Brooke et al developed a functional grading scale for the upper extremity. While developed for persons with muscular dystrophy, it can be applied to patients with other disorders of the upper extremity.
Level of Function
Grade
can raise the arm over the head, starting with the arm at the side and abducting the arm in a full arc until the hand is over the head
1
can raise the arm over the head only be flexing the elbow or using accessory muscles
2
cannot raise the hands above the head AND can raise an 8 ounce glass of water to the mouth
3
can raise the hand to the mouth AND cannot lift an 8 ounce glass of water to the mouth
4
cannot raise hand to mouth AND has useful function in hand (can hold a pen, pick up coins off the table, etc.)
5
cannot raise hand to mouth AND has no useful function in hand
6
where:
• The original wording of the functional descriptions describes both sides being affected, presumably to an equivalent degree.
• Flexing the elbow in Grade 2 reduces the circumference of movement and makes the task easier to do.
• Grades 1 to 4 might be subdivided into those with and without useful hand function.
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