Hygiene

Score 0 1 2 3 4 Category Impossible to clean Severely difficult to clean Moderately difficult Minimal difficulty No hygiene problems Description Cant get into armpit/hand, unable to cut the nails Smelly, skin breakdown problems, extensive skin buildup Occasionally smelly, occasional skin breakdown and debris buildup Rarely smells, no skin problems, rare debris buildup No hygiene problems

Cosmesis
Score 0 Category Severe deformity Description Contractures at rest, extremely embarrassing for patient/caregiver, very low selfesteem Contractures obvious, embarrassing, low self-esteem Contractures present, mildly embarrassing No deformity at rest, if using hand, one can tell theres a problem No deformity at any time

1 2 3 4

Moderate deformity Mild deformity Minimal deformity No deformity

Ability to dress Score 0 Category Very difficult Description Completely dependent on caregivers; requires extensive modification to clothing, tight muscles causing distress getting 1 Difficult arms through Can wear normal clothes but dependent on caregivers; some difficulty getting arms through 2 3 4 Moderate assistance Minimal assistance Completely independent but no distress Completely dependent but not difficult Child does most of the dressing No help required if clothes are selected for them Houses Functional classification system

Class 0 1 2 3 4 5 6

Designation Does not use Poor passive assist Fair passive assist Good passive assist Poor active assist Fair active assist Good active assist

Activity level Does not use Uses as stabilizing weight only Can hold onto object placed in hand Can hold onto object and stabilize it for use by other hand Can actively grasp object and hold it weakly Can actively grasp object and stabilize it well Can actively grasp object and then manipulate it against other hand Can perform bimanual activities easily and occasionally uses the hand spontaneously Uses hand completely independently without reference to the other hand

Spontaneous use, partial

Spontaneous use, complete

Patient/ parent satisfaction Score 0 1 2 3 4 Category Poor Marginal Minor worthwhile gain Good result Excellent result Description Worse than preoperative Was not worth doing Little improvement, but worthwhile Reached expectation Better than expected