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Chedoke Arm and Hand Activity Inventory Score Form CAHAI-13 Version Date Name 1. total assist weak U/L 25 2. maximal assist weak U/L 25-49 3. moderate assist weak U/L 50-74 4. minimal assist weak U/L 75 Activity Scale 5. supervision 6. modified independence device 7. complete independence timely safely Affected Limb Score Open jar of coffee holds jar holds lid Call 911 holds receiver dials phone Draw a line with a ruler holds ruler holds pen Pour a glass of water holds glass holds pitcher Wring out washcloth Do up five buttons Dry back with towel reachs for towel Grasps towel end Put toothpaste on toothbrush holds toothpaste holds brush Cut medium resistance putty holds knife holds fork 10. Zip up the zipper holds zipper 11. Clean a pair of eyeglasses wipes lenses 12. Place container on table 13. Carry bag up the stairs Total Score /91 Comments COPY FREELY DO NOT CHANGE Copyright 2004 Chedoke Arm and Hand Activity Inventory Hamilton ON Funded by The Ontario Ministry of Health and Long Term Care. maximal assist weak U/L 25-49 3. moderate assist weak U/L 50-74 4. minimal assist weak U/L 75 Activity Scale 5. supervision 6. modified independence device 7. complete independence timely safely Affected Limb Score Open jar of coffee holds jar holds lid Call 911 holds receiver dials phone Draw a line with a ruler holds ruler holds pen Pour a glass of water holds glass holds pitcher Wring out washcloth Do up five buttons Dry back with towel reachs for towel Grasps towel end Put toothpaste on toothbrush holds toothpaste holds brush Cut medium resistance putty holds knife holds fork 10. supervision 6. modified independence device 7. complete independence timely safely Affected Limb Score Open jar of coffee holds jar holds lid Call 911 holds receiver dials phone Draw a line with a ruler holds ruler holds pen Pour a glass of water holds glass holds pitcher Wring out washcloth Do up five buttons Dry back with towel reachs for towel Grasps towel end Put toothpaste on toothbrush holds toothpaste holds brush Cut medium resistance putty holds knife holds fork 10. Zip up the zipper holds zipper 11. Clean a pair of eyeglasses wipes lenses 12. Place container on table 13. Zip up the zipper holds zipper 11. Clean a pair of eyeglasses wipes lenses 12. Place container on table 13. Carry bag up the stairs Total Score /91 Comments COPY FREELY DO NOT CHANGE Copyright 2004 Chedoke Arm and Hand Activity Inventory Hamilton ON Funded by The Ontario Ministry of Health and Long Term Care. maximal assist weak U/L 25-49 3. moderate assist weak U/L 50-74 4. minimal assist weak U/L 75 Activity Scale 5. supervision 6. modified independence device 7. complete independence timely safely Affected Limb Score Open jar of coffee holds jar holds lid Call 911 holds receiver dials phone Draw a line with a ruler holds ruler holds pen Pour a glass of water holds glass holds pitcher Wring out washcloth Do up five buttons Dry back with towel reachs for towel Grasps towel end Put toothpaste on toothbrush holds toothpaste holds brush Cut medium resistance putty holds knife holds fork 10. Zip up the zipper holds zipper 11. Clean a pair of eyeglasses wipes lenses 12. Place container on table 13.

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