Terapia Ocupacional Terapia Ocupacional

Occupational Therapy
Functional Levels of the Hemiplegic Upper Extremity

  • Classification of Function - 7 Levels
    • Level 1 - No voluntary motion, no functional use

      Level 2 - Beginning active motion, no functional use

      Level 3 - Passive Stabilizer
      Minimal voluntary motion, able to do the following activities.

        1. Move arm away from side while putting shirt into pants on affected side.
        2. Move arm away from side while adjusting side or back of shirt with good arm.
        3. Stabilize shirt at bottom for buttoning in front.
        4. Stabilize wet cloth at lap level while good am applies soap.
        5. Weight down paper while good arm is writing.
      Level 4 - Active Stabilizer
      Moderate mass flexion pattern, including some shoulder motion against gravity, and moderate gross grasp are capable of performing the following activities. 
        1. Hold up trousers while transferring from and to toilet. 
        2. Hold toothbrush while good arm applies tooth paste. 
        3. Hold handle and help open a long chest or dresser drawer. 
        4. Stabilize mixing bowl at table level while good arm mixes or stirs. 
        5. Stabilize a bottle with a cap while good arm opens with a cap opener.
      Level 5 - Gross Motor Assist
      Strong mass flexion pattern, some elbow extension, moderate gross grasp and some lateral pinch should be able to perform the following activities. Some release is helpful but not necessary. 
        1. Assist good arm in pulling on or taking off socks and nylons. 
        2. Reach and wash those parts (in front) which cannot be reached by good arm. 
        3. Hold dish while washing or wiping with good arm
        4. Hold and assist in pulling a broom for sweeping. 
        5. Assist good arm in wringing a rag or sponge.
      Level 6 - Fine Motor Assist
      Ability to combine components of strong mass flexion and extension patterns, including fair plus shoulder control, strong grasp, release and strong pinch are able to perform the following activities. 
        1. Assist in tying bows. 
        2. Assist in fastening a side zipper. 
        3. Hold utensil and stabilize potato while cutting it with a knife. 
        4. Hold lid on hot pot while good arm pours out hot liquids. 
        5. Hold pencil and beginning to write legibly
      Level 7 - Dominant with fine motor
      Fair plus to good isolated control in shoulder, elbow and wrist, strong grasp and release, lateral and palmar prehension, and ability to use fingers individually are able to perform the following activities. 
        1. Laces shoes. 
        2. Thread needle. 
        3. Managing a safety pin to secure material. 
        4. Screw nut onto bolt
        5. Pick up coins
  • Classification of Function - 4 Levels
    • Level 1 - Placement of Arm
         No prehension
        Move then fix in space, hold paper, leaning into it
      Level 2 - Use in Relationship to an Object
        Shoulder abduction clamp to hold object under arm
        Forearm hook to carry
        Finger hook to carry
        Fixed hand to push and pull, as weight to stabilize
      Level 3 - Use of Prehension
        Supportive - handrail
        Transportive - moving objects
        Use of Tool - use of object to accomplish a task
      Level 4 - Skilled Independent Finger Motion