Item | Experts | ||||||
---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5* | 6* | CVI | |
Section A Caring for you affected arm (not using it in tasks or activities) | |||||||
1. Cleaning Palm | 0 | 1 | 0 | 1 | 1 | 1 | 0.67 |
2. Cutting finger nails | 1 | 1 | 1 | 0 | 1 | 1 | 0.83 |
3. Putting on a glove | 1 | 0 | 1 | 0 | 1 | 1 | 0.67 |
4. Cleaning armpit | 0 | 1 | 1 | 1 | 1 | 1 | 0.83 |
5. Putting arm through a sleeve | 1 | 1 | 0 | 1 | 1 | 1 | 1.00 |
6. Put on a splint (If not used circle 0) | 1 | 1 | 1 | 1 | 1 | 1 | 1.00 |
7. Positioning arm on a cushion or support in sitting (If not used circle 0) | 1 | 0 | 0 | 1 | 1 | 1 | 0.67 |
Section B Using your affected arm to complete tasks or activities | |||||||
1. Do up buttons on clothing | 1 | 1 | 1 | 1 | 1 | 1 | 1.00 |
2. Pick up a glass, bottle, or can | 1 | 1 | 1 | 1 | 1 | 1 | 1.00 |
3. Use a key to unlock the door | 1 | 1 | 1 | 1 | 1 | 1 | 1.00 |
4. Write on paper | 1 | 0 | 0 | 1 | 1 | 1 | 0.67 |
5. Open a previously opened jar | 1 | 1 | 1 | 1 | 0 | 1 | 0.83 |
6. Eat with a knife and fork | 1 | 1 | 0 | 1 | 1 | 1 | 0.83 |
7. Hold an object still while using unaffected hand | 1 | 1 | 1 | 0 | 0 | 0 | 0.50 |
8. Difficulty with balance when walking due to your arm | 1 | 0 | 1 | 1 | 0 | 1 | 0.67 |
9. Dial a number on home phone | 1 | 1 | 1 | 0 | 1 | 1 | 0.83 |
10. Tuck in your shirt | 1 | 1 | 1 | 1 | 1 | 1 | 1.00 |
11. Comb or brush your hair | 1 | 1 | 1 | 1 | 1 | 1 | 1.00 |
12. Brush your teeth | 1 | 1 | 1 | 1 | 1 | 1 | 1.00 |
13. Drink from a cup or mug | 1 | 1 | 0 | 1 | 1 | 1 | 0.83 |