SHUEE Test Administration

Home   Introduction      Test Administration       Test Scoring and Interpretation       References       Forms     Case Studies

The Shriners Hospital Upper Extremity Evaluation (SHUEE) utilizes the following testing materials.

 

Testing Materials

  Billfold style wallet to hold paper money
  8 x 10 sheet of standard weight paper
  Two 2” in diameter and approximately ½” thick, flat sided, wooden beads.

Stiff cord for stringing beads

  Three dollar sized bills made of standard weight paper
  Four plastic coins of any size
  One wide-mouth clear 2-2 ½” diameter bottle with 2-2 ½” screw cap
  One can Play-Doh®
  Standard fork and knife (not child size)
  Shoe with tie fastener
  Sock
  Cracker
  Stickers of any size or type
  One 30” ball

Videotaping

Any standard video recorder, with a tripod, can be used for the taping evaluation. Sound recording is not needed. The taping area should be spacious enough for the client to toss the large ball and crawl towards camera. An 8’ x 8’ area is adequate.

The videographer should be aware of which body segment is being analyzed. Table I can be provided to videographer as a reference. This allows the videographer to adjust camera angles as needed. If a second person is not available, the SHUEE can be performed by one person with the camera stationary. In this situation, it is helpful to have a video monitor to ensure proper camera angles.  The activities section of this manual describes camera angle specifics for each task.

Subject Preparation

Typical testing area.

For best observation of client’s extremity, remove all caps/hats, restrain long hair, and roll up sleeve of involved extremity above the elbow. Optimal position of the camera relative to client is important during video recording. The camera needs to be focused only on client’s upper body and the table top. It is not necessary to have evaluator in camera angle. Position client sideways to the camera with uninvolved side closest to the camera and involved side furthest from the camera.

This position allows best visibility of the involved hand and thumb during video. Repositioning of the client and/or camera is occasionally necessary to optimize subsequent visual analysis of the appropriate planes of motion at each joint. For best postural control, client should be seated at a table. A table with wheels is optimal to allow it to be rolled out of the way for certain tasks. For clarity for later viewing, a clutter-free background with light blue background is suggested.  To reduce clutter during filming, the test bag should be on the floor at the evaulator’s feet.  Items should be removed from the bag prior to the test.

Evaluator Guidelines

With experience, the evaluator can perform the test in 15 minutes. While the SHUEE does provide specific verbal instructions, the SHUEE does not limit verbal interactions between evaluator and client. For example, the evaluator is encouraged to provide positive feedback. The optimum sequence for administration of the SHUEE can be found on Table I. Modification of sequence to suit the client or evaluator needs or preferences is acceptable.

Table 1: SHUEE Test Item Sequence (table can be printed and laminated to aid in completion of the test)

  

Evaluation Form

Demographic Information

  • Client Name
  • Age – current year and month
  • Client’s Diagnosis
  • History – include any significant birth history or previous surgery

Subjective (may be asked of client or parent/guardian)

  • Functional limitations – what movements prevent the client from being able to accomplish tasks?
  • What task would the client like to be able to perform?
  • What “new” movement would help the most?
  • What are the goals of the client and family?

Range of Motion

  • Standard passive and active range of motion assessments are completed with the limb segments in anatomical positions. For brevity, record only those areas that are not within normal limits. “Within normal limits” is defined as being within 10 degrees of normal range. [1]

Tone

  • Circle the number corresponding to the client’s degree of tone as noted by the Modified Ashworth Scale. [2]

 

Activities of Daily Living (may be asked of client or parent/guardian)

  • Domains
  • Upper extremity dressing
  • Lower extremity dressing
  • Orthotics
  • Shoes
  • Fasteners
  • Hygiene
  •   Scoring of Independence Level
  • Independent – with no assistance needed by caregiver
  • Assistance – client is able to perform task with minimum assistance
  • Dependent – maximum assistance needed for task or completely dependent on caregiver for task
  • Comments
  • Specific clarification of the performance of the task

 

SPONTANEOUS FUNCTIONAL ANALYSIS (SFA), DYNAMIC POSITIONAL ANALYSIS (DPA), and GRASP/RELEASE ANALYSIS (GRA)  

Dynamic Positional Analysis

Overview

The second page consists of the analysis sheet for Spontaneous Functional Analysis (SFA), Dynamic Positional Analysis (DPA), and Grasp/Release Analysis (GRA). The examiner will present 16 tasks to the client. These activities have been grouped together to evaluate specific joint movement. These tasks are developmentally age appropriate tasks addressing the areas of Activities of Daily Living, Fine Motor and Gross Motor Skills. The GRA is done after the tasks related to the SFA and DPA have been completed. A DPA score will be given to all 16 tasks while a SFA score will only be given to 9 of the 16 tasks.

Activities

All items must be placed on table, presented at midline, without reference to which hand should be used unless otherwise noted. Suggested sequence of tasks can be found on Table 1. Prior to starting test, state the reason for the test. Example: “I am going to ask you to do some things, like string beads, things like that. Show me how you normally would do it. Go ahead and take off one of your socks and shoes. It doesn’t matter which one.”

Click each task to watch an example video clip.  All video examples, with exception of sock donning and shoe tying, are simulated to illicit a zero on the SFA scale to allow demonstration of the therapist physically cueing the child.

  1. Money from wallet

Action: Present client with billfold style wallet and ask client to remove paper bills while observing the thumb/finger position.

Verbiage: “Take the paper money out of the wallet like you normally would.”

If client doesn’t use involved extremity, physically cue by touching involved upper extremity and say, “Now do it again, letting this hand help.” Replace money in wallet and repeat task.

Camera: Focus on webspace of thumb, making certain it is visible.

 

  1. Fold pieces of paper

Action: Hand client sheet of plain paper to fold in any fashion and observe thumb/finger position. Roll table out of way to elicit two-handed use.

Verbiage: “Now fold this paper in ½ in any fashion.”

If involved hand isn’t used, physically cue by touch and say, “Now let this hand help.”

Camera: Focus on web space of thumb, making certain it is visible.

 

  1. Tear piece of paper

Action: Once paper is folded, ask client to tear paper. Evaluator may initiate three tears. Paper does not have to be torn on fold. This task demonstrates thumb/finger position.

Verbiage: “I’m going to start tearing this paper and I want you to finish it.”

Camera: Focus on web space of thumb, making certain it is visible.

 

  1. String large beads

Action: Client will be given string and 3 large beads and asked to string beads. This task demonstrates thumb/finger position.

Verbiage: “Now I want you to string these beads.”

If involved upper extremity isn’t used, remove bead and say, “Let’s do it again and let this hand help.” Physically cue by touching involved upper extremity.

Camera: Focus on web space of thumb, making certain it is visible.

 

  1. Unscrew bottle cap

Action: Client is handed a bottle with a screw cap and asked to remove cap. Client should hold bottle with involved upper extremity. Cap may be loosened by examiner and does not have to be replaced by the client. Wrist position is observed in this task.

Verbiage: “Please take the top off of this bottle.”

After client completes task, ask them to repeat it. Place cap back onto bottle and state, “Now, I want you to do that one more time.” This is simply for ease of scoring.

If client doesn’t include involved extremity, physically cue client by touching involved extremity and saying, “Now do it again, letting the other hand help.” Replace cap and repeat task.

Camera: Focus on wrist angle, view should be radial (thumb side) of wrist.

 

  1. Pull Play-Doh® Apart

Action: Examiner molds Play-Doh® into cylindrical shape and client is asked to pull Play-Doh® apart at least three times while wrist position is observed.

Verbiage: “Now tear this Play-Doh® into three pieces.” If client doesn’t include involved extremity, physically cue client by touching involved extremity and saying, “Now do it again, letting the other hand help.”

Camera: Focus on wrist angle, view should be radial (thumb side) of wrist.

 

  1. Cut Play-Doh® With Knife

Action: Examiner molds Play-Doh® into a flat circle for cutting and presents client with knife and fork. It is understood that client uses dominant hand for cutting, however, for evaluation purposes, client must hold knife in involved hand while wrist position is observed.

Verbiage: “Pretend this is something good to eat and show me how you would cut it.”

If the client states he cannot cut, state, “Just do the best you can.” Typically clients will use dominant side for holding knife. If this is the case, say to client, “I know this sounds crazy, but I want you to put the knife in this hand.” At that time, physically cue client by touching involved extremity.

Camera: Focus on wrist angle, view should be radial (thumb side) of wrist.

 

  1. Throws large ball

Action:  Examiner gives client large ball and asks client to throw ball back. The ball can be tossed or bounced. This task is usually performed twice, videotaping from both sides, observing wrist position.

Verbiage: “Now let’s stand up. I want you to stand over here.”

(Move table out of way and guide client to approximately four feet across from therapist with involved extremity furthest from camera.) “I want you to toss this ball to me and I’ll toss it back.” After two tosses, state, “Now, let’s switch places.” Guide client to where you were standing, placing involved extremity closest to camera. The ball is then tossed again two times.

Camera:  Focus on wrist angle, view should be radial (thumb side) of wrist.

 

  1. Accepts change

Action: Examiner gives three coins to client, placing each into open palm of involved side to demonstrate supination. Remove table so subject does not use table to facilitate supination.

Verbiage: “Let me give you these coins.”

If client uses non-involved hand physically cue client by touching involved extremity and state, “Now let’s try it with this hand”.

Camera: Camera should be focusing on forearm and angle may need to be looking along length of forearm from hand to get best view of supination.

 

  1. Receives high-five

Action: Examiner asks client to receive low “5” with involved extremity demonstrating supination. Remove table so client does not use table to facilitate supination.

Verbiage: “Let me give you 5.”

If client uses non-involved hand, physically cue client to use involved extremity and state, “Let’s do it with this hand”. If child then attempts to give you 5, reiterate, “No, I want to give you five”. “Can you turn your hand up towards the ceiling like this?” and demonstrate supination.

Camera:  Camera should be focusing on forearm and angle may need to be looking along length of forearm from hand to get best view of supination.

 

  1. Take object to mouth

Action: Examiner provides client with a cracker to eat and observes client taking cracker to his/her mouth with involved side to demonstrate supination. If client doesn’t demonstrate supination, ask them to place palm to mouth to facilitate this.

Verbiage: “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 to your mouth.”

If client uses non-involved hand, physically touch involved hand and state, “Now use this hand”. If client does not supinate state, “Now can you place your palm on your mouth, like this?” Evaluator then demonstrates palm to mouth.

Camera: Camera should be focusing on forearm and angle may need to be looking along length of forearm from hand to get best view of supination.

  1. Touch opposite ear

Action: Examiner asks client to touch contralateral ear with the palm of the involved upper extremity to demonstrate supination.

Verbiage: “Can you touch this palm to this ear? Like this?” Evaluator then touches involved hand and contralateral ear. Evaluator then demonstrates palm to contralateral ear. If client states he cannot, state, “Just do your best.”

Camera: Camera should be focusing on forearm and angle may need to be looking along length of forearm from hand to get best view of supination.

 

  1. Place sticker on ball

Action: Examiner asks client to place sticker on ball, using involved side, with ball placed at arm’s length from client. Client may need physical cues to remain at arm’s length distance from ball to demonstrate elbow extension.

Verbiage: “Put this sticker on this ball.”

Camera:   Focus on elbow directly from side to note elbow extension.

 

  1. Put socks on

Action: Client should have one sock and shoe removed. Client demonstrates sock donning, assisting with involved extremity to demonstrate elbow extension.

Verbiage: “Go ahead and put your sock back on for me.”

If client doesn’t assist with involved extremity, physically cue client by touching involved extremity and say, “Now let this arm help”. If child flexes lower extremity which prevents upper extremity elbow extension, instruct the child to, “Put your leg on the floor and let me see you do it again”.

Camera: Focus on elbow directly from side to note elbow extension.

 

  1. Fasten shoes

Action:  Client demonstrates fastening shoes with involved upper extremity. Clients who are too young or refuse to fasten shoes may be evaluated as they assist with this activity. The objective is to look at elbow extension in reaching to the shoe, not their ability to complete the task.

Verbiage: “Now tie your shoe.” If client states he cannot, state, “Just pretend you are tying”. If he doesn’t use involved upper extremity in task, physically cue by touching involved upper extremity, and state, “Let this hand help”. If child keeps lower extremity flexed or crossed, ask client, “Put your leg down and reach for your shoe”.

Camera:   Focus on elbow directly from side to note elbow extension.

 

  1. Crawl

Action: Client is asked to crawl towards camera in quadruped position demonstrating elbow extension on the involved side. Client only needs to crawl approximately four or five feet.

Verbiage: “I know this is silly, but I want you to get down and crawl towards the camera.” If client commando crawls or creeps, ask child, “Can you come up on your hands and knees?”

Camera:   Focus on elbow directly from side to note elbow extension.


Grasp/Release Analysis

Action: Once the client performs the 16 tasks, the therapist or client then positions the wrist in: flexion, neutral, extension.

The therapist asks client to take bead from therapist. Bead should be held by side, not flat, and not stuffed into client’s hand. A comment section is available to document if the client is able to perform with difficulty or ease.

Verbiage: “Now I want you to stand over here.” Move client in front of background positioning the client between the therapist and camera. Support the forearm with the radial (thumb) side towards camera. If the wrist is not already held in a flexed position, flex wrist and ask, “Can you take this bead from me?” “ Now can you straighten your wrist and still pick up the bead?” Then, therapist must position wrist and then once again ask client to grasp bead while therapist holds in neutral. “Now can you bring your wrist all the way up and pick up the bead?” Then, therapist must position wrist and then once again ask client to grasp bead while therapist holds in extension. For some clients, placing them into wrist extension will take maximum physical effort on therapist’s part. Reposition client to allow ulnar side of hand to be closest to camera and repeat all three tasks with same directions.

Camera: Focus on wrist angle; view should be radial and then ulnar side of wrist

 

Printable version of SHUEE manual

 

Patient Referral

916-453-2191
916-453-2111 (Emergency Referral)
916-453-2395 (fax)
referrals.ncal@shrinenet.org

a graphic of some silhouettes of children playing