline (1947-July 2021)

#	Searches	Results
1	exp Child/	1993692
2	exp Infant/	1180056
3	Adolescent/	2111703
4	(newborn* or new-born* or neonat* or neo-nat* or infan* or child* or adolesc* or paediatr* or pediatr* or baby* or babies* or toddler* or kid or kids or boy* or girl* or juvenile* or teen* or youth* or pubescen* or preadolesc* or prepubesc* or preteen or tween).ti,ab.	2584896
5	exp Upper Extremity/ph, pp OR exp Hand Strength/ OR (exp Upper Extremity/ AND (exp "Musculoskeletal Physiological Phenomena"/ OR exp "Motor Skills"/ OR exp "Task Performance and Analysis"/ OR exp “Motor Skills Disorders” OR exp “Psychomotor Performace”))	67372
6	((hand* or arm* or elbow* or forearm* or shoulder* or manual or bimanual or upper extremit* or upper limb*) adj3 (activit* or abilit* or agility or function* or perform* or skill*)).ti,ab.	53084
7	5 or 6	109266
8	(Analy* or evaluat* or assessment* or assessing or instrument or instruments or measure or measurement* or measures or quantifying or scale or scales or score or scores or test or tests or tool or tools).ti.	2648737
9	1 or 2 or 3 or 4	4515271
10	7 and 8 and 9	2872

Table 2

Selection Criteria to Identify the Performance-Based Outcome Measures of UE for the Pediatric Population (Aim 1)

Inclusion Criteria	Exclusion Criteria
Pediatric population (0–18 years)	Adult population (>18 years)
UE function evaluated	PBOM not incorporating the evaluation of UE function
Performance-based	Self-reported; proxy-reported
English or French	No information on psychometric properties
Cited more than twice in the literature	Other language
Access to a copy of the PBOM

Table 3

Included Outcome Measures Listed by Most Frequently Reported in the Literature

Outcome Measure Name	Citation Count	Author (Year)	Purpose	Population Intended	Age	# of Domains	Domains
Assisting Hand Assessment (AHA)	203	Krumlinde-Sundholm L., Eliasson A-C. (2003)	Measures and describes how children with an upper limb disability in one hand use his/her affected hand (assisting hand) collaboratively with the non-affected hand in bimanual play	Children with unilateral upper limb impairments	18 months-12 years	6	General usage, arm use items, grasp/release, fine motor adjustments, coordination, pace
Melbourne Assessment of Unilateral Upper Limb (MAUUL)	134	Randall M., Johnson L., Reddihough D. (1999)	Measure to quality of unilateral upper limb movement	Children with neurological conditions	2.5–15 years	14	NA
Jebsen-Taylor Hand Function Test	122	Jebsen, R. H., Taylor, N., Trieschmann, R. B., Trotter, M. J. & Howard, L. A. (1969)	Assess a broad aspects of hand function commonly used in activities of daily living	Neurological or musculoskeletal conditions	6 years and over	7	Writing, turning cards, picking up small common objects, simulated feeding, stacking checkers, picking up large light objects, picking up large heavy objects
Quality of Upper Extremity Skills Tests (QUEST)	105	DeMatteo, C., Law, M., Russell, D., Pollock, N., Rosenbaum, P. & Walter, S. (1992)	Evaluate quality of UE function	Children with neuromotor dysfunction with spasticity	18 months-8 years	4	Dissociated movement, grasp, protective extension, weight bearing
Box and Blocks	90	Hyres and Buhler (1957) & modified by Mathiowetz V, Volland G, Kashman N, Weber K (1985)	Evaluate unilateral gross manual dexterity	All children	3 years and over	1	Dominant and non-dominant hand
Bruininks-Oseretsky (BOT-2)	52	Bruininks, R., and Bruininks, B. (2005)	Measure fine and gross motor skills of children and youth	Children with motor impairments	4–21 years	4	Fine Manual control, manual coordination, body coordination, strength and agility
Movement Assessment Battery for Children (M-ABC)	51	Henderson, S. & Sugden, D. (1992)/ Henderson, S. E., Sugden, D. A., & Barnett, A. L. (2007).	Designed to identify and describe impairments in motor performance	All children	3–16	3	Manual Dexterity, Ball Skills, Static and Dynamic Balance
Functional Independence Measure for Children (WeeFIM)	40	Msall, ME., DiGaudia, K., Rogers, BT., LaForest, S., Catanzaro, NL., Campbell, J., Wilczenski, F., & Duffy, LC. (1994)	Measures the impact of developmental strengths and difficulties on independence at home, in school, and in the community	Children with disabilities	6 months-8 years	6	Self-care, sphincter control, mobility (transfers), locomotion, communication, and social cognition,
Peabody Developmental Motor Scales (PDMS)-2	32	M. Rhonda Folio M., & Fewell, R. (2000)	Provides an in-depth assessment and training or remediation of gross and fine motor skills	All children	Birth-5 years	6	Reflexes, stationary, locomotion, object manipulation, grasping, visual-motor integration
Performance of Upper Limb (PUL)	32	Mayhew A, Mazzone ESE, Eagle M, et al. (2013)	Assess upper limb function in ambulant and non-ambulant patients	Children with Duchenne muscular dystrophy	5–27 years	1	Upper limb function
Shriners Hospital for Children Upper Extremity Evaluation (SHUEE)	26	Davids JR, Peace LC, Wagner LV, Gidewall MA, Blackhurst DW, Roberson WM. (2006)	Assess the segmental, dynamic alignment of the involved UE when performing functional tasks	Children with hemiplegic cerebral palsy	3–18 years	6	AROM, PROM, spasticity, spontaneous functional analysis, dynamic positional analysis, grasp-and-release analysis
Purdue Pegboard Test	17	Tiffen & Asher (1948)	Measure unimanual and bimanual finger and hand dexterity	All children	5–89 years	2	Unimanual and bimanual dexterity
Motor Function Measure (MFM)	16	Bérard C, Payan C, Hodgkinson I, Fermanian J (2004)	Assess severity and disease progression of neuromuscular diseases	Children with neuromuscular diseases	Over 6 years	3	Standing and transfer, Axial and proximal motor function, Distal motor function
Functional Dexterity Test (FDT)	15	Aaron, D. & Jansem, C. (2003)	Measure the patient's ability to use the hand for functional daily tasks that require 3-jaw chuck prehension between the fingers and the thumb	Patient's with hand injuries	5 years and over	1	NA
Hand Assessment of Infants (HAI)	12	Krumlinde-Sundholm L, Ek L, Sicola E, Sjöstrand L, Guzzetta A, Sgandurra G, Cioni G, Eliasson AC. (2017)	Assess upper limb function	Infants at risk of developing cerebral palsy	3–12 months	2	Unimanual and bimanual
Pediatric Arm Function Test (PAFT)	10	Uswatte, G., Taub, E., Griffin, A., Rowe, J., Vogtle, L., & Barman, J. (2012)	Assess capacity to carry out actions and tasks with the more-affected arm	Children with hemiplegic cerebral palsy	2–8 years	2	Unilateral (proximal and distal) and bilateral
Upper Limb Physician Rating Scale (ULPRS)	10	Eun Sook Park, Ji-Woon Joo, Seon Ah Kim, Dong-Wook Rha, and Soo Jin Jung (2014)	Assesses movement quality of the upper limbs	Children with spastic cerebral palsy	5–13 years	1	NA
Assessment of Children Hand Skills (ACHS)	8	Chien, CW., Brown, T., McDonald, R. (2010)	Evaluate real life hand skill performance	Children with disabilities	2–12 years	3	Leisure and play, school/education, and activities of daily living
Test of Gross Motor Development (TGMD) -2	8	Ulrich (2000)	Assess gross motor functioning in children	preschool, early elementary, and special education	3–10 years	2	Locomotor and object control
Besta Scale	6	Fedrizzi, E., Pagliano, E., Andreucci, E., Oleari G. (2003)	Asses hand function	Children with hemiplegic cerebral palsy	18 months to 12 years	3	Grip, spontaneous use, stereognosis
Selective Control of the Upper Extremity Scale (SCUES)	6	Wagner, L.V, Davids, JR & Hardin JW (2016)	Assess selective motor control of the upper extremity in children	Children with unilateral cerebral palsy	3–18 years	1	Range of Motion
Bayley Scales of Infant and Toddler Development (BSID) - 3rd edition	5	Bayley (2006)	Assess the development of infants and toddlers	All children	1–42 months	5	Cognitive, Language, Motor, Social-Emotional, and Adaptive Behaviour scales
Minnesota Handwriting Assessment	5	Reisman, J. (1999)	Analyzes handwriting skills with first and second grade students	All children	1st and 2nd grade (6–8 years)	5	Rate, legibility, form, alignment, size, spacing
Mini Assisting Hand Assessment (Mini AHA)	5	Greaves S, Imms C, Dodd K, Krumlinde-Sundholm L. (2013)	Measure how effectively children with unilateral cerebral palsy use their involved hand collaboratively with their well-functioning hand to perform bimanual play tasks.	Unilateral cerebral palsy	8–18 months	1	NA
Both Hands Assessment (BoHA)	5	Elvrum, A-K., Zethraeus, B-M., Vik, T., & Krumlinde-Sundholm, L.(2017)	Measure the effective use of both hands in bimanual activity performance, as well as to quantify the possible side difference between hands	Bilateral cerebral palsy	18 months—12 years	1	NA
Unilateral Below Elbow Test (UBET)	5	Bagley, A., Molitor, F., Wagner, L., Tomhave, W., & James, M. (2006)	Measure how children use their prostheses to accomplish developmentally appropriate two-handed tasks, without their prosthesis and how the type prosthesis affects child's ability to accomplish functional tasks	Children with unilateral congenital below elbow deficiency	2–21 years	1	NA
Brachial Plexus Outcome Measure (BPOM)	4	Ho ES, Curtis CG, & Clarke HM (2012)	Measure the activity capacity of the affected limb	Children with obstetrical brachial plexus	4–19 years	1	NA
In-Hand Manipulation Test	4	Exner, C. (1990)	Assess the quality and efficiency of in-hand manipulation skills in children	All children	pre-school and school aged	1	NA
Assessment of Capacity for Myoelectric Control (ACMC)	4	Hermansson, L., Fisher, A., Bernspang, B., & Eliasson, A-C. (2005)	Assess the ability to control a myoelectric prosthetic hand	Upper limb reduction deficiency or amputation	Over 2 years	4	Gripping, holding, releasing, coordinating
Upper Extremity Rating Scale (UERS)	4	Koman LA, Williams RM, Evans PJ, et al. (2008)	Evaluate range of motion (a technical component of function)	Children with hemiplegic cerebral palsy	3–18 years	5	Shoulder active motion, elbow active motion, forearm active motion, wrist active motion, hand
Test of Infant Motor Performance (TIMP)	3	Campbell SK, Wright BD, Linacre JM. (2002)	Assessing the postural and selective control of movement needed for functional motor performance in early infancy.	Premature infants	34 weeks post-conception age to 4 months post-term	1	NA
Video Observations Aarts and Aarts, module Determine Developmental Disregard (VOA-DDD)	3	Aarts PB, Jongerius PH, Aarts, MA., Hartingsveldt, JV., Anderson, PG., & Beumer, A. (2007)	Extended evaluation of motor behaviour of affected upper limb	Children with spastic unilateral cerebral palsy	4–10 years	2	Duration and frequency of activity

Table 4

Linking Rules Data Extraction Table for 32 Outcome Measures

1. Name of Instrument	2. Item aka Verbatim Health Information	3. Perspective	4. Response Options	5. Classification of Response	6. Main Meaningful Concept	7. Additional Meaningful Concept	8. ICF Category: Main Meaningful Concept	9. ICF Category: Other Meaningful Concept	10. Annotation
Assisting Hand Assessment (AHA)	AH Initiation/usage
	Touches	Capacity	N/A	N/A	touch		d1201 - Touching
	Holds	Capacity	N/A	N/A	hold		d4401—Grasping
	Initiates use	Capacity	N/A	N/A	initiating		d2100—Undertaking a simple task
	Attends assisting hand	Capacity	N/A	N/A	attends assisting hand		d4458—Hand and arm use, other specified
	Stabilizes by weight	Capacity	N/A	N/A	stabilizes		b7158—Stability of joint function, other specified		general stability
	Arm use
	Proceeds	Capacity	N/A	N/A	proceeds		d2100—Undertaking a simple task
	Uses assisting hand	Capacity	N/A	N/A	uses assisting hand		d4458—Hand and arm use, other specified
	Strategies	Capacity	N/A	N/A	strategies		d1759—Solving problems, unspecified		general problem solving
	Grip-release functions
	Stabilizes by grip	Capacity	N/A	N/A	grip	stability	d4401—Grasping	b7158—Stability of joint function, other specified	general stability
	Hand choice	Capacity	N/A	N/A	hand choice		b7602—Coordination of voluntary movements
	Coordinates	Capacity	N/A	N/A	coordination		b7602—Coordination of voluntary movements
	Reaches	Capacity	N/A	N/A	reach		d4452—Reaching
	Varies fingers	Capacity	N/A	N/A	finger movement		b7600—Control of simple voluntary movements
	Fine motor adjustments
	Grip types	Capacity	N/A	N/A	grip		d4401—Grasping
	Releases	Capacity	N/A	N/A	release		d4403—Releasing
	Grasp hold of	Capacity	N/A	N/A	grasp		d4401—Grasping
	Flows	Capacity	N/A	N/A	flow		d4409—Fine hand use, unspecified		flowing
	Coordination ability
	Calibrates	Capacity	N/A	N/A	calibration		d4458—Hand and arm use, other specified
	Varies arm position	Capacity	N/A	N/A	arm coordination		b7602—Coordination of voluntary movements
	Performance pace
	Varies grips	Capacity	N/A	N/A	grasp		d4401—Grasping
	Adjusts object	Capacity	N/A	N/A	adjusts object		d4402—Manipulating
	Manipulates	Capacity	N/A	N/A	manipulates		d4402—Manipulating
Melbourne assessment of unilateral upper limb function- 2(MAUUL-2)	Reach forward	Capacity	N/A	N/A	reach		d4452 - Reaching
	Reach sideways to elevated position	Capacity	N/A	N/A	reach		d4452 - Reaching
	Grasp of crayon	Capacity	N/A	N/A	grasp		d4401—Grasping
	Drawing grasp	Capacity	N/A	N/A	grasp		d4401—Grasping
	Release of crayon	Capacity	N/A	N/A	releasing		d4403—Releasing
	Grasp of pellet	Capacity	N/A	N/A	grasp		d4401—Grasping
	Release of pellet	Capacity	N/A	N/A	releasing		d4403—Releasing
	Manipulation	Capacity	N/A	N/A	manipulation		d4402—Manipulating
	Pointing	Capacity	N/A	N/A	pointing		b7600—Control of simple voluntary movements
	Reach to brush from forehead to back of neck	Capacity	N/A	N/A	grooming		d520—Caring for body parts
	Palm to bottom → simulating wiping	Capacity	N/A	N/A	wiping		d530—Toileting
	Pronation/supination	Capacity	N/A	N/A	pronation/supination		b7100—Mobility of a single joint
	Reach to opposite shoulder	Capacity	N/A	N/A	reach to opposite shoulder		b7602—Coordination of voluntary movements
	Hand to mouth and down	Capacity	N/A	N/A	hand to mouth and down		b7602—Coordination of voluntary movements
Jebsen-Taylor Hand Function (JTHF)	Writing a short sentence (24 letters, 3rd grade reading difficulty)	Capacity	N/A	N/A	writing		d1700—Using general skills and strategies of the writing process
	Turning over a 3×5 inch card	Capacity	N/A	N/A	turning card		d4402—Manipulating
	Picking up small common objects	Capacity	N/A	N/A	picking up small object		d4400—Picking up
	Simulated feeding	Capacity	N/A	N/A	feeding		d550—Eating
	Stacking checkers	Capacity	N/A	N/A	stacking		d4402—Manipulating
	Picking up large light cans	Capacity	N/A	N/A	picking up light object		d4408—Fine hand use, other specified		large object
	Picking up large heavy cans	Capacity	N/A	N/A	picking up heavy object		d4408—Fine hand use, other specified		large object
Quality of Upper Extremity Skills Test (QUEST)	Dissociated Movements
	Shoulder
	Flexion	Capacity	N/A	N/A	flexion		b7600—Control of simple voluntary movements
	Flexion with fingers extended	Capacity	N/A	N/A	flexion with fingers extended		b7601—Control of complex voluntary movements
	Abduction	Capacity	N/A	N/A	abduction		b7600—Control of simple voluntary movements
	Abduction with fingers extended	Capacity	N/A	N/A	abduction with fingers extended		b7601—Control of complex voluntary movements
	Elbow
	Flexion with supination	Capacity	N/A	N/A	flexion with supination		b7601—Control of complex voluntary movements
	Extension with supination	Capacity	N/A	N/A	extension with supination		b7601—Control of complex voluntary movements
	Flexion with pronation	Capacity	N/A	N/A	flexion with pronation		b7601—Control of complex voluntary movements
	Extension with pronation	Capacity	N/A	N/A	extension with pronation		b7601—Control of complex voluntary movements
	Wrist
	Extension with elbow extension	Capacity	N/A	N/A	extension with elbow extension		b7601—Control of complex voluntary movements
	Extension with elbow flexion	Capacity	N/A	N/A	extension with elbow flexion		b7601—Control of complex voluntary movements
	Extension with pronation	Capacity	N/A	N/A	extension with pronation		b7601—Control of complex voluntary movements
	Extension with supination	Capacity	N/A	N/A	extension with supination		b7601—Control of complex voluntary movements
	Flexion with supination	Capacity	N/A	N/A	flexion with supination		b7601—Control of complex voluntary movements
	Independent movement
	Fingers	Capacity	N/A	N/A	fingers		b7600—Control of simple voluntary movements
	Thumb	Capacity	N/A	N/A	thumb		b7600—Control of simple voluntary movements
	Arm position during grasp/release
	Grasp using thumb	Capacity	N/A	N/A	grasp using thumb		d4401—Grasping
	Grasp using palm	Capacity	N/A	N/A	grasp using palm		d4401—Grasping
	Release from thumb and fingers	Capacity	N/A	N/A	releasing thumb and fingers		d4403—Releasing
	Release from palm	Capacity	N/A	N/A	release palm		d4403—Releasing
	Sitting Posture during Grasp
	Head	Capacity	N/A	N/A	posture		b7601—Control of complex voluntary movements
	Trunk	Capacity	N/A	N/A	body posture		b7601—Control of complex voluntary movements
	Shoulders	Capacity	N/A	N/A	posture		b7601—Control of complex voluntary movements
	Grasp
	Grasp of 1" cube	Capacity	N/A	N/A	grasp		d4401—Grasping
	Grasp of cereal	Capacity	N/A	N/A	grasp		d4401—Grasping
	Grasp of pencil/crayon	Capacity	N/A	N/A	grasp		d4401—Grasping
	Weight Bearing
	Weight bearing in prone	Capacity	N/A	N/A	weight bearing		b7603—Supportive functions of arm or leg
	Weight bearing in prone with reach	Capacity	N/A	N/A	weight bearing		b7603—Supportive functions of arm or leg
	Weight bearing in sitting with hands forward	Capacity	N/A	N/A	weight bearing		b7603—Supportive functions of arm or leg
	Weight bearing in sitting with hands by side	Capacity	N/A	N/A	weight bearing		b7603—Supportive functions of arm or leg
	Weight bearing in sitting with hands behind	Capacity	N/A	N/A	weight bearing		b7603—Supportive functions of arm or leg
	Protective Extension
	Protective extension—forward	Capacity	N/A	N/A	protective extension		b755—Involuntary movement reaction functions
	Protective extension—side	Capacity	N/A	N/A	protective extension		b755—Involuntary movement reaction functions
	Protective extension—backward	Capacity	N/A	N/A	protective extension		b755—Involuntary movement reaction functions
Box and Blocks	Dominant Hand
	I want to see how quickly you can pick up one block at a time with your right (or left) hand [examiners points to the hand]. Carry it to the other side of the box and drop it. Make sure your fingertips cross the partition. Watch me while I show you. If you pick up two blocks at a time, they will count as one. If you drop one on the floor or table after you have carried it across, it will still be counted, so do not waste time picking it up. If you toss the blocks without your fingertips crossing the partition, they will not be counted. Before you start, you will have a chance to practice for 15 s. Do you have any questions? Place your hands on the sides of the box. When it is time to start, I will "ready" and then "go".	Capacity	N/A	N/A	pick up block, carry block, drop block, fingertips across partition, toss blocks, place hand on side of box		d4400—Picking up; d4301—Carrying in the hands; d4403—Releasing ; b7600—Control of simple voluntary movements ; d4454—Throwing; b7600—Control of simple voluntary movements
	Non-dominant hand
	Now you are to do the same thing with your left (or right) hand. First you can practice. Put your hands on the sides of the box as before. Pick up one block at a time with your hand, and drop it on the other side of the box. Ready. Go.	Capacity	N/A	N/A	put hands on sides of box; pick up one block; drop block on other side of box		b7600—Control of simple voluntary movements; d4400—Picking up; d4403—Releasing
Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)	Fine motor Precision Domain
	Filling in shapes—circle	Capacity	N/A	N/A	drawing or colouring		d4408—Fine hand use, other specified		colouring
	Filling in shapes—star	Capacity	N/A	N/A	filling in shape		d4408—Fine hand use, other specified		colouring in
	Drawing lines through paths—crooked	Capacity	N/A	N/A	drawing crooked lines		d4408—Fine hand use, other specified		drawing
	Drawing lines through paths—curved	Capacity	N/A	N/A	drawing curved lines		d4408—Fine hand use, other specified		drawing
	Connecting dots	Capacity	N/A	N/A	connecting dots		d4408—Fine hand use, other specified		connecting dots
	Folding paper	Capacity	N/A	N/A	folding paper		d4402—Manipulating
	Cutting out a circle	Capacity	N/A	N/A	cutting a circle		d4402—Manipulating
	Fine motor Integration Domain
	Copying a circle	Capacity	N/A	N/A	copying a circle		d4408—Fine hand use, other specified		drawing
	Copying a square	Capacity	N/A	N/A	coping a square		d4408—Fine hand use, other specified		drawing
	Copying overlapping circles	Capacity	N/A	N/A	copying overlapping circles		d4408—Fine hand use, other specified		drawing
	Copying a wavy line	Capacity	N/A	N/A	copying a wavy line		d4408—Fine hand use, other specified		drawing
	Copying a triangle	Capacity	N/A	N/A	copying a triangle		d4408—Fine hand use, other specified		drawing
	Copying a diamond	Capacity	N/A	N/A	copying a diamond		d4408—Fine hand use, other specified		drawing
	Copying a star	Capacity	N/A	N/A	copying a star		d4408—Fine hand use, other specified		drawing
	Copying overlapping pencils	Capacity	N/A	N/A	copying overlapping pencils		d4408—Fine hand use, other specified		drawing
	Manual Dexterity Domain
	Making dots in circles	Capacity	N/A	N/A	making dots in circles		d4408—Fine hand use, other specified		making dots
	Transferring pennies	Capacity	N/A	N/A	transferring pennies		d4402—Manipulating
	Placing pegs into a pegboard	Capacity	N/A	N/A	placing pegs into a peg board		d4402—Manipulating
	Sorting cards	Capacity	N/A	N/A	sorting cards		d4402—Manipulating
	Stringing blocks	Capacity	N/A	N/A	stringing blocks		d4402—Manipulating
	Upper limb coordination Domain
	Dropping and catching a ball—both hands	Capacity	N/A	N/A	dropping ball	catching ball	d4403—Releasing	d4455—Catching
	catching a tossed ball—both hands	Capacity	N/A	N/A	catching a ball with both hands		d4455—Catching
	dropping and catching a ball—one hand	Capacity	N/A	N/A	dropping ball with one hand	catching	d4403—Releasing	d4455—Catching
	catching a tossed ball—one hand	Capacity	N/A	N/A	catching a ball with one hand		d4455—Catching		dribbling
	Dribbling a ball—one hand	Capacity	N/A	N/A	dribbling a ball with one hand		d4458—Hand and arm use, other specified		dribbling
	Dribbling a ball—alternating hands	Capacity	N/A	N/A	dribbling a ball with alternating hands		d4458—Hand and arm use, other specified
	throwing a ball at a target	Capacity	N/A	N/A	throwing a ball at a target		d4454—Throwing
Movement Assessment Battery for Children—2	Age band 1
	Manual Dexterity
	Posting coins preferred hand	Capacity	N/A	N/A	posting coins		d4402—Manipulating
	posting coins non-preferred hand	Capacity	N/A	N/A	posting coins		d4402—Manipulating
	threading beads	Capacity	N/A	N/A	threading beads		d4402—Manipulating
	drawing trail 1	Capacity	N/A	N/A	drawing trail		d4408—Fine hand use, other specified		drawing trail
	Aiming and catching
	catching beanbag	Capacity	N/A	N/A	catching		d4455—Catching
	throwing beanbag onto mat	Capacity	N/A	N/A	throwing		d4454—Throwing
	Age band 2
	Manual Dexterity
	placing pegs preferred hand	Capacity	N/A	N/A	placing pegs		d4402—Manipulating
	placing pegs non-preferred hand	Capacity	N/A	N/A	placing pegs		d4402—Manipulating
	threading lace	Capacity	N/A	N/A	threading lace		d4402—Manipulating
	drawing trail 2	Capacity	N/A	N/A	drawing trail		d4408—Fine hand use, other specified		drawing trail
	Aiming and catching
	catching with two hands	Capacity	N/A	N/A	catching		d4455—Catching
	throwing beanbag onto mat	Capacity	N/A	N/A	throwing		d4454—Throwing
	Age band 3
	Manual Dexterity
	Turning pegs preferred hand	Capacity	N/A	N/A	turning pegs		d4453—Turning or twisting the hands or arms
	Turning pegs non-preferred hand	Capacity	N/A	N/A	turning pegs		d4453—Turning or twisting the hands or arms
	triangle with nuts and bolts	Capacity	N/A	N/A	triangle nuts and bolts		d4402—Manipulating
	drawing trail 3	Capacity	N/A	N/A	drawing trail		d4408—Fine hand use, other specified		drawing trail
	Aiming and catching
	Catching with 1 hand best hand	Capacity	N/A	N/A	catching		d4455—Catching
	catching with 1 hand other hand	Capacity	N/A	N/A	catching		d4455—Catching
	throwing at wall target	Capacity	N/A	N/A	throwing		d4454—Throwing
Functional Independence Measure for Children (WeeFIM)	Eating	Performance	N/A	N/A	eating		d550—Eating
	Grooming	Performance	N/A	N/A	grooming		d520—Caring for body parts
	Bathing	Performance	N/A	N/A	bathing		d510—Washing oneself
	Dressing—upper	Performance	N/A	N/A	dressing upper body		d540—Dressing
	Dressing—lower	Performance	N/A	N/A	dressing lower body		d540—Dressing
	Toileting	Performance	N/A	N/A	toileting		d530—Toileting
Peabody Developmental Motor Scales (PDMS) -2	Object Manipulation
	Catching ball [Sitting legs spread apart facing you, you and child sitting 3 ft apart] (Roll ball from between your legs to child "Catch the ball")	Capacity	N/A	N/A	catching		d4455—Catching
	Rolling ball [sitting legs spread apart facing you, you and child sitting 3 ft apart] (Roll ball from between your legs to child. Place ball on floor between child's knees "Roll the ball to me")	Capacity	N/A	N/A	rolling		d4458—Hand and arm use, other specified		rolling
	Flinging ball [standing in an open area] (give tennis ball to child and stand 5 ft away. Extend your hands to child "Throw the ball to me"	Capacity	N/A	N/A	flinging		d4454—Throwing
	Throwing ball [standing in an open area] (give tennis ball to child and stand 5 ft away "throw the ball to me"	Capacity	N/A	N/A	throwing		d4454—Throwing
	Throwing ball overhand [standing in an open area] (demonstrate throwing tennis ball overhand at least 3 ft forward. Give the ball to child "throw the ball as far as you can"	Capacity	N/A	N/A	throwing	as far as you can	d4454—Throwing	b7301—Power of muscles of one limb
	Throwing ball underhand [standing in an open area] (demonstrate throwing a tennis ball underhand at least 5 ft. give ball to child "throw the ball as far as you can"	Capacity	N/A	N/A	throwing	as far as you can	d4454—Throwing	b7301—Power of muscles of one limb
	Catching ball [standing in an open area] stand 5 ft. in front of child "Catch the ball" Toss ball so that it arrives at chest height, contacting child's outstretched arms	Capacity	N/A	N/A	catching		d4455—Catching
	Throwing ball overhand [standing in an open area] demonstrate throwing tennis ball overhand at least 7 ft. give ball to child stand 8 ft away "throw me the ball"	Capacity	N/A	N/A	throwing		d4454—Throwing
	Throwing ball underhand [standing in an open area] Demonstrates throwing the tennis ball underhand at least 7 ft. forward. Give the ball to child stand 8 ft. away "throw me the ball"	Capacity	N/A	N/A	throwing		d4454—Throwing
	Catching ball [standing in an open area] Stand 5 ft. in front of child "Catch the ball" Toss ball so that it arrives at chest height, contacting child's outstretched arms	Capacity	N/A	N/A	catching		d4455—Catching
	Throwing ball—overhand [standing in an open area] Demonstrate throwing tennis ball overhand at least 10 ft. give ball to child. Stand 11 ft. away "Throw the ball as far as you can"	Capacity	N/A	N/A	throwing	as far as you can	d4454—Throwing	b7301—Power of muscles of one limb
	Hitting target - underhand [standing 5ft. From wall] From 5 ft. away toss tennis ball underhand to 2 ft. target taped on wall (2ft. Above floor) "throw the ball and hit the target like I did"	Capacity	N/A	N/A	throwing	hitting target	d4454—Throwing	b7602 - Coordination of voluntary movements
	Catching ball [standing in an open area] Stand 5ft. In front of child "Catch the ball" Toss ball so that it arrives at chest height	Capacity	N/A	N/A	catching		d4455—Catching
	Hitting target—overhand [standing 5 ft. from wall] From 5 ft. away toss tennis ball twice overhand to 2 ft. target taped on wall (2 ft. above floor) "throw the ball and hit the target like I did"	Capacity	N/A	N/A	throwing	hitting target	d4454—Throwing	b7602—Coordination of voluntary movements
	Throwing ball - underhand [standing in an open area] Demonstrate throwing tennis ball underhand at least 10ft. Give ball to child. Stand about 12 ft. away "Throw the ball as far as you can"	Capacity	N/A	N/A	throwing	as far as you can	d4454—Throwing	b7301—Power of muscles of one limb
	Hitting target - overhand [standing 12 ft. from wall] From 12 ft. away toss tennis ball overhand to 2 ft. target taped on wall (2 ft. above floor) "throw the ball and hit the target like I did"	Capacity	N/A	N/A	throwing	hitting target	d4454—Throwing	b7602—Coordination of voluntary movements
	Bouncing ball [standing 5 ft. from wall] using 1 hand bounce tennis ball so it bounces once and then hits wall. Give ball to child "bounce the ball like I did"	Capacity	N/A	N/A	bouncing		d4458 - Hand and arm use, other specified		bouncing
	Catching ball [standing in an open area] stand 5 ft. in front of child "Catch the ball" toss tennis ball in a 45-degree arc so it arrives at child's hands	Capacity	N/A	N/A	catching		d4455—Catching
	Catching bounced ball Bounce tennis ball on floor once and catch it with 1 hand "Bounce and catch the ball like I did"	Capacity	N/A	N/A	catching		d4455—Catching
	Grasping
	Grasping reflex [lying on back] Stimulate child's palm by inserting your index finger into thumb side of palm	Capacity	N/A	N/A	grasping reflex		b7502—Reflexes generated by other exteroceptive stimuli
	Grasping cloth [lying on back] spread washcloth over your forearm place child's hand on top of washcloth	Capacity	N/A	N/A	grasping		d4401—Grasping
	Releasing rattle—disappearing reflex [lying on back] place rattle in child's hand. After child holds rattle for 5 s observe amount of time before release	Capacity	N/A	N/A	releasing		d4403—Releasing
	Grasping rattle [lying on back] Lightly touch child's palm with rattle "Get your rattle"	Capacity	N/A	N/A	grasping		d4401—Grasping
	Holding rattle [lying on back] place rattle in child's hand	Capacity	N/A	N/A	holding		d4401—Grasping
	Manipulating rattle [lying on back] shake rattle and place it in child's hand "Shake your rattle"	Capacity	N/A	N/A	manipulating		d4402—Manipulating
	Grasping rattle [sitting on lap facing table] Place rattle on table within 3 in. of child's hand. "Get your rattle"	Capacity	N/A	N/A	grasping		d4401—Grasping
	Pulling string [lying on stomach] place toy on a string so string is at midline between child's hands "Get the toy"	Capacity	N/A	N/A	pulling string		d4450—Pulling
	Securing paper [sitting on lap, facing table] place 8.5×11 in. paper within 3 in. of child's hand "Get the paper"	Capacity	N/A	N/A	securing paper		d4402—Manipulating
	Grasping cube [sitting on lap facing table] place cube on table within 3in. Of child's hand "Get the block"	Capacity	N/A	N/A	grasping		d4401—Grasping
	Grasping cube [sitting on lap facing table] place cube on table within 3 in. of child's hand "Get the block" observe how the child picks up cube	Capacity	N/A	N/A	grasping		d4401—Grasping
	Shaking rattle [sitting on lap facing table] Place rattle in child's hand "Shake your rattle"	Capacity	N/A	N/A	shaking		d4402—Manipulating
	Shaking rattle [sitting on lap facing table] Shake rattle back and forth through a 90-degree arc 3 times. Place it on table in front of child "Shake the rattle"	Capacity	N/A	N/A	shaking		d4402—Manipulating
	Grasping cube [sitting on lap facing table] Place cube on table within 3 in. of child's hand. "Get the block" Observe how child picks up cube	Capacity	N/A	N/A	grasping		d4401—Grasping
	Grasping pellets [sitting on lap facing table] Place 2 food pellets on table within child's reach "Get all the food"	Capacity	N/A	N/A	grasping		d4401—Grasping
	Manipulating paper [sitting on lap facing table] cut 8.5×11 in. sheet of paper in half. Place half on table "Watch me crumple the paper" Crumple paper in 1 hand. Place other half of paper within 3 in. of child's hand "Crumple paper like I did"	Capacity	N/A	N/A	manipulating		d4402—Manipulating
	Grasping pellets [sitting on lap facing table] Place 2 food pellets on table within child's reach "Get all the food"	Capacity	N/A	N/A	grasping		d4401—Grasping
	Grasping pellets [sitting on lap facing table] place 2 food pellets on table within child's reach "Get all the food"	Capacity	N/A	N/A	grasping		d4401—Grasping
	Grasping cube [sitting on lap facing table] place cube on table within 3 in. of child's hand. "Get the block" Observe how child picks up cube	Capacity	N/A	N/A	grasping		d4401—Grasping
	Grasping cube [sitting on lap facing table] place 2 cubes side by side. Pick up both cubes with 1 hand. Place cubes on table "Pick up both blocks with 1 hand like I did"	Capacity	N/A	N/A	grasping		d4401—Grasping
	Grasping marker [sitting at table] Place paper and marker by child's hand on table "make a mark" Observe how child holds marker	Capacity	N/A	N/A	grasping		d4401—Grasping
	Grasping marker [sitting at table] place paper and marker by child's hand on table "Make a mark" Observe how child holds marker	Capacity	N/A	N/A	grasping		d4401—Grasping
	Unbuttoning buttons [sitting at table] Place button strip on table "unbutton these as fast as you can"	Capacity	N/A	N/A	unbuttoning	as fast as you can	d4408—Fine hand use, other specified	b7602—Coordination of voluntary movements	unbuttoning
	Buttoning button [sitting at table] Place button strip on table. Unbutton the buttons. Point to an end button "Button and unbutton this one as fast as you can"	Capacity	N/A	N/A	buttoning	as fast as you can	d4408—Fine hand use, other specified	b7602—Coordination of voluntary movements	buttoning
	Grasping marker [sitting on table] Place paper and marker by child's hand on table "Make a mark" Observe how child holds marker	Capacity	N/A	N/A	grasping		d4401—Grasping
	Touching fingers. At the rate of 1 touch per second, beginning with index finger, touch each finger in succession to thumb "touch like I did as fast as you can"	Capacity	N/A	N/A	touching fingers	as fast as you can	b7602—Coordination of voluntary movements	b7602—Coordination of voluntary movements
Performance of Upper Limb (PUL)	Thumb key grip	Capacity	N/A	N/A	grip		d4401—Grasping
	3-point grip	Capacity	N/A	N/A	grip		d4401—Grasping
	finger pinch	Capacity	N/A	N/A	finger pinch		d4401—Grasping
	place fingers on diagram	Capacity	N/A	N/A	place finger on diagram		b7602—Coordination of voluntary movements
	pick up coins	Capacity	N/A	N/A	pick up		d4400—Picking up
	supination	Capacity	N/A	N/A	supination		b7100—Mobility of a single joint
	push on a light	Capacity	N/A	N/A	push on a light		d4451—Pushing
	tracing a path	Capacity	N/A	N/A	tracing a path		d4408—Fine hand use, other specified		tracing
	tearing paper	Capacity	N/A	N/A	tearing paper		d4402—Manipulating
	remove lid from container	Capacity	N/A	N/A	removing lid		d4453—Turning or twisting the hands or arms
	Stack light and heavy cans	Capacity	N/A	N/A	stacking cans	weight component—cans	d4402—Manipulating	b7301—Power of muscles of one limb
	Lift light and heavy cans	Capacity	N/A	N/A	lifting cans	weight component—cans	d4300—Lifting	b7301—Power of muscles of one limb
	moving weights on table (100g, 200g, 500g, 1000g)	Capacity	N/A	N/A	moving weights	weight component—cans	d4458—Hand and arm use, other specified	b7301—Power of muscles of one limb	moving
	hand to table	Capacity	N/A	N/A	hand to table		b7602—Coordination of voluntary movements
	hand to mouth with and without weights (50g, 200g)	Capacity	N/A	N/A	hand to mouth	weight component	b7602—Coordination of voluntary movements	b7301—Power of muscles of one limb
	lifting upper extremity weights (50g, 200g, 500g, 1000g) at shoulder height	Capacity	N/A	N/A	lifting shoulder height	weight component	d4300—Lifting	b7301—Power of muscles of one limb
	lifting upper extremity weights (50g, 200g, 500g, 1000g) above shoulder height	Capacity	N/A	N/A	lifting above shoulder	weight component	d4300—Lifting	b7301—Power of muscles of one limb
Shriners Hospital for Children Upper Extremity Evaluation (SHUEE)	Spontaneous functional analysis/dynamic positional analysis
	Take the paper money out of the wallet like you normally would	Capacity	N/A	N/A	take the money		d4400—Picking up
	Now fold this paper in 1/2 in any fashion	Capacity	N/A	N/A	fold the paper		d4402—Manipulating
	I'm going to start tearing this paper and I want you to finish it	Capacity	N/A	N/A	tearing paper		d4402—Manipulating
	Now I want you to string these beads	Capacity	N/A	N/A	stringing beads		d4402—Manipulating
	Please take the top off of this bottle	Capacity	N/A	N/A	remove bottle top		d4453—Turning or twisting the hands or arms
	Now tear this Play-Doh into three pieces	Capacity	N/A	N/A	tearing		d4402—Manipulating
	Pretend this is something good to eat and show me how you would cut it	Capacity	N/A	N/A	cutting food		d550—Eating
	Now let's stand up. I want you to stand over here. I want you to toss this ball to me and I'll toss it back	Capacity	N/A	N/A	standing; throwing; catching		d4104—Standing; d4454—Throwing; d4455—Catching
	Let me give you these coins	Capacity	N/A	N/A	handling coins		d4402—Manipulating
	Let me give you 5	Capacity	N/A	N/A	high five		b7602—Coordination of voluntary movements
	Now I want you to show me how you would eat this. You don't have to eat it if you don’t want to. Just take it into your mouth	Capacity	N/A	N/A	Eating		d550—Eating
	Can you touch this palm to this ear?	Capacity	N/A	N/A	coordinated movement		b7602—Coordination of voluntary movements
	Put this sticker on this ball	Capacity	N/A	N/A	coordinated movement		b7602—Coordination of voluntary movements
	Go ahead and put your sock back on for me	Capacity	N/A	N/A	dressing (sock)		d5402—Putting on footwear
	Now tie your shoe	Capacity	N/A	N/A	Tying		d5408—Dressing, other specified		Tying
	I know this is silly but I want you to get down and crawl towards the camera	Capacity	N/A	N/A	Crawl	Get down	d4550—Crawling	d4108—Changing basic body position, other specified	Get down
	Grasp
	Can you take this bead from me?	Capacity	N/A	N/A	pick up		d4400—Picking up
	Now can you straighten your wrist and still pick up the bead?	Capacity	N/A	N/A	pick up	straighten wrist	d4400—Picking up	b7100—Mobility of a single joint
	Now can you bring your wrist all the way up and pick up the bead?	Capacity	N/A	N/A	pick up	straighten all the way	d4400—Picking up	b7100—Mobility of a single joint
PURDUE pegboard	Right hand
	“Pick up one pin at a time with your right hand from the right-handed cup. Starting with the top hole, place each pin in the right-handed row. (Leave the pin used for demonstration in the hole.) Now you may insert a few pins for practice. If during the testing time you drop a pin, do not stop to pick it up. Simply continue by picking another pin out of the cup.” “Stop. Now take out the practice pins and put them back into the right-handed cup.” “When I say ‘Begin,’ place as many pins as possible in the right-handed row, starting with the top hole. Work as rapidly as you can until I say ‘Stop.’ Are you ready? Begin.” "Stop"	Capacity	N/A	N/A	pick up; place each pin; insert a few pins; pick up another pin; remove practice pins		d4400—Picking up; d4402—Manipulating; d4402—Manipulating; d4400—Picking up; d4403—Releasing;
	Left hand
	“Pick up one pin at a time with your left hand from the left-handed cup. Place each pin in the left-handed row, starting with the top hole. You may insert a few pins for practice.” “Stop. Now take out the practice pins, and put them back into the left-handed cup.” “When I say ‘Begin,’ place as many pins as possible in the left-handed row, starting with the top hole. Work as rapidly as you can until I say ‘Stop.’ Are you ready? Begin.” "Stop"	Capacity	N/A	N/A	pick up; place each pin; insert a few pins; pick up another pin; remove practice pins		d4400—Picking up; d4402—Manipulating; d4402—Manipulating; d4400—Picking up; d4403—Releasing;
	Both hands
	“For this part of the test, you will use both hands at the same time. Pick up a pin from the right-handed cup with your right hand, and at the same time pick up a pin from the left-handed cup with your left hand. Then place the pins down the rows. Begin with the top hole of both rows. (Demonstrate. Then replace the pins used for demonstration.) Now you may insert a few pins with both hands for practice.” “Stop. Take out the practice pins, and put them back in their cups.” “When I say ‘Begin,’ place as many pins as possible with both hands, starting with the top hole of both rows. Work as rapidly as you can, until I say ‘Stop.’ Are you ready? Begin.” "Stop"	Capacity	N/A	N/A	pick up; place each pin; insert a few pins; pick up another pin; remove practice pins		d4400—Picking up; d4402—Manipulating; d4402—Manipulating; d4400—Picking up; d4403—Releasing;
	Right + Left + Both hands Assembly
	“Pick up one pin from the right-handed cup with your right hand. While you are placing it in the top hole in the right-handed row, pick up a washer with your left hand. As soon as the pin has been placed, drop the washer over the pin. While the washer is being placed over the pin with you left hand, pick up a collar with your right hand. While the collar is being dropped over the pin, pick up another washer with your left hand and drop it over the collar. This completes the first ‘assembly,’ consisting of a pin, a washer, a collar, and a washer. While the final washer for the first assembly is being placed with your left hand, start the second assembly immediately by picking up another pin with your right hand. Place it in the next hole; drop a washer over it with your left hand, and so on, completing another assembly. Now take a moment to try a few practice assemblies.” “Stop. Now return the pins, collars, and washers to their proper cups.” “When I say ‘Begin,’ make as many assemblies as possible, beginning with the top hole. Work quickly until I say ‘Stop.’	Capacity	N/A	N/A	pick up one pin; placing it in top; pick up washer; drop washer; pick up collar; drop pin	coordination	d4400—Picking up; d4402—Manipulating; d4400—Picking up; d4403—Releasing; d4400—Picking up; d4403—Releasing	b7602—Coordination of voluntary movements
Motor Function Measure (MFM)	Supine
	Raises one hand from the mat and moves it to the opposite shoulder	Capacity	N/A	N/A	raise hand and move to opposite shoulder		b7602—Coordination of voluntary movements
	Seated on the chair or in their wheelchair
	Forearms on the table but not elbows: raises both hands to the top of the head at the same time, head and trunk in the axis	Capacity	N/A	N/A	raises both head to top of head at the same time		b7602—Coordination of voluntary movements
	The pencil on the table: reaches the pencil with one hand, elbow in complete extension at the end ofthe movement	Capacity	N/A	N/A	reaches	elbow in complete ext	d4452—Reaching	b7100—Mobility of a single joint
	10 coins placed on the table: successively picks up and holds 10 coins in one hand within 20 s	Capacity	N/A	N/A	picks up coins	holds coins	d4400—Picking up	d4401—Grasping
	One finger placed in the center of the fixed CD: traces the complete border of the disk with one finger without support of the hand	Capacity	N/A	N/A	traces		b7602—Coordination of voluntary movements
	The pencil on the table: picks up the pencil placed next to their hand and draws a continuous series ofloops of 1 cm height in the 4-cm-long frame	Capacity	N/A	N/A	picks up pencil	draws	d4400—Picking up	d4408—Fine hand use, other specified	drawing
	Holding the sheet of paper: tears the paper folded in 4, beginning at the fold	Capacity	N/A	N/A	tear paper		d4402—Manipulating
	The tennis ball on the table: picks up the ball, raises it off the table and turns over the hand holding onto the ball	Capacity	N/A	N/A	pick up ball	raising and turning over the hand	d4400—Picking up	b7602—Coordination of voluntary movements
	A finger placed in the center of the fixed square: raises the finger and places it successively in thecenter of the 8 squares of the diagram without touching the lines	Capacity	N/A	N/A	raises finger and places it successfully in center		b7602—Coordination of voluntary movements
	Upper limbs along the trunk: places the two forearms and/or hands on the table at the same time	Capacity	N/A	N/A	places two forearms at same time		b7602—Coordination of voluntary movements
Functional Dexterity Test (FDT)	Non-injured hand first
	“Please start with your non-injured hand. Start by turning the peg at the top opposite corner [point to peg], turn all the pegs over as quickly as possible, turning over one row of pegs, then reversing the order in the next row, in a zigzag fashion" “Do not turn your hand up to face the ceiling (supinate) or touch the board for help in turning the peg; each of these motions carries a penalty of 5 s. If you drop a peg, time is stopped, and a 10-s penalty is added. You then need to retrieve the peg and put it in the pegboard in the unturned position. Then continue to turn the pegs with the peg that you just put back. The clock starts where it was stopped, and the time is continued.” “Turn over all the pegs on the board with your non-injured hand.”	Capacity	N/A	N/A	turning the peg; supinate; drop peg; pick up peg; put it in pegboard;	coordination	d4453—Turning or twisting the hands or arms; b7600—Control of simple voluntary movements; d4403—Releasing; d4400—Picking up; d4402—Manipulating	b7602—Coordination of voluntary movements
	Injured hand
	Same as above	N/A	N/A	N/A
Hand Assessment of Infants (HAI)	B Grasps from an easy position	Capacity	N/A	N/A	grasps		d4401—Grasping
	B Holds for a while	Capacity	N/A	N/A	hold		d4401—Grasping
	B Moves fingers	Capacity	N/A	N/A	move fingers		b7600—Control of simple voluntary movements
	B Quality of movements	Capacity	N/A	N/A	quality of movement		b7101—Mobility of several joints
	B Quality of holding	Capacity	N/A	N/A	quality of holding		d4401—Grasping
	B Object location when grasping	Capacity	N/A	N/A	object location when grasping		b7602—Coordination of voluntary movements
	B Amount of hand use	Capacity	N/A	N/A	hand use		d4409—Fine hand use, unspecified		general hand use
	B Initiates use for objects in midline	Capacity	N/A	N/A	initiates use		d2100—Undertaking a simple task
	B Initiates use for objects on the side	Capacity	N/A	N/A	initiates use		d2100—Undertaking a simple task
	B Moves upper arm	Capacity	N/A	N/A	moves upper arm		b7101—Mobility of several joints
	B Moves forearm	Capacity	N/A	N/A	moves forearm		b7100—Mobility of a single joint
	B Adjusts arm/hand orientation	Capacity	N/A	N/A	adjust hand/arm		b7600—Control of simple voluntary movements
	L Moves upper arm	Capacity	N/A	N/A	moves upper arm		b7101—Mobility of several joints
	L Holds for a while	Capacity	N/A	N/A	hold		d4401—Grasping
	L Moves fingers	Capacity	N/A	N/A	moves finger		b7101—Mobility of several joints
	L Grasps from an easy position	Capacity	N/A	N/A	grasps		d4401—Grasping
	Bim Bilateral holding of object	Capacity	N/A	N/A	grasps		d4401—Grasping
	L Moves forearm	Capacity	N/A	N/A	moves forearm		b7100—Mobility of a single joint
	L Initiates use for objects on the side	Capacity	N/A	N/A	initiates use		d2100—Undertaking a simple task
	Bim Bilateral object contact	Capacity	N/A	N/A	touch		d1201—Touching
	L Quality of holding	Capacity	N/A	N/A	quality of holding		d4401—Grasping
	L Object location when grasping	Capacity	N/A	N/A	object location		b7602—Coordination of voluntary movements
	Bim Transfers between hands	Capacity	N/A	N/A	transfers between hands		b7602—Coordination of voluntary movements
	L Initiates use for objects in midline	Capacity	N/A	N/A	initiates use		b7100—Mobility of a single joint
	Bim Bilateral manipulation	Capacity	N/A	N/A	manipulation		d4402—Manipulating
	L Adjusts arm/hand orientation	Capacity	N/A	N/A	adjust arm/hand		b7600—Control of simple voluntary movements
	L Amount of hand use	Capacity	N/A	N/A	hand use		d4409—Fine hand use, unspecified		general hand use
	L Quality of movements	Capacity	N/A	N/A	quality of movement		b7101—Mobility of several joints
	Bim Transfers in a sequence	Capacity	N/A	N/A	hand transfers		b7602—Coordination of voluntary movements
Pediatric Arm Function Test (PAFT)	Unilateral items
	Reach above head	Capacity	N/A	N/A	reaching		d4452—Reaching
	Reach at waist level	Capacity	N/A	N/A	reaching		d4452—Reaching
	Reach across midline	Capacity	N/A	N/A	reaching		d4452—Reaching
	Grasp ball	Capacity	N/A	N/A	grasp		d4401—Grasping
	Carry ball	Capacity	N/A	N/A	carry		d4301—Carrying in the hands
	Release ball into cup	Capacity	N/A	N/A	release		d4403—Releasing
	Pour ball out of cup	Capacity	N/A	N/A	pouring		d4453—Turning or twisting the hands or arms
	Throw ball onto target	Capacity	N/A	N/A	throw		d4454—Throwing
	Isolated finger use	Capacity	N/A	N/A	finger use		b7600—Control of simple voluntary movements
	Removing big-knob puzzle piece	Capacity	N/A	N/A	removing puzzle		d4402—Manipulating
	Crayon grasp	Capacity	N/A	N/A	grasp		d4401—Grasping
	Crayon use	Capacity	N/A	N/A	crayon use		d4409—Fine hand use, unspecified		general use
	Grasp cracker-sized food (e.g., animal or graham cracker, saltine)	Capacity	N/A	N/A	grasp		d4401—Grasping
	Grasp small food item (e.g., cheerio or raisin)	Capacity	N/A	N/A	grasp		d4401—Grasping
	Eat with a spoon	Capacity	N/A	N/A	eating		d550—Eating
	Bilateral items
	Separate pull-apart toy	Capacity	N/A	N/A	pull apart		d4458—Hand and arm use, other specified		pull apart
	Carry large ball (e.g., basketball)	Capacity	N/A	N/A	carry		d4302—Carrying in the arms
	Throw ball into hoop	Capacity	N/A	N/A	throw		d4454—Throwing
	Place hat on head	Capacity	N/A	N/A	hat on head		d5400—Putting on clothes
	Put on boots (using hands)	Capacity	N/A	N/A	put on boots		d5402—Putting on footwear
	Quadruped weight-bearing	Capacity	N/A	N/A	weight bearing four limbs		b7603—Supportive functions of arm or leg
	Crawling	Capacity	N/A	N/A	crawling		d4550—Crawling
Upper Limb Physician Rating Scale (ULPRS)	Active elbow extension (normal 180 degrees)	Capacity	N/A	N/A	elbow ext		b7100—Mobility of a single joint
	Active supination in extension (Elbow extended, forearm supinates) mid-position: palm to 90 degree horizontal	Capacity	N/A	N/A	elbow ext + supination		b7101—Mobility of several joints
	Active supination in flexion (elbow flexed at 90 degree forearm supinates)	Capacity	N/A	N/A	supination in flexion		b7101—Mobility of several joints
	Active wrist dorsiflexion (forearm supported, active dorsiflexion of wrist) mid-position: palm level with forearm	Capacity	N/A	N/A	wrist dorsiflexion		b7100—Mobility of a single joint
	Wrist dorsiflexion (angle of movement)	Capacity	N/A	N/A	wrist dorsiflexion		b7100—Mobility of a single joint
	Finger opening	Capacity	N/A	N/A	finger opening		b7101—Mobility of several joints
	Thumb in function	Capacity	N/A	N/A	thumb movement		b7100—Mobility of a single joint
	Associated increase in muscle tone	Capacity	N/A	N/A	increased muscle tone		b7350—Tone of isolated muscles and muscle groups
	Two handed function	Capacity	N/A	N/A	bilateral function		b7602—Coordination of voluntary movements
Assessment of Children's Hand Skills	Manual gesture	Capacity	N/A	N/A	gesture		d4409—Fine hand use, unspecified		general manual gesture
	Body contact hand skills	Capacity	N/A	N/A	hand skills		d4409—Fine hand use, unspecified		hand skills
	Grasping	Capacity	N/A	N/A	grasp		d4401—Grasping
	Holding	Capacity	N/A	N/A	grasp		d4401—Grasping
	In-hand manipulation	Capacity	N/A	N/A	manipulation		d4402—Manipulating
	Releasing	Capacity	N/A	N/A	release		d4403—Releasing
	Isolated finger movement	Capacity	N/A	N/A	finger movement		b7600—Control of simple voluntary movements
	Reaching	Capacity	N/A	N/A	reaching		d4452—Reaching
	Turning	Capacity	N/A	N/A	turning		d4453—Turning or twisting the hands or arms
	Carrying	Capacity	N/A	N/A	carrying		d4309—Lifting and carrying, unspecified		general carrying
	Throwing	Capacity	N/A	N/A	throwing		d4454—Throwing
	Catching	Capacity	N/A	N/A	catching		d4455—Catching
	Moving	Capacity	N/A	N/A	moving		d4459—Hand and arm use, unspecified		general moving
	Stabilizing	Capacity	N/A	N/A	stabilizing		b7159—Stability of joint functions, unspecified		general stabilization
	Transferring	Capacity	N/A	N/A	transferring		d4409—Fine hand use, unspecified		general transferring
	Using both hands simultaneously	Capacity	N/A	N/A	simultaneous movement		b7602—Coordination of voluntary movements
	Using both hands cooperatively	Capacity	N/A	N/A	coordination		b7602—Coordination of voluntary movements
	Accuracy	Capacity	N/A	N/A	control		b7601—Control of complex voluntary movements
	Pace	Capacity	N/A	N/A	pace		b7609—Control of voluntary movement functions, unspecified		pace
	Movement quality	Capacity	N/A	N/A	movement quality		b7101—Mobility of several joints
Test of Gross Motor Development -2	1. Striking a stationary ball (the ability to strike a stationary ball with a plastic bat)	Capacity	N/A	N/A	striking		d4458—Hand and arm use, other specified		striking
	2. Stationary dribble (the ability to dribble a basket ball a minimum of four times with the dominant hand before catching the ball with both hands, without moving feet)	Capacity	N/A	N/A	dribble		d4458—Hand and arm use, other specified		dribbling ball
	3. Catch (the ability to catch a plastic ball that has been tossed underhand)	Capacity	N/A	N/A	catching		d4455—Catching
	4. Overhand throw (the ability to throw a ball at a point on a wall with the preferred hand)	Capacity	N/A	N/A	throwing		d4454—Throwing
	5. Underhand roll (the ability to roll a ball between two cones with the preferred hand)	Capacity	N/A	N/A	rolling		d4458—Hand and arm use, other specified		rolling
Besta Scale	Grip (three cubes of different sizes)	Capacity	N/A	N/A
	Pick up the cubes first with the unaffected hand and then with the impaired hand	Capacity	N/A	N/A	pick up		d4400—Picking up
	Spontaneous use of affected hand during bilateral manipulation	Capacity	N/A	N/A
	Throw a large ball	Capacity	N/A	N/A	throw		d4454—Throwing
	Tear a sheet of paper into many pieces	Capacity	N/A	N/A	tear sheet		d4402—Manipulating
	Unscrew and screw the cap of a bottle	Capacity	N/A	N/A	unscrew	screw	d4453—Turning or twisting the hands or arms	d4453—Turning or twisting the hands or arms
	Open a packet tied with adhesive tape	Capacity	N/A	N/A	open packet		d4408—Fine hand use, other specified		opening
	Open a packet tied with string in a single knot	Capacity	N/A	N/A	open packet		d4408—Fine hand use, other specified		opening
	Wrap an object in paper forming a parcel	Capacity	N/A	N/A	wrap an object		d4408—Fine hand use, other specified		wrapping
	Cut out geometrical figures and stick them onto a sheet of paper	Capacity	N/A	N/A	cut out	sticking	d4402—Manipulating	d4402—Manipulating
	Fold a piece of paper and place it in an envelope	Capacity	N/A	N/A	folding paper	place it envelop	d4402—Manipulating	d4402—Manipulating
	Stereognosis
	Small spoon	Capacity	N/A	N/A	sensation of touch		b265—Touch function
	Coin	Capacity	N/A	N/A	sensation of touch		b265—Touch function
	Brush	Capacity	N/A	N/A	sensation of touch		b265—Touch function
	Small ball	Capacity	N/A	N/A	sensation of touch		b265—Touch function
	Doll	Capacity	N/A	N/A	sensation of touch		b265—Touch function
Selective Control of the Upper Extremity Scale (SCUES)	Selective motor control—shoulder	Capacity	N/A	N/A	Selective motor control—shoulder		b7601—Control of complex voluntary movements
	Selective motor control—elbow	Capacity	N/A	N/A	Selective motor control—elbow		b7601—Control of complex voluntary movements
	Selective motor control—forearm	Capacity	N/A	N/A	Selective motor control—forearm		b7601—Control of complex voluntary movements
	Selective motor control—wrist	Capacity	N/A	N/A	Selective motor control—wrist		b7601—Control of complex voluntary movements
	Selective motor control—fingers/thumb	Capacity	N/A	N/A	Selective motor control—fingers/thumb		b7601—Control of complex voluntary movements
Bayley Scales of Infant and Toddler Development (BSID)—3	Fine Motor subtest
Hands are fisted	Capacity	N/A	N/A	hands fisted		b7350—Tone of isolated muscles and muscle groups
	Attempts to bring hand to mouth	Capacity	N/A	N/A	bring hand to mouth		b7602—Coordination of voluntary movements
	Retains ring [ring with string]	Capacity	N/A	N/A	hold		d4401—Grasping
	Keeps hands open	Capacity	N/A	N/A	hand open		b7350—Tone of isolated muscles and muscle groups
	Rotates wrist [ring with string]	Capacity	N/A	N/A	rotate wrist		b7100—Mobility of a single joint
	Grasps suspended ring [ring with string]	Capacity	N/A	N/A	grasp		d4401—Grasping
	Reaches for block [block with hole]	Capacity	N/A	N/A	reaching		d4452—Reaching
	Touches block [block with hole]	Capacity	N/A	N/A	touch		b7602—Coordination of voluntary movements
	Whole hand grasp [block with hole]	Capacity	N/A	N/A	grasp		d4401—Grasping
	Reaches unilaterally	Capacity	N/A	N/A	reaching		d4452—Reaching
	Raking grasp [food pellet]	Capacity	N/A	N/A	grasp		d4401—Grasping
	Partial thumb opposition [block with hole]	Capacity	N/A	N/A	thumb opposition		b7100—Mobility of a single joint
	Transfers ring [ring]	Capacity	N/A	N/A	transferring hand		b7602—Coordination of voluntary movements
	Whole hand grasp [food pellet]	Capacity	N/A	N/A	grasp		d4401—Grasping
	Transfers block [block without hole]	Capacity	N/A	N/A	transferring block		b7602—Coordination of voluntary movements
	Thumb-fingertip grasp [block without hole]	Capacity	N/A	N/A	grasp		d4401—Grasping
	Blocks to midline [2 blocks without hole]	Capacity	N/A	N/A	midline		b7602—Coordination of voluntary movements
	Partial thumb opposition [food pellet]	Capacity	N/A	N/A	thumb opposition		b7100—Mobility of a single joint
	Lifts cup by handle [cup with handle]	Capacity	N/A	N/A	lift cup		d4300—Lifting
	Thumb finger-tip grasp [food pellet]	Capacity	N/A	N/A	grasp		d4401—Grasping
	turns pages of book [picture book]	Capacity	N/A	N/A	turn page		d4402—Manipulating
	palmar grasp [crayon or pencil]	Capacity	N/A	N/A	grasp		d4401—Grasping
	isolates extended index finger [pegboard]	Capacity	N/A	N/A	extend finger		b7100—Mobility of a single joint
	scribbles spontaneously [crayon or pencil]	Capacity	N/A	N/A	scribble		d1450—Acquiring skills to use writing implements
	block stacking 2 blocks [blocks]	Capacity	N/A	N/A	stacking blocks		d4402—Manipulating		stacking
	imitates random stroke [2 crayons]	Capacity	N/A	N/A	imitates random stroke		d1450—Acquiring skills to use writing implements
	places 10 pellets in bottle [food pellets]	Capacity	N/A	N/A	places pellets in bottle		d4402—Manipulating
	transitional grasp [crayon or pencil]	Capacity	N/A	N/A	grasp		d4401—Grasping
	coins in slot [bank and pennies]	Capacity	N/A	N/A	coins in slot		d4402—Manipulating
	connecting blocks: apart	Capacity	N/A	N/A	pull apart blocks		d4458—Hand and arm use, other specified		pull apart
	intermediate tripod grasp [crayon or pencil]	Capacity	N/A	N/A	grasp		d4401—Grasping
	block stacking 6 blocks [blocks]	Capacity	N/A	N/A	stacking blocks		d4402—Manipulating
	uses hand to hold paper in place [crayon or pencil and paper]	Capacity	N/A	N/A	hand to stabilize		b7603—Supportive functions of arm or leg
	imitates horizontal stroke [crayon or pencil and paper]	Capacity	N/A	N/A	imitates horizontal stroke		d1450—Acquiring skills to use writing implements
	imitates vertical stroke [crayon or pencil and paper]	Capacity	N/A	N/A	imitates vertical stroke		d1450—Acquiring skills to use writing implements
	connecting blocks: together	Capacity	N/A	N/A	connecting blocks		d4402—Manipulating
	imitates circular stroke [crayon or pencil and paper]	Capacity	N/A	N/A	imitates circular stroke		d1450—Acquiring skills to use writing implements
	builds train of blocks [10 blocks]	Capacity	N/A	N/A	builds train		d4402—Manipulating
	String 3 blocks [shoelace and blocks]	Capacity	N/A	N/A	stringing 3 blocks		d4402—Manipulating
	imitates hand movement	Capacity	N/A	N/A	imitates hand movement		b7602—Coordination of voluntary movements
	snips paper [paper and scissors]	Capacity	N/A	N/A	snips paper		d4402—Manipulating
	grasp dynamic grasp [crayon or pencil]	Capacity	N/A	N/A	grasp		d4401—Grasping
	Tactilely discriminates shapes [pegs, blocks without hole, square pieces, drawstring bag]	Capacity	N/A	N/A	tactile discrimination		b265—Touch function
	Builds wall [blocks]	Capacity	N/A	N/A	builds wall		d4402—Manipulating
	Cuts paper [paper and scissors]	Capacity	N/A	N/A	cuts paper		d4402—Manipulating
	Builds bridge [blocks]	Capacity	N/A	N/A	builds bridge		d4402—Manipulating
	imitates plus sign [crayon or pencil and paper]	Capacity	N/A	N/A	imitates plus sign		d1450—Acquiring skills to use writing implements
	block stacking 8 blocks [blocks]	Capacity	N/A	N/A	block stacking		d4402—Manipulating
	cuts on line [crayon or pencil and paper]	Capacity	N/A	N/A	cuts on line		d4402—Manipulating
	Builds T [blocks]	Capacity	N/A	N/A	builds T		d4402—Manipulating
	buttons 1 button [button sleeve]	Capacity	N/A	N/A	buttons 1 button		d4408—Fine hand use, other specified		buttoning
	builds steps [blocks]	Capacity	N/A	N/A	builds steps		d4402—Manipulating
	traces designs [pencil traces sheet]	Capacity	N/A	N/A	traces		b7602—Coordination of voluntary movements
	imitates square [crayon or pencil and paper]	Capacity	N/A	N/A	imitates square		d1450—Acquiring skills to use writing implements
	copies plus sign [crayon or pencil and paper]	Capacity	N/A	N/A	copies plus sign		d1450—Acquiring skills to use writing implements
	taps finger	Capacity	N/A	N/A	taps finger		b7100—Mobility of a single joint
	places 20 pellets in bottle [food pellets]	Capacity	N/A	N/A	places pellets in bottle		d4402—Manipulating
	cuts circle [paper and scissors]	Capacity	N/A	N/A	cuts circle		d4402—Manipulating
	cuts square [paper and scissors]	Capacity	N/A	N/A	cuts square		d4402—Manipulating
	copies square [crayon or pencil and paper]	Capacity	N/A	N/A	copies square		d1450—Acquiring skills to use writing implements
	Minnesota Handwriting Assessment	Child asked to write out the sentence	Performance	N/A	N/A	write out sentence		d1701—Using grammatical conventions in writing compositions
Mini Assisting Hands Assessment (Mini-AHA)	Bimanual manipulation	Capacity	N/A	N/A	manipulation		d4402—Manipulating
	chooses assisting hand	Capacity	N/A	N/A	assisting hand		d4459—Hand and arm use, unspecified		general assisting hand
	varies grasp	Capacity	N/A	N/A	grasp		d4401—Grasping
	grasps (object location)	Capacity	N/A	N/A	grasp		d4401—Grasping
	adjusts arm position	Capacity	N/A	N/A	arm position		b7602—Coordination of voluntary movements
	symmetrical arm/hand use	Capacity	N/A	N/A	symmetrical arm use		b7602—Coordination of voluntary movements
	readjust grasp	Capacity	N/A	N/A	grasp		d4401—Grasping
	flow in bimanual performance	Capacity	N/A	N/A	bimanual		b7602—Coordination of voluntary movements
	releases	Capacity	N/A	N/A	releases		d4403—Releasing
	initiates use	Capacity	N/A	N/A	initiates use		d2100—Undertaking a simple task
	reaches	Capacity	N/A	N/A	reaches		d4452—Reaching
	stabilize by grasp	Capacity	N/A	N/A	grasp		d4401—Grasping
	moves forearm	Capacity	N/A	N/A	moves forearm		b7100—Mobility of a single joint
	moves fingers	Capacity	N/A	N/A	moves fingers		b7101—Mobility of several joints
	moves upper arm	Capacity	N/A	N/A	moves upper arm		b7100—Mobility of a single joint
	amount of use	Capacity	N/A	N/A	amount of use		d4409—Fine hand use, unspecified		general use
	stabilize by weight	Capacity	N/A	N/A	stabilize		b7603—Supportive functions of arm or leg
	grasp from an easy position	Capacity	N/A	N/A	grasp		d4401—Grasping
	contact with objects	Capacity	N/A	N/A	contact with object		d1201—Touching
	holds	Capacity	N/A	N/A	hold		d4401—Grasping
Both Hands Assessment (BoHa)	Manipulates	Capacity	N/A	N/A	manipulation		d4402—Manipulating
	grip force regulation	Capacity	N/A	N/A	grasp	force regulation	d4401—Grasping	b7301—Power of muscles of one limb
	proceeds	Capacity	N/A	N/A	proceeds		d4409—Fine hand use, unspecified		general fine hand use
	flow in bimanual performance	Capacity	N/A	N/A	flow in bimanual		b7602—Coordination of voluntary movements
	coordinates	Capacity	N/A	N/A	coordinates		b7602—Coordination of voluntary movements
	stabilize objects	Capacity	N/A	N/A	stabilize object		b7603—Supportive functions of arm or leg
	moves fingers	Capacity	N/A	N/A	moves finger		b7101—Mobility of several joints
	varies type of grasp	Capacity	N/A	N/A	grasp		d4401—Grasping
	readjust grasp	Capacity	N/A	N/A	grasp		d4401—Grasping
	orients object	Capacity	N/A	N/A	orients objects		d4402—Manipulating
	quality of arm movements	Capacity	N/A	N/A	quality of arm movement		b7101—Mobility of several joints
	grasps	Capacity	N/A	N/A	grasp		d4401—Grasping
	speed of movements	Capacity	N/A	N/A	speed of movement		b7602—Coordination of voluntary movements
	releases	Capacity	N/A	N/A	releases		d4403—Releasing
	reaches	Capacity	N/A	N/A	reaches		d4452—Reaching
	initiates	Capacity	N/A	N/A	initiates		d2100—Undertaking a simple task
Unilateral Below Elbow Test (UBET)	2–4 year old
	take play doh out of a plastic bag	Capacity	N/A	N/A	take out		d4400—Picking up
	bang cymbals together	Capacity	N/A	N/A	bang together		d4458—Hand and arm use, other specified		bang together
	put sock on foot	Capacity	N/A	N/A	put on socks		d5402—Putting on footwear
	thread beads	Capacity	N/A	N/A	threading		d4402—Manipulating
	open a jar of bubbles	Capacity	N/A	N/A	open jar		d4453—Turning or twisting the hands or arms
	ride on a rolling racer	Capacity	N/A	N/A	ride on rolling racer		d4153—Maintaining a sitting position
	open drawstring bag and dump lego duplo out	Capacity	N/A	N/A	open drawstring	dump out	d4402—Manipulating	d4402—Manipulating
	Separate Lego Duplo	Capacity	N/A	N/A	pull apart		d4458—Hand and arm use, other specified		pull apart
	open a box of crayons and remove one	Capacity	N/A	N/A	open box	remove crayon	d4408—Fine hand use, other specified	d4400—Picking up	open box
	5–7 year old
	cut paper circle from construction paper	Capacity	N/A	N/A	cutting paper		d4402—Manipulating
	remove cap from felt tip marker	Capacity	N/A	N/A	remove cap from marker		d4408—Fine hand use, other specified		remove cap
	sharpen pencil	Capacity	N/A	N/A	sharpen pencil		d4408—Fine hand use, other specified		sharpen pencil
	do up buttons on vest	Capacity	N/A	N/A	buttoning		d4408—Fine hand use, other specified		buttoning
	tie shoelaces in a knot	Capacity	N/A	N/A	ties shoe laces		d4402—Manipulating
	turn kaleidoscope	Capacity	N/A	N/A	turning		d4453—Turning or twisting the hands or arms
	separate legos	Capacity	N/A	N/A	separate legos		d4408—Fine hand use, other specified		separate legos
	use bow and arrow	Capacity	N/A	N/A	use bow and arrow	sport	d4458—Hand and arm use, other specified	d9201—Sports	use bow and arrow
	ride on rolling racer	Capacity	N/A	N/A	ride on rolling racer		d4153—Maintaining a sitting position
	8–10 year old
	swing a bat	Capacity	N/A	N/A	swinging bat	sport	d4458—Hand and arm use, other specified	d9201—Sports	swinging bat
	winds string onto yo-yo	Capacity	N/A	N/A	winding string		d4458—Hand and arm use, other specified		winding string
	open a band aid	Capacity	N/A	N/A	open band aid		d4402—Manipulating
	tie shoelaces in a bow	Capacity	N/A	N/A	tie shoelace		d4402—Manipulating
	do up buttons on a shirt	Capacity	N/A	N/A	buttoning		d4408—Fine hand use, other specified		buttoning
	make a telescope with paper and a rubber band	Capacity	N/A	N/A	manipulation	crafts	d4402—Manipulating	d9203—Crafts
	place glove on unaffected hand	Capacity	N/A	N/A	dressing		d5400—Putting on clothes
	draw a line with a ruler	Capacity	N/A	N/A	drawing		d4408—Fine hand use, other specified		drawing
	start zipper on vest	Capacity	N/A	N/A	zipper		d4408—Fine hand use, other specified		zipper
	11–21 year old
	cut paper from a roll to wrap a videotape	Capacity	N/A	N/A	cut paper		d4402—Manipulating
	tear a piece of tape	Capacity	N/A	N/A	tearing		d4402—Manipulating
	secure wrap no a videotape with tape	Capacity	N/A	N/A	secure wrap		d4408—Fine hand use, other specified		secure wrap
	cut putty on plate with knife and fork	Capacity	N/A	N/A	cutting		d4402—Manipulating
	open a three ring binder	Capacity	N/A	N/A	open binder		d4408—Fine hand use, other specified		open binder
	start zipper on vest	Capacity	N/A	N/A	zipper		d4408—Fine hand use, other specified		zipper
	tie shoelaces in a bow	Capacity	N/A	N/A	tie shoe laces		d4402—Manipulating
	do up buttons on a shirt	Capacity	N/A	N/A	buttoning		d4408—Fine hand use, other specified		buttoning
	use dust pan and small broom	Capacity	N/A	N/A	dust pan and broom		d6408—Doing housework, other specified		dust pan and broom
Brachial Plexus outcome measure (BPOM)	combs back of head	Capacity	N/A	N/A	combing		d5202—Caring for hair
	pulls apart theraputty	Capacity	N/A	N/A	pull apart		d4458—Hand and arm use, other specified
	opens large container	Capacity	N/A	N/A	opening		d4408—Fine hand use, other specified
	holds plate with palm up	Capacity	N/A	N/A	hold	palm up	d4401—Grasping	b7100—Mobility of a single joint
	pretends to eat candy	Capacity	N/A	N/A	eat		d550—Eating
	strings bead	Capacity	N/A	N/A	stringing bead		d4402—Manipulating
	plays drums	Capacity	N/A	N/A	playing drums		d9202—Arts and culture
	places container above head	Capacity	N/A	N/A	lifting above head		d4300—Lifting
	uses computer mouse	Capacity	N/A	N/A	uses computer mouse		d4402—Manipulating
	undo button at midline	Capacity	N/A	N/A	unbutton		d4408—Fine hand use, other specified
	hand to back pant pocket	Capacity	N/A	N/A	hand to back pant pocket		b7602—Coordination of voluntary movements
In Hand Manipulation Test	picking up coins and placing them in a bank	Capacity	N/A	N/A	picking up coins	placing them	d4400—Picking up	d4402—Manipulating
	picking up chips and placing them in a container	Capacity	N/A	N/A	pick up chips	placing them	d4400—Picking up	d4402—Manipulating
	removing and replacing small bottle lids	Capacity	N/A	N/A	removing lid		d4453—Turning or twisting the hands or arms
	picking up and placing cubes; turning over cubes	Capacity	N/A	N/A	picking up coins	placing; turning over	d4400—Picking up	d4402—Manipulating
	picking up, turning over, and placing pegs	Capacity	N/A	N/A	pick up	turning and placing	d4400—Picking up	d4402—Manipulating
	picking writing tools	Capacity	N/A	N/A	picking writing tools		d4400—Picking up
	putting a key into a lock	Capacity	N/A	N/A	putting key into lock		d4402 - Manipulating
	turning pages in a magazine	Capacity	N/A	N/A	turning pages		d4402 - Manipulating
	picking up playing cards	Capacity	N/A	N/A	picking up playing cards		d4400 - Picking up
Assessment of Capacity for Myoelectric Control (ACMC)	Gripping
	grips with weight supported	Capacity	N/A	N/A	grips		d4401 - Grasping
	positions the hand and grips	Capacity	N/A	N/A	grips	position hands	d4401 - Grasping	b7602 - Coordination of voluntary movements
	uses the tripod pinch grip with weight supported	Capacity	N/A	N/A	grips		d4401 - Grasping
	positions the hand and uses the tripod pinch grip	Capacity	N/A	N/A	grips	position hands	d4401 - Grasping	b7602 - Coordination of voluntary movements
	adjusts grip force to avoid crushing	Capacity	N/A	N/A	grips	avoid crushing	d4401 - Grasping	b7300 - Power of isolated muscles and muscle groups
	grips with the arm in different positions	Capacity	N/A	N/A	grips	arm different position	d4401 - Grasping	b7101 - Mobility of several joints
	grips through iterative refinement, manipulates	Capacity	N/A	N/A	grips	manipulation	d4401 - Grasping	d4402 - Manipulating
	grips object by feeding arm forwards	Capacity	N/A	N/A	reach		d4452 - Reaching
	grips object moving towards the hand	Capacity	N/A	N/A	catch		d4455 - Catching
	grips with no visual feedback	Capacity	N/A	N/A	grips		d4401 - Grasping
	adjusts grip force with no visual feedback	Capacity	N/A	N/A	grip force		b7300 - Power of isolated muscles and muscle groups
	grips behind the back to manipulate object	Capacity	N/A	N/A	grips	manipulate	d4401 - Grasping	d4402 - Manipulating
	Holding
	holds with arm supported	Capacity	N/A	N/A	hold	arm supported	d4401 - Grasping	b7603 - Supportive functions of arm or leg
	holds without support	Capacity	N/A	N/A	hold		d4401 - Grasping
	holds without crushing	Capacity	N/A	N/A	hold	without crushing	d4401 - Grasping	b7300 - Power of isolated muscles and muscle groups
	holds with the arm moving	Capacity	N/A	N/A	hold	arm moving	d4401 - Grasping	b7101 - Mobility of several joints
	holds with no visual feedback	Capacity	N/A	N/A	hold		d4401 - Grasping
	holds with the arm moving, no visual feedback	Capacity	N/A	N/A	hold	arm moving	d4401 - Grasping	b7101 - Mobility of several joints
	Releasing
	releases with arm supported	Capacity	N/A	N/A	release	arm supported	d4403 - Releasing	b7603 - Supportive functions of arm or leg
	positions the hand and releases	Capacity	N/A	N/A	release	position hand	d4403 - Releasing	b7101 - Mobility of several joints
	loosens grip without dropping object	Capacity	N/A	N/A	release	without dropping	d4403—Releasing	b7300—Power of isolated muscles and muscle groups
	releases the grip with arm in different positions	Capacity	N/A	N/A	release	different position	d4403—Releasing	b7602—Coordination of voluntary movements
	releases through iterative refinement, manipulation	Capacity	N/A	N/A	release	manipulation	d4403—Releasing	d4402—Manipulating
	releases object with arm swinging low	Capacity	N/A	N/A	release		d4403—Releasing
	releases object by feeding arm forward at, or above, shoulder height	Capacity	N/A	N/A	release	reaching	d4403—Releasing	d4452—Reaching
	releases synchronized with the other hand	Capacity	N/A	N/A	release	synchronize with other hand	d4403—Releasing	b7602—Coordination of voluntary movements
	releases with no visual feedback	Capacity	N/A	N/A	release		d4403—Releasing
	releases behind the back to manipulate object	Capacity	N/A	N/A	release	manipulate	d4403—Releasing	d4402—Manipulating
	Coordinating
	coordinates grip using both hands	Capacity	N/A	N/A	coordinates	grip	b7602—Coordination of voluntary movements	d4401—Grasping
	coordinates release using both hands	Capacity	N/A	N/A	coordinates	release	b7602—Coordination of voluntary movements	d4401—Grasping
Upper Extremity Rating Scale (UERS)	Shoulder: active motion	Capacity	N/A	N/A	shoulder motion		b7100—Mobility of a single joint
	Elbow: active motion	Capacity	N/A	N/A	elbow motion		b7100—Mobility of a single joint
	Forearm: active motion (examine with elbow 45–90 degree)	Capacity	N/A	N/A	forearm motion		b7100—Mobility of a single joint
	Wrist: active motion (examine with elbow 45–90 degree)	Capacity	N/A	N/A	wrist motion		b7100—Mobility of a single joint
	Hand (grasp/release)	Capacity	N/A	N/A	grasp	release	d4401—Grasping	d4403—Releasing
Test of Infant Motor Performance (TIMP)	Observed items
	individual right finger movement	Capacity	N/A	N/A	finger movement		b7100—Mobility of a single joint
	individual left finger movement	Capacity	N/A	N/A	finger movement		b7100—Mobility of a single joint
	fingers object/surface on right	Capacity	N/A	N/A	fingers object/surface on right		d4452—Reaching
	fingers object/surface on left	Capacity	N/A	N/A	fingers object/surface on left		d4452—Reaching
	fidgety movement	Capacity	N/A	N/A	fidgety movement		b7611—Specific spontaneous movements
	ballistic movement of the arm or legs (swipes or swats)	Capacity	N/A	N/A	ballistic movement of the arm or legs (swipes or swats)		b7611—Specific spontaneous movements
	oscillation of arm or leg during movement	Capacity	N/A	N/A	oscillation of arm or leg during movement		b7611—Specific spontaneous movements
	Reaches for person or object	Capacity	N/A	N/A	reaches for person or object		d4452—Reaching
	Elicited items
	Defensive reaction—arm movement	Capacity	N/A	N/A	defensive reaction—arm movement		b755—Involuntary movement reaction functions
	rolling: elicited from the arms	Capacity	N/A	N/A	rolling: elicited from the arms		d4107—Rolling Over
	pull to sit	Capacity	N/A	N/A	pull to sit		d4103—Sitting
	lateral straightening of the head and body with arm support	Capacity	N/A	N/A	supportive stability with arm		b7603—Supportive functions of arm or leg
	crawling	Capacity	N/A	N/A	crawling		d4450—Pulling
Video Observations Aarts and Aarts, module Determine Developmental Disregard (VOA-DDD)	Stringing beads (child was asked to take beads from six different cans and string them on a thread)	Capacity	N/A	N/A	stringing beads		d4402—Manipulating
	Decorating a muffin
	Child was asked to put a placemat on the table and to put a place on the placemat	Capacity	N/A	N/A	placemat on table and put place on placemat		d6300—Preparing simple meals
	Child was asked to take the muffin from the saucer and put it on the plate and to take the paper off the muffin and put the paper on the saucer	Capacity	N/A	N/A	take the muffin from the saucer and put it on the plate and to take the paper off the muffin and put the paper on the saucer		d6300—Preparing simple meals
	Child was asked to subsequently decorate the muffin by taking candies from the egg-cup and two pots and to put the caster sugar on the muffin	Capacity	N/A	N/A	decorate the muffin by taking candies from the egg-cup and two pots and to put the caster sugar on the muffin		d6300—Preparing simple meals
	For the older children, when decorating the muffin was finished, they were asked to cut the muffin into pieces	Capacity	N/A	N/A	they were asked to cut the muffin into pieces		d6300—Preparing simple meals
	Once completed they were asked to clean their hands with a napkin	Capacity	N/A	N/A	washing hands		d5100—Washing body parts

Results

• Literature Review: The search conducted in MEDLINE, EMBASE, CINAHL, and OTSeeker in July 2021 generated a total of 6775 articles. Duplicates were removed (n=802), and the selection criteria were applied to 5973 titles and abstracts. After the initial screening, 1786 full-text articles were reviewed, 1191 met the inclusion criteria, in which 77 outcome measures were identified and 32 were included in the linking process. A PRISMA flow chart was used to illustrate the identification and selection process of the articles and outcome measures at each stage of the review (Moher et al., 2009) (Figure 1). The included outcome measures were published between 1948 and 2013. The most commonly cited included the Assisting Hand Assessment (AHA) (Krumlinde-Sundholm & Eliasson, 2003), Melbourne Assessment of Unilateral Upper Limb (MAUUL) (Randall et al., 1999), the Jebsen-Taylor Hand Function Test (JTHFT) (Jebsen et al., 1969), the Quality of Upper Extremity Skills Test (QUEST) (DeMatteo et al., 1992), the Box and Blocks (Mathiowetz et al., 1985). Refer to Table 3 for an in-depth overview of data extracted from the included outcome measures.

• Linking to the ICF: Five hundred and thirty-eight items were extracted from the 32 included outcome measures, which were then linked to the ICF. Some items were coded to more than one code as there were additional meaningful concepts found within the items. The kappa coefficient was calculated at 0.721 which indicates a substantial agreement among the three raters (McHugh, 2012). The Activity and Participation domain represented 364 codes (68%) followed by the Body Functions domain 174 codes (32%). The most frequently identified ICF codes were d4402—Manipulating (n=99, 18%) and d4401—Grasping (n=85, 16%). The most coded ICF Chapter was Chapter 4: Mobility, specifically Fine hand use (n=301, 56%) and Hand and arm use (n=17%). As mentioned, a table for each outcome measure was created using the Cieza et al. (2019) linking process (Table 4). Additionally, a pie chart was created for each outcome measure with the breakdown of codes identified (Table 5) (the AHA as an example).

Discussion:

• Literature Review: This scoping review identified the most frequently reported pediatric PBOMs of UE function in the literature and linked the extracted items to the domains of the ICF. A total of 32 outcome measures that met the inclusion criteria were included and 538 items were linked to the ICF. The most frequently cited outcome measures included the AHA, the MAUUL, the JTHFT, the QUEST and the Box and Block. In terms of the ICF Linking process, the most frequently reported codes were d4402—Manipulating (n=99, 18%) and d4401—Grasping (n=85, 16%).

  A total of 27 of the included measures were developed specifically for a pediatric population, while the JTHFT, Box and Blocks, and FDT measures were originally developed for an adult population but were later validated for a pediatric population. The Purdue Pegboard Test and the Assessment of Capacity for Myoelectric Control (ACMC) can be used throughout the lifespan.

• Linking to the ICF: One issue faced during the linking process was inherently related to the limited coding structure of the ICF itself. For example, the ICF Framework is divided into Health Condition, Body Functions and Structures, Activities, Participation, Environmental Factors, and Personal Factors (Figure 2a). However, the ICF Coding Structure is divided into Body Functions, Body Structures, Activities and Participation, and Environmental Factors (Figure 2b). The major difference is the individual category of “Activity” and “Participation” in the ICF Framework while “Activities and Participation” is combined in the Coding Structure. By linking to the ICF Coding Structure, we were unable to determine which items were directly related to the Participation component and those related to Personal Factors could not be coded due to the nature of the coding structure. Therefore, although the domains of the ICF provided a helpful framework to understand the influence of various factors on the individual, the WHO's definition of participation provided little detail about the construct, making it difficult to use as a guide to select appropriate and specific measurement tools without a more refined parsing of the underlying concepts (Adair et al., 2018). Unfortunately, test developers aren’t always aware of this limitation when developing new outcome measures. This could lead to items being duplicated or constructs being misrepresented and could further generate gaps between the constructs quantified by the outcome measure and those of the ICF when determining which ICF health-related components are lacking. As the items were coded to the Body Functions and Activity domains of the ICF, youth with conditions such as osteogenesis imperfecta (OI) and arthrogryposis multiplex congenita (AMC), who have reported experiencing difficulties with participation at home, at school, and in the wider community (Elfassy, Cachecho, et al., 2020; Elfassy, Darsaklis, et al., 2020; Marr et al., 2017) will not be able to identify such needs using the ICF. When items are not coded to include the Participation domain of the ICF, it can result in an incomplete understanding of the individual's functioning and may lead to inadequate intervention strategies. Additionally, since Personal Factors are not coded in the ICF, this area is oftentimes overlooked. Therefore, it is important for clinicians administering outcome measures to carefully consider all domains when using the ICF to assess and classify individuals’ functioning. Since treatment plans are often developed on the basis of the results of the assessments, clinicians should also consider the importance of participation for children and youth and the personal factors (Elfassy, Cachecho, et al., 2020; Elfassy, Darsaklis, et al., 2020). This can be achieved through PBOMs but also through guided interviews using measures like the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) (Law et al., 2019; Palisano, 1993). OT and PTs working with children and youth should use their clinical judgment to ensure that a child and family-centered approach is implemented and that all needs are addressed.

As reported, the ICF is composed of four chapters (b=body function, s=body structure, d=activities and participation, e=environmental factors) followed by a numeric code. The number of digits which make up the code indicate the category and its level. The more digits (4^th level coding) available, the more precise description of the ICF (World Health Organization (WHO)., 2013). According to the linking rules “all meaningful concepts [should be linked] to the most precise ICF category” (Cieza et al., 2019). In the scoping review by Lesher et al. (2017), the items were only linked to the first level category. For example, in the JTHFT, Lesher et al. (2017) coded in Body Functions: b1“Mental” and b7 “Neuromuscular and Movement”, in Activity and Participation: d1 “Learning and Applying Knowledge”, d2 “General Tasks and Domains”, d5 “Self-Care”, d6 “Domestic Life”, whereas the fourth level codes found in Table 4 were much more precise and specific. Linking the meaningful concepts to the most precise category is important for communication and collaboration between clinicians. When coding to the first level category of the ICF, granularity and precision are lost, which can ultimately result in a decreased understanding of the level of function of an individual. Precise coding helps to ensure that the different clinicians such as OTs, PTs and physicians are using the same language to describe an individual's functioning, which can facilitate communication and coordination of care (Selb et al., 2015; World Health Organization (WHO)., 2001).

Figure 1

Prisma diagram yof included outcome

Figure 2

Differences between ICF as a model of functioning and as a coding system (Salvador-Carulla & Garcia-Gutierrez, 2011)

Table 5

Pie Chart Representation of Codes Used for Each Outcome Measure

Another important aspect to consider when linking the items of the outcome measures to the ICF was that some items were linked with more than one meaningful concept. Therefore, these items were linked to two or more codes. An example of an item with multiple meanings was found in the Performance of Upper Limb Test where the item stated “hand to mouth with and without weight”. The meaningful concepts “hand to mouth”, “with and without weight” were linked to b7602 - Coordination of voluntary movements and b7301 - Power of muscles of one limb respectively. This particular example is in line with Linking rule #3 which states “identify any additional concepts contained in the piece of information in addition to the main concepts already identified”.

The second version of the linking rules (2005) had omitted the “other specified” and “unspecified” categories of the ICF to reduce the ambiguity of the results in the linking process (Cieza et al., 2005). However, in the latest version, Cieza et al. (2019) recommend the use of “other specified [8]” such as picking up large heavy cans—d4408 Fine hand use, other specified and “unspecified [9]” such as proceeds—d4409 Fine hand use, unspecified has shown that not using 8 and 9 categories led to lost information”. The difference is that the content and information be added and written in the newly developed extraction table. The modification of this rule has been necessary for this study as “other specified” represented 12% (n=65) of the results and “unspecified” denoted 3% (n=15). Coding to these two categories was beneficial because it allowed for the inclusion of meaningful concepts that did not fit precisely into other existing ICF categories. By using these categories, clinicians can still accurately describe the individual's functioning and address all relevant aspects of their condition, even when no specific ICF category exists for a particular concept. This ensures that no meaningful aspect of the individual's condition is omitted from the coding process (Cieza et al., 2019). Therefore, while the ICF is composed of four chapters and numeric codes, the more digits available for coding, the more precise and comprehensive the description of an individual's functioning, which in turn can improve collaboration between clinicians and promote care.

Limitations

In this latest iteration of Cieza et al.'s linking rules, the authors suggest using a Linking Extraction Table when linking health information to the ICF (Cieza et al., 2019). Specifically, they recommend extracting the “perspective adopted in information”, “response options”, and “classification of response options”. However, when linking PBOM, many categorizations of response options did not apply as the outcome measure was often related to function. Furthermore, since the outcome measures were to be performed in a clinical rehabilitation setting evaluated by a clinician, 28 out of the 32 measures were assessing capacity. Yet, contextual factors such as physical and social environment, as well as personal factors such as motivation, influence the relations between capacity and performance (Holsbeeke et al., 2009).

Conclusion

The scoping review identified 32 PBOMs used in the assessment of pediatric UE function. The most frequented reported outcome measures were the AHA, JTHFT, MAAUL, QUEST, and Box and Blocks. A majority of the meaningful concepts extracted from the PBOMs were linked with the Chapter 4: Mobility, Fine hand use of the ICF. Due to the nature of the ICF Coding Structure, the areas of “Participation” and “Personal Factors” were lacking in the linking process. Overall, clinicians need to aware of the limitations between the ICF Framework and the ICF Coding structure and ensure they are addressing all the needs of children and youth. This can be achieved by combining assessments and outcome measures to bridge the gap between what is lacking in one measure and complement treatments provided to children and youth.

Key Messages

• Difference between ICF Framework and ICF Coding Structure as Participation and Personal Factors may be overlooked.

• Clinicians should use this review to help determine which areas of ICF are identified in various PBOMs and ensure that they implement an additional outcome measure to bridge the gap and provide holistic care to children and youth.