The Hand Function Evaluation Model (HFEM) aims to guide assessment of the impairment and disabilities for preschool-age children presenting hand dysfunction. In the HFEM, hand function is evaluated at three levels: 1) sensorimotor performance, 2) developmental progress, and 3) hand function performance. At the first level, assessment of sensorimotor performance includes grip strength, dexterity, and stereognosis of the child. In particular, the evaluation of the grip strength includes four subtypes: power, tip pinch, three point chuck, and lateral pinch grip. As the child is viewed globally in relation to his/her developmental progress, the HFEM proposes that, at the second level, standardized developmental assessments be used to identify children at risk for hand skill delays. In the HFEM, hand function is considered as the primary outcome at the third level, where hand function refers to the abilities of the hand to cope with purposeful everyday activities including self-care and academic skills. Therefore, both unimanual and bimanual activities essential to pre-academic and self-care demands are important for hand function of preschool-age children. Two unilateral hand function tasks (writing and chopsticks) and two bimanual function tasks (buttoning and scissors) are proposed in the HFEM as outcome indicators relevant to preschool-age children who are living in Hong Kong. In evaluation, therapist can follow the suggested assessments at each level to evaluate hand function of preschool-age children.
Domain of occupation
This model has a primary focus on hand evaluation and is more relevant to children with Eastern cultural background
Li-Tsang, C. W. P. (2003). The hand function of children with and without neurological motor disorders. British Journal of Developmental Disabilities, 49, 99-110.
The Conceptual Model for Performance in Handwriting views that handwriting is important for one’s work and/or education domains of occupations. It considers the performance components, performance areas (functional performance), performance contexts, and the interactive relationship among them. Prerequisites to handwriting include performance components in sensory, perceptual, motor cognitive, and language functions, as well as integrations of these components.
The Biomechanical frame of reference for positioning children for function is applied to individuals who are unable to maintain posture from appropriate automatic muscle activity caused by neuromuscular or musculoskeletal dysfunction. The goals of this frame of reference are (1) to enhance development of postural reactions, which can be done by reducing the demands of gravity and aligning the body, and (2) to improve functional performance by providing external support for proximal stability to improve distal function.
The Neuro-Developmental Treatment (NDT) frame of reference is used to analyze and treat posture and movement impairments based on kinesiology and biomechanics. To identify difficulties and plan for intervention, the following concepts are to be considered in NDT, including planes of movement, alignment, range of motion, base of support, muscle strength, postural control, weight shifts, and mobility. NDT assumes that posture and movement impairments are changeable. Thus, it utilizes movement analysis to identify missing or atypical elements.
This frame of reference adapts a top-down approach to identify visual perceptual factors that limit an individual’s daily participation, and adaptive and compensation approaches are used to facilitate engagement in meaningful occupation. It uses theories from cognition, developmental psychology, education, and Warren’s developmental hierarchy of visual perceptual skills. Visual Perceptual skill development is viewed to be developed from a hierarchy, starting from oculomotor control, visual fields, visual acuity.
The Children’s Hand Skills Framework (CHSF) is used as a conceptual guide to analyze and describe children’s hand skills in the assessment and intervention process. The CHSF divides children’s hand skill use into six major categories, based on the extent to which the hands contact objects/parts of the body or not. The first two categories are manual gesture and body contact hand skills that do not contact specific objects.