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Testing Eligibility for Evaluation & Therapy of the Hand (TEETH) (draft 1.4)
Purpose: TEETH is a self administered questionnaire to detect the problem in your hand and upper extremity. Instructions: Please make a tick mark (√) against the question in appropriate column. It should rightly indicate the “level of difficulty” you are facing. Name: ………………………………………………… Age/ Gender: Affected Hand:
/
Dominant Hand:
Occupation: ………………… Diagnosis: ………………………………………………………………….
Do you have problem……. Sr. No.
Question
1 2 3 4 5 6 7 8 9 10 11 12 13
Moving either of the arms in all directions? Holding an apple with right or left hand? Releasing an apple after holding? In holding a hammer in your hand? With hammering nails with your dominant hand? Holding a pen for writing in your dominant hand? Writing with the pen with your dominant hand? Lifting Rs. 1 coin from the Tabletop? Releasing Rs. 1 coin into the piggy bank? Making tower with the blocks? (4 minimum) Passing object in the one hand to another? Unscrewing bottle top with your dominant hand? Turning one page at a time with your dominant hand?
14
Throwing an apple at least 5 feet away with your dominant hand? Rotating the pencil to use the eraser end? Lifting large heavy box with both the hands? Holding a paper during scissor use? Using scissors to cut paper or the cloth with your dominant hand? Combing hair? Eating with the hand? Cutting with knife? Buttoning or unbuttoning? Lifting the heavy basket with right or left hand? Finding things in a pocket, bag, using touch only (without looking)? Opening lock with the key? TOTAL number of tick marks in each column
15 16 17 18 19 20 21 22 23 24 25
Name and signature of the examiner
Level of difficulty No
Mild
Moderate
Severe
Complete
A
B
C
D
E
Date of Evaluation:
/
/
©Nandgaonkar Hemant P. (September, 2012)
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Testing Eligibility for Evaluation & Therapy of the Hand (TEETH) (draft 1.4)
Scoring: Scoring criterion: Scoring for each “NO difficulty” item = 0 Scoring for each “Mild difficulty” item = 1 Scoring for each “Moderate difficulty” item = 2 Scoring for each “Severe difficulty” item = 3 Scoring for each “Complete difficulty” item = 4
Formula for calculating total score: Total score = A(0)+B(1)+C(2)+D(3)+E(4)=
Criterion for interpretation: Sr. No 1 2 3 4 5
Level of difficulty No difficulty Mild difficulty Moderate difficulty Severe difficulty Complete difficulty
If Total score is 0 (zero) >0 till 25 > 25 till 50 > 50 till 99 100
©Nandgaonkar Hemant P. (September, 2012)