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Ou up during a typical night during the past two weeks? 0x 1x 2-3x 4-5x 5+x 11. Do you have difficulty with the grasping and use of small objects such as keys or pens? 1 2 3 4 5 1. Writing 1 2 3 4 5 2. Buttoning of clothes 1 2 3 4 5 3. Holding a book while reading 1 2 3 4 5 4. Gripping of a telephone handle 1 2 3 4 5 5. Opening of jars 1 2 3 4 5 6. Household chores 1 2 3 4 5 7. Carrying of grocery bags 1 2 3 4 5 8. Bathing and dressing 1 2.

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