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Shriners Hospital for Children Upper Extremity Evaluation (SHUEE)
Availability
Availability: The SHUEE manual and training materials are available for free and can be obtained through the electronic supplement to the original article Davids et al., 2006 or by contacting the authors.
 
Shriners Hospital also offers training workshops around the country. Call Shriners Hospitals for Children-Greenville: 864-240-6277.
Classification
Supplemental: Cerebral Palsy (CP)
Short Description of Instrument
Construct measured: spontaneous functional use and dynamic segmental alignment of the affected UE while performing 16 functional tasks.
Generic vs. disease specific: disease specific
Means of administration: Evaluator administers items in a standard procedure, which is video-recorded. The video-recording is then analyzed and scored.
Intended respondent: Child
Background: The Shriners Hospital for Children Upper Extremity Evaluation (SHUEE) was developed by clinicians at Shriners Hospital in Greenville, NC. The SHUEE is a video-based tool used to assess upper extremity function in children with cerebral palsy aged 3–18. Simple objects found in any household are introduced to the child with instructions to do a task, such as remove paper money from a wallet or remove the lid from a plastic container. The measure Includes active and passive ROM, functional tasks, and analysis of UE grasp (release and joint position during movement).
Comments/Special Instructions
Video-based evaluation that is administered in a standardized sequence. Has two main sections:
 
  1. Range of motion (ROM), tone, activities of daily living (ADL) and family’s goals
  2. Spontaneous functional use, dynamic positional analysis, grasp and release are documented and scored based on video-recording.
 
Used for establishing baseline function, identification of problem areas, and treatment planning.
Scoring
The SHUEE has 5 subsections:
 
  1. Upper extremity (UE) ROM – includes ROM measurements of shoulder, elbow, wrist, hand, fingers, thumb, and a modified Ashworth scale (0 – 4) for tone analysis during range.
  2. ADLs – therapist rates seven activities on a 3-point scale-independent, dependent or assist.
  3. Spontaneous functional analysis – an examination of 9 different activities, assessing spontaneous use of the affected arm using a modified House scale (6- point scale, from “does not use” to “spontaneous use”).
  4. Dynamic positional analysis – analyzes 5 different segments (thumb, finger, wrist, forearm, and elbow) and describes the position of the segment during 16 different activities.
  5. Grasp & Release – ability to grasp and release an object when the wrist is in three different positions: flexion, neutral and extension
 
A score is given to each subscale and converted to a percentage.
Administration time: 15 minutes; scoring 10–30 minutes depending on examiner experience
Rationale/Justification
Strengths/Weaknesses: comprehensive evaluation for baseline UE functioning. Lengthy to administer and score
Psychometric Properties:
Internal consistency – not reported
Intrarater reliability – ICC’s of 0.99 for Spontaneous Functional Analysis; 0.98 for Dynamic Positional Analysis; weighted kappa = 1.00 for grasp and release
Interater reliability – ICC’s of 0.90 for Spontaneous Functional Analysis; 0.89 for Dynamic Positional Analysis
Test-retest – not reported
Content validity – not reported
Concurrent validity – fair correlation with self-care section of the PEDI (r = .47) and good inverse correlation with the non-dominant time on the Jebsen-Taylor test (r =.76)
Construct validity – determined by the analysis of SHUEE scores before and after a common orthopaedic surgical intervention (flexor carpi ulnaris
to extensor carpi radialis brevis tendon transfer). The Shriners Hospital for Children Upper Extremity Evaluation wrist score improved for all eighteen subjects after the flexor tendon transfer, and the mean improvement was significant (p< 0.001).
References
Davids JR, Peace LC, Wagner LV, Gidewall MA, Blackhurst DW, Roberson WM. Validation of the Shriners Hospital for Children Upper Extremity Evaluation (SHUEE) for children with hemiplegic cerebral palsy. J Bone Joint Surg Am. 2006;88(2):326–333.
 
Tedesco AP, Nicolini-Panisson RD, de Jesus A. SHUEE on the evaluation of upper limb in cerebral palsy. Acta Ortopedica Brasileira. 2015;23(4):219–222.
 
Additional References:
 
Gilmore R, Sakzewski L, Boyd R. Upper limb activity measures for 5- to 16-year-old children with congenital hemiplegia: a systematic review. Dev Med Child Neurol. 2010;52(1):14–21.
 
Heaver C, Jarvis S, Johnson B, Kuiper J, Freeman RL. Shriners Hospital for Children Upper Extremity Evaluation (SHUEE): A reliability study. Gait Posture. 2015;425(Suppl 1):S27–S28.
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