Free
Brief Report  |   November 2013
Functional Test for the Hemiparetic Upper Extremity Normative Database
Author Affiliations
  • Veronica T. Rowe, MS, OTR/L, is Clinical Instructor, Department of Occupational Therapy, University of Central Arkansas, Doyne Health Science Center, Suite 300, 201 Donaghey Avenue, Conway, AR 72035, and Doctoral Student, Texas Woman’s University; vrowe@uca.edu
Article Information
Assessment Development and Testing / Hand and Upper Extremity / Departments
Brief Report   |   November 2013
Functional Test for the Hemiparetic Upper Extremity Normative Database
American Journal of Occupational Therapy, November/December 2013, Vol. 67, 717-721. doi:10.5014/ajot.2013.008797
American Journal of Occupational Therapy, November/December 2013, Vol. 67, 717-721. doi:10.5014/ajot.2013.008797
Abstract

OBJECTIVE. The purpose of this study was to develop a normative database of results of the Functional Test for the Hemiparetic Upper Extremity (FTHUE) from able-bodied participants.

METHOD. Ninety healthy adults, aged 20–80, were assessed on the timed tasks of the FTHUE with their nondominant upper extremity serving as the weaker side.

RESULTS. A normative table with means and standard deviations for the timed tasks of the FTHUE was created to provide reference values for upper-extremity performance. Significant differences were found among participants by gender and age.

CONCLUSION. The FTHUE is an easy-to-administer, inexpensive, quick evaluation. It yields standardized data that allow clinicians to observe their clients performing functional tasks. The table of normative data will further assist clinicians in their assessment of clients with hemiparesis.

With shortened lengths of stay for physical rehabilitation, clinicians frequently cite the need for assessments that are time efficient while providing reliable and valid outcome measures. In addition, functional information is now being required by insurers and third-party payers such as the Centers for Medicare and Medicaid Services (CMS; 2012) . In July 2012, CMS proposed the Physician Fee Schedule Final Rule for CY 2013, which establishes payment practices for outpatient therapy services billed under Medicare Part B (CMS, 2012). Under the rule, outpatient therapy providers billing the Medicare program will have to report functional data for patients on the claim form.
Assessments that can measure function in mildly to severely impaired neurologically involved clients are needed. The Functional Test for the Hemiparetic Upper Extremity (FTHUE; Wilson, Baker, & Craddock, 1984) was developed by the stroke service of Rancho Los Amigos Hospital to serve as an objective measure of the function of the upper extremities of adults with hemiparesis during the execution of purposeful movements and has been found to be valid and reliable. This test is easy, quick, and inexpensive for assessing outcomes of upper-extremity treatment programs. Wilson et al. (1984)  reported the FTHUE can be successfully administered in many different settings, from acute care to outpatient and home care, and takes approximately 30 min to administer. The equipment required is readily available for administration and can be stored and transported in a single container for easy access.
The FTHUE consists of 17 graded activities, 8 of which came from the Extremity Functional Use Test (Aldwell, Wilson, & Braun, 1969). These activities are arranged in seven levels by degree of difficulty, and they measure specific motor abilities required to perform each task (Wilson et al., 1984). These specific tasks measure functions from resisted contralateral muscle contraction in the upper extremity to coordination and finger dexterity (Wilson et al., 1984). Each task is graded on a pass–fail basis, and 15 of the tasks are timed with a stopwatch. Completion of tasks results in a score ranging from 1 (lowest function) to 7 (highest function). The score is determined by the level of the most difficult task that can be achieved. However, in a study by Winstein et al. (2004), the FTHUE score was reported as the number of items successfully completed out of the 17-item hierarchically arranged battery of functional tasks (Table 1).
Table 1.
FTHUE Tasks With Start and Stop Times Defined
FTHUE Tasks With Start and Stop Times Defined×
LevelTaskStart TimeStop Time
1Participant is unable to complete higher level tasksNot applicable
2A. Associated reactionNot tested
B. Hand into lapNondominant arm at sideNondominant hand in lap
3C. Arm clearance during shirt tuckBoth arms in lapDominant hand tucks shirt in on nondominant side
D. Hold a pouchNot tested
E. Stabilize a pillowNondominant arm on pillowPillowcase on pillow
4F. Stabilize a jarNondominant arm at side, dominant hand holds jarLid off jar
G. Stabilize a packageHands in lap (tape on dominant hand side)Tape on package
H. Wringing a ragHands in lapOne squeeze of rag
5I. Hold a pan lidHands in lap (pan on table)Pan on table
J. Hook and zip a zipperHands holding jacket endsZipper unhooked
K. Fold a sheetUnfolded sheet in lap, hands at sidesSheet folded approximately 12-in. square
6L. Blocks and boxNondominant hand in lap (blocks on nondominant side)All blocks in box
M. Box on shelfNondominant hand in lapBox on table
N. Coin in coin gaugeNondominant hand in lapDime in slot
7O. Cat’s cradleHands at sides (string in lap)String pulled tight
P. LightbulbLightbulb in nondominant handLightbulb screwed in tight
Q. Remove rubber bandRubber band on nondominant hand at level of MCPsRubber band off hand and placed on table
Table Footer NoteNote. FTHUE = Functional Test for the Hemiparetic Upper Extremity; MCP = metacarpophalangeal.
Note. FTHUE = Functional Test for the Hemiparetic Upper Extremity; MCP = metacarpophalangeal.×
Table 1.
FTHUE Tasks With Start and Stop Times Defined
FTHUE Tasks With Start and Stop Times Defined×
LevelTaskStart TimeStop Time
1Participant is unable to complete higher level tasksNot applicable
2A. Associated reactionNot tested
B. Hand into lapNondominant arm at sideNondominant hand in lap
3C. Arm clearance during shirt tuckBoth arms in lapDominant hand tucks shirt in on nondominant side
D. Hold a pouchNot tested
E. Stabilize a pillowNondominant arm on pillowPillowcase on pillow
4F. Stabilize a jarNondominant arm at side, dominant hand holds jarLid off jar
G. Stabilize a packageHands in lap (tape on dominant hand side)Tape on package
H. Wringing a ragHands in lapOne squeeze of rag
5I. Hold a pan lidHands in lap (pan on table)Pan on table
J. Hook and zip a zipperHands holding jacket endsZipper unhooked
K. Fold a sheetUnfolded sheet in lap, hands at sidesSheet folded approximately 12-in. square
6L. Blocks and boxNondominant hand in lap (blocks on nondominant side)All blocks in box
M. Box on shelfNondominant hand in lapBox on table
N. Coin in coin gaugeNondominant hand in lapDime in slot
7O. Cat’s cradleHands at sides (string in lap)String pulled tight
P. LightbulbLightbulb in nondominant handLightbulb screwed in tight
Q. Remove rubber bandRubber band on nondominant hand at level of MCPsRubber band off hand and placed on table
Table Footer NoteNote. FTHUE = Functional Test for the Hemiparetic Upper Extremity; MCP = metacarpophalangeal.
Note. FTHUE = Functional Test for the Hemiparetic Upper Extremity; MCP = metacarpophalangeal.×
×
Wilson et al. (1984)  emphasized that the validity of the FTHUE is demonstrated by information from several objective measures of the upper extremity being integrated within a single functional score. Filiatrault, Arsenault, Dutil, and Bourbonnais (1991)  established a significant correlation between the scores on the upper-extremity motor function section of the Fugl-Meyer Test (Fugl-Meyer, Jääskö, Leyman, Olsson, & Steglind, 1975) and the FTHUE, which indicates that either test may be used as a valid assessment of upper-extremity motor function.
A normative database against which to compare values of timed tasks in the FTHUE has not been generated. The purpose of this study was to develop a normative database for the FTHUE. Normative data will enable clinicians to compare their clients’ performance with healthy people who are age and gender matched. Current practice demands use of assessments that produce valid, reliable outcomes on which to base treatment decisions, thus affecting research, practice, and the policies of rehabilitation (AOTA, 2007).
Method
Research Design
A cross-sectional cohort design was used to amass normative data on the FTHUE assessment. This study was approved and monitored by the University of Central Arkansas institutional review board. All participants agreed to and signed an approved informed consent.
Participants
Participants were recruited from the southern United States in and around Arkansas and Georgia. Students from the University of Central Arkansas and their families and acquaintances were the majority of participants. No participants exhibited any upper-extremity deficits, and all voluntarily signed an informed consent that confirmed exclusion of the following conditions: problems of the neuromuscular or musculoskeletal systems; difficulty or inability to comprehend instructions; less than full range of movement in arms and hands; a history of brain injury, stroke, or any other central nervous system pathology; peripheral neuropathies in upper extremities; osteoarthritis or rheumatoid arthritis that limit arm and hand movements; a fracture of arms or hands within the past year; use of muscle relaxants or other medications on a daily basis that could affect movement, reaction times, or strength; uncorrected vision or auditory impairments; or any joint deformities that limit active range of motion in arms and hands.
Procedures and Data Collection
The FTHUE was administered with each participant seated in an armless chair in front of a standard-height table (when necessary for certain tasks). Fifteen of the 17 tasks of the FTHUE were given according to the standardized protocol obtained from the Los Amigos Research & Education Institute. The first (“Associated reaction”) and third tasks (“Hold a pouch”) were excluded from this study because they are not timed. Specific times to start and stop the stopwatch for each of the other tasks were defined for this study (see Table 1). Participants’ nondominant upper extremity served as the weaker side with which to perform the tasks. For example, the nondominant upper extremity was used as a stabilizer during the 9th task (“Hold a pan lid”).
Innate differences in hand function are influenced by hand dominance (Cooper, 2007). Although most activities in life are accomplished bimanually, the dominant hand acts as the more dexterous main executor, whereas the nondominant hand acts as supporter (Eggers & Mennen, 1997). Thus, the nondominant upper extremity mimicked an affected or weaker side of a person who has sustained a neurological event. The use of the nondominant side was chosen for normative data to more closely represent the range of timed movements of a hemiplegic upper extremity.
Evaluators collecting data included the author and four occupational therapy graduate students from the University of Central Arkansas. The author trained and directly observed all evaluators until competency in administration was achieved. To ensure consistency in test administration, interrater reliability was calculated at the beginning of the study and with approximately every 5th participant enrolled throughout the study. Seven participants were videorecorded for reliability and subsequently timed by all evaluators. The intraclass correlation coefficient (ICC) ranged from .99 to 1.00. All individual tasks exhibited excellent ICCs.
Data Analysis
Means and standard deviations were calculated for each task of the FTHUE. Two-way analyses of variance (Age Group × Task and Gender × Task) were computed separately for the mean of the 15 timed tasks. Statistical significance was determined by p < .05. IBM SPSS Statistics Version 19 (IBM, Armonk, NY) was used to calculate all results.
Results
Ninety healthy participants without physical disabilities (45 men, 45 women) were recruited and enrolled (none withdrawn and no missing data) as a sample of convenience over a 6-mo period. Genders were equally represented in each age decade from 20 to 80 yr (10 men, 10 women for 20–29-yr-olds; 7 men, 7 women for all other age decades). Average times and standard deviations to complete each task computed within each age decade and for gender are shown in Table 2. Gender differences are displayed by task, not age group, because of low number of men and women per age group.
Table 2.
Normative Table for the FTHUE, by Clustered Age and Gender Groups
Normative Table for the FTHUE, by Clustered Age and Gender Groups×
Age or Gender Group, M FTHUE Task Times (SD)
Task20–29 yr (n = 20)30–39 yr (n = 14)40–49 yr (n = 14)50–59 yr (n = 14)60–69 yr (n = 14)70–80 yr (n = 14)Total M Time/TaskTotal M Time/Task: MenTotal M Time/Task: Women
2-B hand into lap0.64 (0.19)0.68 (0.14)0.7 (0.20)0.5 (0.15)0.7 (0.25)0.7 (0.20)0.64 (0.20)0.65 (0.22)0.63 (0.18)
3-C arm clearance/shirt tuck2.6 (0.94)2.2 (0.85)2.1 (0.80)1.6 (0.81)**2.0 (0.56)2.1 (0.44)2.1 (0.82)2.10 (0.82)2.3 (0.80)
3-E stabilize pillow8.8 (2.95)6.4 (2.96)*8.3 (4.04)7.7 (2.38)9.5 (4.04)15.9 (8.04)9.4 (5.19)11.4 (5.90)7.4 (3.38)*
4-F stabilize jar2.7 (0.71)2.7 (0.91)2.6 (0.69)2.3 (0.41)2.7 (1.00)2.7 (0.75)2.6 (0.75)2.7 (0.81)2.5 (0.68)
4-G stabilize package15.5 (4.52)14.8 (4.61)14.4 (4.60)13.6 (2.80)15.1 (6.44)15.8 (5.55)14.9 (4.77)17.0 (5.34)12.8 (2.85)*
4-H wringing rag3.0 (1.04)3.1 (0.63)2.7 (1.10)2.5 (0.74)2.7 (0.99)2.8 (0.78)2.8 (0.91)2.6 (0.91)2.9 (0.89)
5-I hold pan lid10.8 (3.07)9.5 (1.99)10.1 (3.30)8.9 (2.65)**13.0 (3.92)10.5 (2.77)10.5 (3.19)10.8 (3.34)10.2 (3.03)
5-J hook & zip7.5 (4.50)6.7 (2.14)5.7 (2.46)7.8 (4.04)7.2 (2.78)9.5 (8.35)7.4 (4.56)7.0 (3.67)7.8 (5.33)
5-K fold sheet13.0 (5.96)**16.5 (5.50)13.7 (5.36)**15.3 (6.37)20.3 (8.13)19.1 (4.97)16.1 (6.53)14.6 (6.75)***17.6 (6.01)
6-L blocks & box5.0 (1.72)5.8 (1.16)5.2 (1.71)5.5 (1.56)6.6 (1.81)6.0 (1.63)5.7 (1.66)5.1 (1.71)*6.2 (1.47)
6-M box on shelf4.8 (3.12)4.3 (0.82)4.4 (1.26)4.4 (1.13)5.1 (1.31)5.1 (1.20)4.7 (1.77)4.4 (1.14)5.0 (2.20)
6-N coin gauge2.3 (0.43)2.3 (0.48)2.3 (0.80)*2.3 (0.43)2.8 (0.65)3.2 (0.89)2.5 (0.70)2.55 (0.84)2.5 (0.54)
7-O cat’s cradle5.3 (2.26)***6.1 (2.73)5.6 (2.69)5.8 (2.27)7.4 (2.91)8.5 (3.64)6.4 (2.90)6.34 (2.88)6.4 (2.96)
7-P lightbulb7.6 (1.86)6.4 (1.51)***7.5 (2.26)6.6 (1.65)7.4 (1.65)9.2 (4.12)7.5 (2.42)6.98 (1.64)7.9 (2.96)
7-Q remove rubber band4.4 (3.05)4.6 (2.09)5.0 (2.62)4.9 (2.36)8.6 (10.61)7.6 (3.41)5.87 (5.02)6.4 (6.51)5.1 (2.73)
Total M time/age group93.7 (17.43)88.7 (14.07)90.3 (20.30)89.8 (15.33)110.5 (23.53)118.12 (21.02)98.2 (21.43)(see below)(see below)
Total M per age group: Men98.6 (17.48)85.7 (14.66)90.4 (23.71)87.6 (16.46)116.3 (29.89)118.5 (25.52)99.4 (24.16)99.4 (24.16)(gender specific)
Total M per age group: Women88.7 (16.8)91.8 (13.88)90.3 (18.19)92.1 (15.04)104.7 (15.12)117.8 (17.48)97.0 (18.49)(gender specific)97.0 (18.48)
Table Footer NoteNote. FTHUE = Functional Test for the Hemiparetic Upper Extremity; M = mean; SD = standard deviation. FTHUE task times are measured in seconds.
Note. FTHUE = Functional Test for the Hemiparetic Upper Extremity; M = mean; SD = standard deviation. FTHUE task times are measured in seconds.×
Table Footer Note*p < .001. **p < .01. ***p < .05.
*p < .001. **p < .01. ***p < .05.×
Table 2.
Normative Table for the FTHUE, by Clustered Age and Gender Groups
Normative Table for the FTHUE, by Clustered Age and Gender Groups×
Age or Gender Group, M FTHUE Task Times (SD)
Task20–29 yr (n = 20)30–39 yr (n = 14)40–49 yr (n = 14)50–59 yr (n = 14)60–69 yr (n = 14)70–80 yr (n = 14)Total M Time/TaskTotal M Time/Task: MenTotal M Time/Task: Women
2-B hand into lap0.64 (0.19)0.68 (0.14)0.7 (0.20)0.5 (0.15)0.7 (0.25)0.7 (0.20)0.64 (0.20)0.65 (0.22)0.63 (0.18)
3-C arm clearance/shirt tuck2.6 (0.94)2.2 (0.85)2.1 (0.80)1.6 (0.81)**2.0 (0.56)2.1 (0.44)2.1 (0.82)2.10 (0.82)2.3 (0.80)
3-E stabilize pillow8.8 (2.95)6.4 (2.96)*8.3 (4.04)7.7 (2.38)9.5 (4.04)15.9 (8.04)9.4 (5.19)11.4 (5.90)7.4 (3.38)*
4-F stabilize jar2.7 (0.71)2.7 (0.91)2.6 (0.69)2.3 (0.41)2.7 (1.00)2.7 (0.75)2.6 (0.75)2.7 (0.81)2.5 (0.68)
4-G stabilize package15.5 (4.52)14.8 (4.61)14.4 (4.60)13.6 (2.80)15.1 (6.44)15.8 (5.55)14.9 (4.77)17.0 (5.34)12.8 (2.85)*
4-H wringing rag3.0 (1.04)3.1 (0.63)2.7 (1.10)2.5 (0.74)2.7 (0.99)2.8 (0.78)2.8 (0.91)2.6 (0.91)2.9 (0.89)
5-I hold pan lid10.8 (3.07)9.5 (1.99)10.1 (3.30)8.9 (2.65)**13.0 (3.92)10.5 (2.77)10.5 (3.19)10.8 (3.34)10.2 (3.03)
5-J hook & zip7.5 (4.50)6.7 (2.14)5.7 (2.46)7.8 (4.04)7.2 (2.78)9.5 (8.35)7.4 (4.56)7.0 (3.67)7.8 (5.33)
5-K fold sheet13.0 (5.96)**16.5 (5.50)13.7 (5.36)**15.3 (6.37)20.3 (8.13)19.1 (4.97)16.1 (6.53)14.6 (6.75)***17.6 (6.01)
6-L blocks & box5.0 (1.72)5.8 (1.16)5.2 (1.71)5.5 (1.56)6.6 (1.81)6.0 (1.63)5.7 (1.66)5.1 (1.71)*6.2 (1.47)
6-M box on shelf4.8 (3.12)4.3 (0.82)4.4 (1.26)4.4 (1.13)5.1 (1.31)5.1 (1.20)4.7 (1.77)4.4 (1.14)5.0 (2.20)
6-N coin gauge2.3 (0.43)2.3 (0.48)2.3 (0.80)*2.3 (0.43)2.8 (0.65)3.2 (0.89)2.5 (0.70)2.55 (0.84)2.5 (0.54)
7-O cat’s cradle5.3 (2.26)***6.1 (2.73)5.6 (2.69)5.8 (2.27)7.4 (2.91)8.5 (3.64)6.4 (2.90)6.34 (2.88)6.4 (2.96)
7-P lightbulb7.6 (1.86)6.4 (1.51)***7.5 (2.26)6.6 (1.65)7.4 (1.65)9.2 (4.12)7.5 (2.42)6.98 (1.64)7.9 (2.96)
7-Q remove rubber band4.4 (3.05)4.6 (2.09)5.0 (2.62)4.9 (2.36)8.6 (10.61)7.6 (3.41)5.87 (5.02)6.4 (6.51)5.1 (2.73)
Total M time/age group93.7 (17.43)88.7 (14.07)90.3 (20.30)89.8 (15.33)110.5 (23.53)118.12 (21.02)98.2 (21.43)(see below)(see below)
Total M per age group: Men98.6 (17.48)85.7 (14.66)90.4 (23.71)87.6 (16.46)116.3 (29.89)118.5 (25.52)99.4 (24.16)99.4 (24.16)(gender specific)
Total M per age group: Women88.7 (16.8)91.8 (13.88)90.3 (18.19)92.1 (15.04)104.7 (15.12)117.8 (17.48)97.0 (18.49)(gender specific)97.0 (18.48)
Table Footer NoteNote. FTHUE = Functional Test for the Hemiparetic Upper Extremity; M = mean; SD = standard deviation. FTHUE task times are measured in seconds.
Note. FTHUE = Functional Test for the Hemiparetic Upper Extremity; M = mean; SD = standard deviation. FTHUE task times are measured in seconds.×
Table Footer Note*p < .001. **p < .01. ***p < .05.
*p < .001. **p < .01. ***p < .05.×
×
Significant differences between age groups were found for the following tasks:
  • Arm clearance during shirt tuck, F(5, 84) = 3.15, p < .01

  • Stabilize a pillow, F(5, 84)= 8.03, p < .001

  • Hold a pan lid, F(5, 84) = 3.18, p < .01

  • Fold a sheet, F(5, 84) = 3.44, p < .01

  • Coin in coin gauge, F(5, 84) = 5.54, p < .001

  • Cat’s cradle, F(5, 84) = 2.92, p < .02

  • Lightbulb, F(5, 84) = 2.65, p < .03.

Participants in the 20–29 age group were fastest with folding a sheet and performing cat's cradle, and those in the 30–39 age group were fastest with putting a pillowcase on a pillow and screwing in a lightbulb. Participants in the 40–49 age group excelled in folding a sheet and putting a coin in a gauge. Participants in the 50–59 age group were fastest at tucking in a shirt and draining water out of a pan.
Significant differences between genders were found for the following tasks:
  • Stabilize a pillow, F(1, 88) = 15.48, p < .001

  • Stabilize a package, F(1, 88) = 22.44, p < .001

  • Fold a sheet, F(1, 88)= 5.02, p < .03

  • Blocks and box, F(1, 88) = 8.88, p < .001.

Women were faster than men at putting a pillowcase on a pillow and wrapping a package, whereas men were faster at folding a sheet and putting blocks in a box.
Discussion
This study provides normative data for movement times during functional tasks in the upper extremities of healthy adults to which clients with hemiparesis may be compared. Significant differences that were found could be attributed to younger age groups being able to perform some tasks faster than older age groups. This finding may be explained because older adults show age-related decline in functional tasks (Dickerson & Fisher, 1993). Moving the less dominant arm out of the way to tuck in a shirt was performed fastest by participants who were in their 50s. The ability to stabilize a pillow while putting on a pillowcase was completed most quickly by participants aged 30 to 39 yr. Using the nondominant upper extremity to hold a lid while draining water out of a pan was completed most swiftly by participants in their 50s. Folding a small sheet to form a square foot was done timely by those in their 20s and 40s.
Gender differences might be explained by a practice effect because some tasks are stereotypically done by certain genders more than others. Women were also quicker than men in handling a pillowcase as well as in wrapping a package. Anecdotally, men tended not to fold a sheet as neatly as women. A difference in quality versus speed might be the reason men were able to fold a sheet faster than women.
Placing a coin in a gauge similar to a pay phone was most efficiently completed by 40- to 49-yr-olds. The youngest age group (20- to 29-yr-olds) manipulated string to create a cat’s cradle with bilateral hands the fastest. Decreased dexterity as people age (Kellor, Frost, Silberberg, Iversen, & Cummings, 1971) could explain this result. Finally, screwing in a lightbulb with the less dominant upper extremity was done the fastest by 30- to 39-yr-olds.
This study is a first attempt to develop a standardized normative table for the FTHUE. It is limited by sample size and the use of human evaluators. A larger, more diverse sample would permit more detailed analyses of interactions by hand dominance. Specifically, more participants in each age group would improve the specificity and meaningfulness of this study. However, this article can begin to assist practitioners in quantifying FTHUE results. In addition, human factors in timing with a stopwatch may limit the precise measurement of timed tasks.
This assessment, along with its normative data table, is beneficial for different levels of recovery. Changes in upper-extremity movement can be documented from acute care through outpatient and home health care rehabilitation. The FTHUE can assist clinicians in their observational evaluations with the use of functional tasks. Not only does the FTHUE yield a standardized score (categorically by level or quantitatively by the total number of tasks completed), but it also allows clinicians to assess specific movements within each task that may require further rehabilitation. Clients performing everyday tasks within a formal, standardized assessment can be compared with normative data on able-bodied people. In addition, clients can easily interpret their results on the FTHUE by recognizing tasks that they successfully completed as well as tasks they still need to master.
Implications for Occupational Therapy Practice
The FTHUE is an easy-to-administer, inexpensive, time-efficient outcome measure. It yields standardized data that can now be compared with age- and gender-matched controls. A table of normative data for the times to complete each task of the FTHUE will further assist clinicians in their assessment of clients with hemiparesis. This assessment allows clinicians to observe their clients performing functional tasks to better analyze performance of the upper extremities.
The FTHUE has the following qualities:
  • Standardized assessment with age- and gender-matched norms

  • Appropriate for a variety of levels of recovery

  • Observational evaluation of functional tasks

  • Easy to administer

  • Inexpensive

  • Time efficient.

Acknowledgments
I thank the students of the University of Central Arkansas who assisted in serving as evaluators and participants in this study. I also thank Steven L. Wolf, Sarah Blanton, and Marsha Neville for their suggestions and critique of previous drafts of the article. Part of the material in this article was presented in a poster session at the AOTA Annual Conference & Expo, Philadelphia, April 2011.
References
Aldwell, C. B., Wilson, D. J., … Braun, R. M. (1969). Evaluation and treatment of the upper extremity in the hemiplegic stroke patient. Clinical Orthopaedics and Related Research, 63, 69–93. [PubMed]
Aldwell, C. B., Wilson, D. J., … Braun, R. M. (1969). Evaluation and treatment of the upper extremity in the hemiplegic stroke patient. Clinical Orthopaedics and Related Research, 63, 69–93. [PubMed]×
American Occupational Therapy Association. (2007). AOTA’s Centennial Vision and executive summary. American Journal of Occupational Therapy, 61, 613–614. http://dx.doi.org/10.5014/ajot.61.6.613 [Article]
American Occupational Therapy Association. (2007). AOTA’s Centennial Vision and executive summary. American Journal of Occupational Therapy, 61, 613–614. http://dx.doi.org/10.5014/ajot.61.6.613 [Article] ×
Centers for Medicare and Medicaid Services. (2012). Medicare program; revisions to payment policies under the physician fee schedule, DME face-to-face encounters, elimination of the requirement for termination of non-random prepayment complex medical review and other revisions to Part B for CY 2013. Final rule with comment period. Federal Register, 77, 68891–69373. [PubMed]
Centers for Medicare and Medicaid Services. (2012). Medicare program; revisions to payment policies under the physician fee schedule, DME face-to-face encounters, elimination of the requirement for termination of non-random prepayment complex medical review and other revisions to Part B for CY 2013. Final rule with comment period. Federal Register, 77, 68891–69373. [PubMed]×
Cooper, C. (Ed.). (2007). Fundamentals of hand therapy. St. Louis, MO: Mosby.
Cooper, C. (Ed.). (2007). Fundamentals of hand therapy. St. Louis, MO: Mosby.×
Dickerson, A. E., … Fisher, A. G. (1993). Age differences in functional performance. American Journal of Occupational Therapy, 47, 686–692. http://dx.doi.org/10.5014/ajot.47.8.686 [Article] [PubMed]
Dickerson, A. E., … Fisher, A. G. (1993). Age differences in functional performance. American Journal of Occupational Therapy, 47, 686–692. http://dx.doi.org/10.5014/ajot.47.8.686 [Article] [PubMed]×
Eggers, I. M., … Mennen, U. (1997). The EFFUL (Evaluation of Function in the Flail Upper Limb) system: A ranking score system to measure improvement achieved by surgical reconstruction and rehabilitation. Journal of Hand Surgery, European Volume, 22, 388–394. http://dx.doi.org/10.1016/S0266-7681(97)80410-X [Article]
Eggers, I. M., … Mennen, U. (1997). The EFFUL (Evaluation of Function in the Flail Upper Limb) system: A ranking score system to measure improvement achieved by surgical reconstruction and rehabilitation. Journal of Hand Surgery, European Volume, 22, 388–394. http://dx.doi.org/10.1016/S0266-7681(97)80410-X [Article] ×
Filiatrault, J., Arsenault, A. B., Dutil, E., … Bourbonnais, D. (1991). Motor function and activities of daily living assessments: A study of three tests for persons with hemiplegia. American Journal of Occupational Therapy, 45, 806–810. http://dx.doi.org/10.5014/ajot.45.9.806 [Article] [PubMed]
Filiatrault, J., Arsenault, A. B., Dutil, E., … Bourbonnais, D. (1991). Motor function and activities of daily living assessments: A study of three tests for persons with hemiplegia. American Journal of Occupational Therapy, 45, 806–810. http://dx.doi.org/10.5014/ajot.45.9.806 [Article] [PubMed]×
Fugl-Meyer, A. R., Jääskö, L., Leyman, I., Olsson, S., … Steglind, S. (1975). The post-stroke hemiplegic patient: 1. A method for evaluation of physical performance. Scandinavian Journal of Rehabilitation Medicine, 7, 13–31. [PubMed]
Fugl-Meyer, A. R., Jääskö, L., Leyman, I., Olsson, S., … Steglind, S. (1975). The post-stroke hemiplegic patient: 1. A method for evaluation of physical performance. Scandinavian Journal of Rehabilitation Medicine, 7, 13–31. [PubMed]×
Kellor, M., Frost, J., Silberberg, N., Iversen, I., … Cummings, R. (1971). Hand strength and dexterity. American Journal of Occupational Therapy, 25, 77–83. [PubMed]
Kellor, M., Frost, J., Silberberg, N., Iversen, I., … Cummings, R. (1971). Hand strength and dexterity. American Journal of Occupational Therapy, 25, 77–83. [PubMed]×
Wilson, D. J., Baker, L. L., … Craddock, J. A. (1984). Functional test for the hemiparetic upper extremity. American Journal of Occupational Therapy, 38, 159–164. http://dx.doi.org/10.5014/ajot.38.3.159 [Article] [PubMed]
Wilson, D. J., Baker, L. L., … Craddock, J. A. (1984). Functional test for the hemiparetic upper extremity. American Journal of Occupational Therapy, 38, 159–164. http://dx.doi.org/10.5014/ajot.38.3.159 [Article] [PubMed]×
Winstein, C. J., Rose, D. K., Tan, S. M., Lewthwaite, R., Chui, H. C., … Azen, S. P. (2004). A randomized controlled comparison of upper-extremity rehabilitation strategies in acute stroke: A pilot study of immediate and long-term outcomes. Archives of Physical Medicine and Rehabilitation, 85, 620–628. http://dx.doi.org/10.1016/j.apmr.2003.06.027 [Article] [PubMed]
Winstein, C. J., Rose, D. K., Tan, S. M., Lewthwaite, R., Chui, H. C., … Azen, S. P. (2004). A randomized controlled comparison of upper-extremity rehabilitation strategies in acute stroke: A pilot study of immediate and long-term outcomes. Archives of Physical Medicine and Rehabilitation, 85, 620–628. http://dx.doi.org/10.1016/j.apmr.2003.06.027 [Article] [PubMed]×
Table 1.
FTHUE Tasks With Start and Stop Times Defined
FTHUE Tasks With Start and Stop Times Defined×
LevelTaskStart TimeStop Time
1Participant is unable to complete higher level tasksNot applicable
2A. Associated reactionNot tested
B. Hand into lapNondominant arm at sideNondominant hand in lap
3C. Arm clearance during shirt tuckBoth arms in lapDominant hand tucks shirt in on nondominant side
D. Hold a pouchNot tested
E. Stabilize a pillowNondominant arm on pillowPillowcase on pillow
4F. Stabilize a jarNondominant arm at side, dominant hand holds jarLid off jar
G. Stabilize a packageHands in lap (tape on dominant hand side)Tape on package
H. Wringing a ragHands in lapOne squeeze of rag
5I. Hold a pan lidHands in lap (pan on table)Pan on table
J. Hook and zip a zipperHands holding jacket endsZipper unhooked
K. Fold a sheetUnfolded sheet in lap, hands at sidesSheet folded approximately 12-in. square
6L. Blocks and boxNondominant hand in lap (blocks on nondominant side)All blocks in box
M. Box on shelfNondominant hand in lapBox on table
N. Coin in coin gaugeNondominant hand in lapDime in slot
7O. Cat’s cradleHands at sides (string in lap)String pulled tight
P. LightbulbLightbulb in nondominant handLightbulb screwed in tight
Q. Remove rubber bandRubber band on nondominant hand at level of MCPsRubber band off hand and placed on table
Table Footer NoteNote. FTHUE = Functional Test for the Hemiparetic Upper Extremity; MCP = metacarpophalangeal.
Note. FTHUE = Functional Test for the Hemiparetic Upper Extremity; MCP = metacarpophalangeal.×
Table 1.
FTHUE Tasks With Start and Stop Times Defined
FTHUE Tasks With Start and Stop Times Defined×
LevelTaskStart TimeStop Time
1Participant is unable to complete higher level tasksNot applicable
2A. Associated reactionNot tested
B. Hand into lapNondominant arm at sideNondominant hand in lap
3C. Arm clearance during shirt tuckBoth arms in lapDominant hand tucks shirt in on nondominant side
D. Hold a pouchNot tested
E. Stabilize a pillowNondominant arm on pillowPillowcase on pillow
4F. Stabilize a jarNondominant arm at side, dominant hand holds jarLid off jar
G. Stabilize a packageHands in lap (tape on dominant hand side)Tape on package
H. Wringing a ragHands in lapOne squeeze of rag
5I. Hold a pan lidHands in lap (pan on table)Pan on table
J. Hook and zip a zipperHands holding jacket endsZipper unhooked
K. Fold a sheetUnfolded sheet in lap, hands at sidesSheet folded approximately 12-in. square
6L. Blocks and boxNondominant hand in lap (blocks on nondominant side)All blocks in box
M. Box on shelfNondominant hand in lapBox on table
N. Coin in coin gaugeNondominant hand in lapDime in slot
7O. Cat’s cradleHands at sides (string in lap)String pulled tight
P. LightbulbLightbulb in nondominant handLightbulb screwed in tight
Q. Remove rubber bandRubber band on nondominant hand at level of MCPsRubber band off hand and placed on table
Table Footer NoteNote. FTHUE = Functional Test for the Hemiparetic Upper Extremity; MCP = metacarpophalangeal.
Note. FTHUE = Functional Test for the Hemiparetic Upper Extremity; MCP = metacarpophalangeal.×
×
Table 2.
Normative Table for the FTHUE, by Clustered Age and Gender Groups
Normative Table for the FTHUE, by Clustered Age and Gender Groups×
Age or Gender Group, M FTHUE Task Times (SD)
Task20–29 yr (n = 20)30–39 yr (n = 14)40–49 yr (n = 14)50–59 yr (n = 14)60–69 yr (n = 14)70–80 yr (n = 14)Total M Time/TaskTotal M Time/Task: MenTotal M Time/Task: Women
2-B hand into lap0.64 (0.19)0.68 (0.14)0.7 (0.20)0.5 (0.15)0.7 (0.25)0.7 (0.20)0.64 (0.20)0.65 (0.22)0.63 (0.18)
3-C arm clearance/shirt tuck2.6 (0.94)2.2 (0.85)2.1 (0.80)1.6 (0.81)**2.0 (0.56)2.1 (0.44)2.1 (0.82)2.10 (0.82)2.3 (0.80)
3-E stabilize pillow8.8 (2.95)6.4 (2.96)*8.3 (4.04)7.7 (2.38)9.5 (4.04)15.9 (8.04)9.4 (5.19)11.4 (5.90)7.4 (3.38)*
4-F stabilize jar2.7 (0.71)2.7 (0.91)2.6 (0.69)2.3 (0.41)2.7 (1.00)2.7 (0.75)2.6 (0.75)2.7 (0.81)2.5 (0.68)
4-G stabilize package15.5 (4.52)14.8 (4.61)14.4 (4.60)13.6 (2.80)15.1 (6.44)15.8 (5.55)14.9 (4.77)17.0 (5.34)12.8 (2.85)*
4-H wringing rag3.0 (1.04)3.1 (0.63)2.7 (1.10)2.5 (0.74)2.7 (0.99)2.8 (0.78)2.8 (0.91)2.6 (0.91)2.9 (0.89)
5-I hold pan lid10.8 (3.07)9.5 (1.99)10.1 (3.30)8.9 (2.65)**13.0 (3.92)10.5 (2.77)10.5 (3.19)10.8 (3.34)10.2 (3.03)
5-J hook & zip7.5 (4.50)6.7 (2.14)5.7 (2.46)7.8 (4.04)7.2 (2.78)9.5 (8.35)7.4 (4.56)7.0 (3.67)7.8 (5.33)
5-K fold sheet13.0 (5.96)**16.5 (5.50)13.7 (5.36)**15.3 (6.37)20.3 (8.13)19.1 (4.97)16.1 (6.53)14.6 (6.75)***17.6 (6.01)
6-L blocks & box5.0 (1.72)5.8 (1.16)5.2 (1.71)5.5 (1.56)6.6 (1.81)6.0 (1.63)5.7 (1.66)5.1 (1.71)*6.2 (1.47)
6-M box on shelf4.8 (3.12)4.3 (0.82)4.4 (1.26)4.4 (1.13)5.1 (1.31)5.1 (1.20)4.7 (1.77)4.4 (1.14)5.0 (2.20)
6-N coin gauge2.3 (0.43)2.3 (0.48)2.3 (0.80)*2.3 (0.43)2.8 (0.65)3.2 (0.89)2.5 (0.70)2.55 (0.84)2.5 (0.54)
7-O cat’s cradle5.3 (2.26)***6.1 (2.73)5.6 (2.69)5.8 (2.27)7.4 (2.91)8.5 (3.64)6.4 (2.90)6.34 (2.88)6.4 (2.96)
7-P lightbulb7.6 (1.86)6.4 (1.51)***7.5 (2.26)6.6 (1.65)7.4 (1.65)9.2 (4.12)7.5 (2.42)6.98 (1.64)7.9 (2.96)
7-Q remove rubber band4.4 (3.05)4.6 (2.09)5.0 (2.62)4.9 (2.36)8.6 (10.61)7.6 (3.41)5.87 (5.02)6.4 (6.51)5.1 (2.73)
Total M time/age group93.7 (17.43)88.7 (14.07)90.3 (20.30)89.8 (15.33)110.5 (23.53)118.12 (21.02)98.2 (21.43)(see below)(see below)
Total M per age group: Men98.6 (17.48)85.7 (14.66)90.4 (23.71)87.6 (16.46)116.3 (29.89)118.5 (25.52)99.4 (24.16)99.4 (24.16)(gender specific)
Total M per age group: Women88.7 (16.8)91.8 (13.88)90.3 (18.19)92.1 (15.04)104.7 (15.12)117.8 (17.48)97.0 (18.49)(gender specific)97.0 (18.48)
Table Footer NoteNote. FTHUE = Functional Test for the Hemiparetic Upper Extremity; M = mean; SD = standard deviation. FTHUE task times are measured in seconds.
Note. FTHUE = Functional Test for the Hemiparetic Upper Extremity; M = mean; SD = standard deviation. FTHUE task times are measured in seconds.×
Table Footer Note*p < .001. **p < .01. ***p < .05.
*p < .001. **p < .01. ***p < .05.×
Table 2.
Normative Table for the FTHUE, by Clustered Age and Gender Groups
Normative Table for the FTHUE, by Clustered Age and Gender Groups×
Age or Gender Group, M FTHUE Task Times (SD)
Task20–29 yr (n = 20)30–39 yr (n = 14)40–49 yr (n = 14)50–59 yr (n = 14)60–69 yr (n = 14)70–80 yr (n = 14)Total M Time/TaskTotal M Time/Task: MenTotal M Time/Task: Women
2-B hand into lap0.64 (0.19)0.68 (0.14)0.7 (0.20)0.5 (0.15)0.7 (0.25)0.7 (0.20)0.64 (0.20)0.65 (0.22)0.63 (0.18)
3-C arm clearance/shirt tuck2.6 (0.94)2.2 (0.85)2.1 (0.80)1.6 (0.81)**2.0 (0.56)2.1 (0.44)2.1 (0.82)2.10 (0.82)2.3 (0.80)
3-E stabilize pillow8.8 (2.95)6.4 (2.96)*8.3 (4.04)7.7 (2.38)9.5 (4.04)15.9 (8.04)9.4 (5.19)11.4 (5.90)7.4 (3.38)*
4-F stabilize jar2.7 (0.71)2.7 (0.91)2.6 (0.69)2.3 (0.41)2.7 (1.00)2.7 (0.75)2.6 (0.75)2.7 (0.81)2.5 (0.68)
4-G stabilize package15.5 (4.52)14.8 (4.61)14.4 (4.60)13.6 (2.80)15.1 (6.44)15.8 (5.55)14.9 (4.77)17.0 (5.34)12.8 (2.85)*
4-H wringing rag3.0 (1.04)3.1 (0.63)2.7 (1.10)2.5 (0.74)2.7 (0.99)2.8 (0.78)2.8 (0.91)2.6 (0.91)2.9 (0.89)
5-I hold pan lid10.8 (3.07)9.5 (1.99)10.1 (3.30)8.9 (2.65)**13.0 (3.92)10.5 (2.77)10.5 (3.19)10.8 (3.34)10.2 (3.03)
5-J hook & zip7.5 (4.50)6.7 (2.14)5.7 (2.46)7.8 (4.04)7.2 (2.78)9.5 (8.35)7.4 (4.56)7.0 (3.67)7.8 (5.33)
5-K fold sheet13.0 (5.96)**16.5 (5.50)13.7 (5.36)**15.3 (6.37)20.3 (8.13)19.1 (4.97)16.1 (6.53)14.6 (6.75)***17.6 (6.01)
6-L blocks & box5.0 (1.72)5.8 (1.16)5.2 (1.71)5.5 (1.56)6.6 (1.81)6.0 (1.63)5.7 (1.66)5.1 (1.71)*6.2 (1.47)
6-M box on shelf4.8 (3.12)4.3 (0.82)4.4 (1.26)4.4 (1.13)5.1 (1.31)5.1 (1.20)4.7 (1.77)4.4 (1.14)5.0 (2.20)
6-N coin gauge2.3 (0.43)2.3 (0.48)2.3 (0.80)*2.3 (0.43)2.8 (0.65)3.2 (0.89)2.5 (0.70)2.55 (0.84)2.5 (0.54)
7-O cat’s cradle5.3 (2.26)***6.1 (2.73)5.6 (2.69)5.8 (2.27)7.4 (2.91)8.5 (3.64)6.4 (2.90)6.34 (2.88)6.4 (2.96)
7-P lightbulb7.6 (1.86)6.4 (1.51)***7.5 (2.26)6.6 (1.65)7.4 (1.65)9.2 (4.12)7.5 (2.42)6.98 (1.64)7.9 (2.96)
7-Q remove rubber band4.4 (3.05)4.6 (2.09)5.0 (2.62)4.9 (2.36)8.6 (10.61)7.6 (3.41)5.87 (5.02)6.4 (6.51)5.1 (2.73)
Total M time/age group93.7 (17.43)88.7 (14.07)90.3 (20.30)89.8 (15.33)110.5 (23.53)118.12 (21.02)98.2 (21.43)(see below)(see below)
Total M per age group: Men98.6 (17.48)85.7 (14.66)90.4 (23.71)87.6 (16.46)116.3 (29.89)118.5 (25.52)99.4 (24.16)99.4 (24.16)(gender specific)
Total M per age group: Women88.7 (16.8)91.8 (13.88)90.3 (18.19)92.1 (15.04)104.7 (15.12)117.8 (17.48)97.0 (18.49)(gender specific)97.0 (18.48)
Table Footer NoteNote. FTHUE = Functional Test for the Hemiparetic Upper Extremity; M = mean; SD = standard deviation. FTHUE task times are measured in seconds.
Note. FTHUE = Functional Test for the Hemiparetic Upper Extremity; M = mean; SD = standard deviation. FTHUE task times are measured in seconds.×
Table Footer Note*p < .001. **p < .01. ***p < .05.
*p < .001. **p < .01. ***p < .05.×
×