Fine & Gross Motor Coordination Assessments

Overview of Assessment Tools for Hand and Upper Extremity Function

This presentation provides an extensive review of assessment tools suitable for individuals of all ages, specifically focusing on hand and upper extremity function. The importance of hand and upper extremity functionality in occupational performance is emphasized, as it plays a critical role in individuals' ability to engage in various daily activities. The presentation encourages viewers to watch related videos for detailed scoring guidance and announces in-person lab opportunities to explore the assessments further.

Assessment Tools Discussed

The following assessment tools are highlighted:

• Nine-Hole Peg Test (9-HPT)

• Purdue Pegboard

• Box and Block Test (BBT)

• Minnesota Dexterity Test

• Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH)

• Upper Extremity Functional Index-20 (UEFI)

• General assessments for fine & gross motor skills and coordination.

Grip and Pinch Strength

Implications for Occupational Therapy (OT)

Understanding grip and pinch strength is crucial in occupational therapy, as it directly impacts a patient's ability to perform daily tasks.

Detailed Assessment of Nine-Hole Peg Test (9-HPT)

Administration

The Nine-Hole Peg Test is a standardized quantitative assessment tool designed to measure finger dexterity.

Performance Measure

• Area of Assessment: Fine motor coordination and eye/hand coordination

• Age Range: 2 - 65+ years

• Time Required: Approximately 1-3 minutes

Contextual Considerations

• Factors to consider include the individual's profile (person, group, population) and the setting where the assessment takes place.

Equipment Required

1. Paper and pencil

2. Wooden or plastic board with 9 holes (10 mm diameter, 15 mm depth), spaced 32 or 50 mm apart

3. Container for pegs (square box: 100 x 100 x 10 mm or shallow round dish)

4. 9 pegs (7 mm diameter, 32 mm length)

5. Stopwatch

Setup and Steps for Administration

1. Position the board at the client’s midline, aligning the peg container toward the hand being tested.

2. Only the hand undergoing evaluation performs the test; the other hand may stabilize the board.

3. Clients must pick pegs from the container, placing them into the holes on the board quickly.

4. After the placement, participants must remove the pegs from the holes and return them back to the container.

Scoring

Scores for the 9-HPT are based on the time taken to complete the task, recorded in seconds. An alternative scoring method records how many pegs are placed within 50 or 100 seconds, expressed in terms of pegs per second (pegs/s). For children, scoring may also involve noting the number of pegs placed before losing interest.

Normative Data for 9-Hole Peg Test

Table 1 - Male Participants' Scores (N=314)

Table 2 - Female Participants' Scores (N=389)

Administration of the Purdue Pegboard

Application

Originally developed to test the dexterity of industrial workers, the Purdue Pegboard is now commonly used by occupational therapists in various settings to assess manual dexterity and coordination.

Performance Measure

• Types of Dexterity Assessed:

1. Gross movements of fingers, hands, and arms.

2. Fine fingertip dexterity crucial for assembly tasks.

• Age Range: 6 - 65+ years

• Time Required: Approximately 5-10 minutes

Equipment Required

1. Purdue Pegboard Test Kit

2. Instruction Manual

3. Test Board

4. Pins, Collars, Washers

5. Stopwatch

Setup and Steps for Administration

Test Configuration

• The pegboard is rectangular with two sets of 25 holes and four concave cups at the top for pegs.

• The subject is seated during the test.

• Each side of the board has pegs that need to be moved to the holes as quickly as possible.

Scoring

The scoring for the Purdue Pegboard involves compiling scores for five batteries:

1. Right Hand (30 seconds)

2. Left Hand (30 seconds)

3. Both Hands (30 seconds)

4. Sum of Right + Left + Both Hands (for analytical purposes, not an actual test)

5. Assembly task (60 seconds)

Administration of the Box and Block Test (BBT)

Overview

The Box and Block Test assesses unilateral gross manual dexterity through a simple task.

Equipment Required

1. Stopwatch

2. Wooden box (dimensions: 53.7 cm x 25.4 cm x 8.5 cm)

3. 150 wooden cubes (2.5 cm each)

Procedure

1. Participants sit at a table with the box positioned in front of them, divided into two compartments.

2. The individual must transfer blocks from one side of the box to the other using one hand for a period of 60 seconds.

3. The score is based on the number of blocks successfully moved over the partition.

Scoring

Multiple blocks moved at once are counted as a single point, and the total score signifies the individual's gross manual dexterity ability.

Administration of the Minnesota Dexterity Test

Overview

This test measures rapid eye-hand coordination and gross motor skills through two test batteries: Placing Test and Turning Test.

Equipment Required

1. Test kit

2. Stopwatch

3. Score sheets or tablet

Time Required

• Approximately 15-60 minutes, depending on individual performance

Administration of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH)

Overview

The DASH is a self-report questionnaire assessing the musculoskeletal disorders of the upper limbs.

Version Information

Three versions exist:

1. Original DASH (30-item questionnaire published in 1996)

2. QuickDASH (shortened version)

3. QuickDASH-9 (further shortened version)
   Although there are optional modules for specific populations like athletes, artists, and high-functioning workers.

Time Required

• Approximately 5-30 minutes

Equipment Required

1. Paper and pencil

Scoring

Utilizes a 5-point Likert scale (1 being lowest difficulty, 5 being highest). Total scores range from 0 (most severe limitation) to 100 (least limitation).

Scoring for Optional Modules

• Calculate scores using the formula:
  [((sum of values/4) - 1) * 25]

Administration of the Upper Extremity Functional Index-20 (UEFI)

Overview

The UEFI assesses functional limitations due to musculoskeletal conditions of the upper limbs, self-administered by patients.

Equipment Required

1. Test form

2. Pencil

Scoring

Each of the 20 activities is scored on a 5-point scale, with total scores ranging between 0 and 80, where 0 indicates severe limitation.

Grip and Pinch Strength Assessment

Overview

Grip and pinch strength are vital indicators of upper extremity performance, with norms established across various demographics.

Grip Strength Norms by Age and Gender

• 
  

• Grip Strength in Pounds for Adults:
  

  Age Range	Male Right	Male Left	Female Right	Female Left
  20-30	121	104	70	61
  …	…	…	…	…
  Pinch Strength Norms by Age and Gender

  Age Range	Men Right	Men Left	Women Right	Women Left
  20-30	18	17	10	10
  …	…	…	…	…

  Conclusion

  This presentation reviewed various assessment tools focusing on fine motor, gross motor, coordination, and strength in upper extremity function. Such assessments are significant in understanding client factors and performance skills in occupational therapy practice. Tools like the DASH and UEFI gain insight into clients' perceived functional limitations and help evoke discussions regarding their impact on daily occupations. As clinicians consider these standards, a focus remains on how they relate to patient outcomes in real-world scenarios, affecting everyday functionalities such as dressing, cooking, and digital interaction.

  References

  • Asher, E. (2007). Occupational therapy assessment tools: An annotated index (3rd ed.). AOTA Press.

  • Dirette, D., & Gutman, S. A. (Eds.). (2021). Occupational therapy for physical dysfunction (8th ed.). Wolters Kluwer.

  • Lafayette Instrument. (n.d.). [Homepage]. https://lafayetteevaluation.com/

  • National Library of Medicine. (2014, July 29). Chesworth, B. M., et al. (2014). Reliability and validity of two versions of the upper extremity functional index. Physiotherapy Canada, 66(3), 243-253. https://doi.org/10.3138/ptc.2013-45

  • Physiopedia. (n.d.). Upper extremity functional index. https://www.physiopedia.com/UpperExtremityFunctional_Index

  • Shirley Ryan Ability Lab. (2025). [Homepage]. https://www.sralab.org/