SHUEE Introduction



This manual provides the examiner with an overview of the administration
and interpretation of the Shriners Hospital Upper Extremity Evaluation (SHUEE).
Evaluator training prior to clinical application of the SHUEE should include:

  • Reading this manual
  • Viewing the Key Interpretation video
  • Completing the Video Proficiency test

Information regarding the assembly of a test kit has also been provided in this manual.

Historical Background

The SHUEE was developed in November 1996 to assess the segmental, dynamic alignment of the involved upper extremity in clients with hemiplegic cerebral palsy when performing functional tasks. Review of the literature revealed evaluation tools that measured those tasks that could be completed, but no standardized methods for documenting the manner in which the functional tasks were performed. Such information is essential in designing interventions and documenting outcome.

The SHUEE was initially developed as a screening test to determine which clients were appropriate candidates for BOTOX injections to the involved upper extremity. It has subsequently been used to trend upper extremity function, select surgical interventions, and document the effects of such interventions. Because the shoulder is rarely addressed surgically in clients with cerebral palsy, the SHUEE focuses on segmental analysis of elbow, forearm, wrist, thumb and fingers. Observation of shoulder girdle is recommended, but not currently included in the SHUEE.

Description of the Test

The SHUEE is a video-based evaluation that was designed for use with clients with hemiplegic type cerebral palsy. The SHUEE presents a descriptive profile for comparing dynamic segmental alignment of the upper extremity, pre-and post intervention. The SHUEE has a numerical score for comparing a client’s own scores to one another.

The test consists of two pages. The first page evaluates the client through standard measurements of active and passive range of motion (ROM), tone, and a history-based assessment of the performance of activities of daily living. The second page evaluates the spontaneous use of the involved extremity and the segmental alignment of the extremity while performing tasks on demand. The SHUEE is designed to evaluate both functional and spontaneous abilities, as well as to document dynamic segmental alignment when performing tasks.

The SHUEE is video-based for several reasons. This allows it to be viewed at a later date. During administration of the test, the client can complete all tasks in a dynamic fashion without starting and stopping for the evaluator to record data. The SHUEE may be evaluated by a multi-disciplinary team consisting of occupational/physical therapists, physicians, and family, resulting in a more comprehensive treatment plan. The videotaped SHUEE becomes an invaluable part of the medical record, documenting functional alignment and pre/post intervention for comparative study.

Clinical and Research Applications

Although to date the SHUEE has only been evaluated for use with clients with hemiplegic cerebral palsy between the ages of 3 and 18 years, other potential applications exist. Further clinical testing is necessary before these other applications can be recommended.

Printable version of SHUEE manual

SHUEE Validation Study

Related Content


SHUEE Test Administration

The Shriners Hospital Upper Extremity Evaluation (SHUEE) utilizes the following testing materials.

Download the printable version of SHUEE manual

Testing Materials

Billfold style wallet to hold paper money

Billfold style wallet to hold paper money

8 x 10 sheet of standard weight paper

8 x 10 sheet of standard weight paper

Two 2″ in diameter and approximately 1/2″ thick, flat sided, wooden beads. Stiff cord for stringing beads

Two 2″ in diameter and approximately 1/2″ thick, flat sided, wooden beads. Stiff cord for stringing beads

Three dollar sized bills made of standard weight paper

Three dollar sized bills made of standard weight paper

Four plastic coins of any size

Picture of a thumb in palm

SHUEE Test Scoring and Interpretation

Shriners Hospital Upper Extremity Evaluation (SHUEE) Test Scoring and Interpretation Scoring

The SHUEE data collection form consists of 2 pages. The first page is primarily descriptive and requires no scoring. The second page is utilized during the video taped portion and requires scoring of the Spontaneous Functional Analysis (SFA), the Dynamic Positional Analysis(DPA), and the Grasp/Release(GRA) segments on the actual SHUEE form. The SFA score is circled and the DPA score is marked in the grid with a check mark.


SHUEE Case Studies

Shriners Hospital Upper Extremity Evaluation (SHUEE) Case Studies

The following section includes 3 case studies for viewing and scoring.  The key gives explanation to the scores and will refer you to the section of the manual which explains the correct score.  You can print out blank scoring forms by clicking the Forms link above.  Score each case on your own and then view the provided scores by clicking the appropriate link.  Questions in regards to scoring can be directed to the authors.


SHUEE References

Shriners Hospital Upper Extremity Evaluation (SHUEE) References

  • Trombly CA. Evaluation of biomechanical and physiological aspects of motor performance. Occupational Therapy for Physical Dysfunction, 4th Ed., Williams & Wilkins, Baltimore, Maryland; 1995, pp 126-130.
  • Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Therapy 1986; 67:206-207.
  • House J, et al. A dynamic approach to the thumb-in-palm deformity in cerebral palsy.