3.2.1. Quality of Upper Extremity Skills Test (QUEST)

It is a criterion-oriented and standardized questionnaire designed and printed by Dematteo et al. in 1992 [31] for children with neurological motor disorders along with spasticity, with an age range of 18 months to 8 years. This test measures the quality of the upper extremity function in children with cerebral palsy through 34 questions in four dimensions, including dissociated movement, grasp, protective extension, and weight bearing. The items of this questionnaire are designed based on the normal developmental sequence and evaluate each upper limb separately. The responses to this questionnaire are dual (yes or no) and their scores are calculated and reported based on the formula suggested in this test. In this test, a higher score indicates a better quality of upper extremity function, which is calculated as a percentage and reported separately for each part. The administration and scoring of this test take 30–45 min, and it can be obtained for free. Based on the investigations, this test is suitable for use in the Manual Ability Classification System (MACS) Levels 1–5 [32, 34, 87].

3.2.2. Box and Blocks Test of Manual Dexterity (BBT)

It is a standard tool designed by Mathiowetz et al. in 1985 [35]. This time-based tool measures the gross manual dexterity of children aged 3 years and older while moving blocks from one side of the compartment to the other side [88]. This test starts with the dominant upper extremity, and the child has 60 s to transfer the blocks from one side of the box, which is separated by a middle wall, to the other side of the box. In the end, the number of blocks transferred to the opposite side is counted and recorded. This process is also repeated in the nondominant part, and the number of transferred blocks is taken into consideration [36]. The size of the blocks in this test (2.5 cm) is such that even children with weak upper limbs can move several blocks [89]. The information of this test is normalized based on the affected and healthy population. It is implemented in 10 min and does not require special training [28, 89].

3.2.3. Jebson–Taylor Hand Function Test (JTHFT)

This test was first designed in 1969 by Jebson et al. and Taylor et al. to measure the effect of treatment on the hand function of adults, and after a few years, it was standardized for use in the age range 6–19 years [39, 90]. This test is normalized based on age and gender and measures the speed and dexterity of a person doing seven daily activities with one hand [89]. The seven subsets of this test include writing, turning over cards, picking up small objects, stacking checkers, simulated feeding, moving light cans, and heavier (1 lb) cans. The time of doing each of these is recorded with the dominant hand and the nondominant hand, and the sum of these times is taken as a person’s functioning score. Less time means better performance. Item scores (and total scores for children) are compared with normative tables according to age and sex. Reassessments allow clients to be compared with their own scores as well as with norms to measure the effectiveness of intervention [8]. This test is performed within 15–30 min and does not require special training. The set of tools for this test can be purchased online. However, one can get information about how to make the tool by reading the main article of this test [28, 90].

3.2.4. Melbourne Assessment of Unilateral Upper Limb Function (MAUUL)

It is a criterion-based tool that was designed and published in 1999 by Randall et al. to evaluate the quality of upper extremity function of children with cerebral palsy and neurological injuries aged 5–15 years [43]. It examines the upper extremity function of children with cerebral palsy through 16 items in the form of activities such as reaching, grasping, releasing, and manipulating objects. The items of this test can be administered in a standard way within 30 min. The administration of all these items is filmed according to the manual of this tool, and their scoring is done based on reviewing the recorded video, which takes approximately 30 min. Each item has its scoring system, which can include numerous sub-skills and a scoring system of 3, 4, or 5 for each subskill. Each subskill describes different characteristics such as range, accuracy, and fluency of movement [28, 91].

Additional studies conducted on this test by Randall et al. using Rasch analysis led to the introduction of the second version of this tool, called Melbourne Assessment of Unilateral Function 2 (MAUL 2) in 2012. MAUL 2 considers four unidimensional subscales, including the range of motion, fluency, accuracy, and dexterity, to define the quality of upper extremity function. Compared to the original test, it has 14 items, and the scoring of several items has been modified [48]. This test is appropriate for children with neurological disorders, from 2 years and 6 months to 15 years, and is more feasible and efficient than its previous version. Also, the possibility of clinical interpretation of its scores has increased [42, 48]. This test is rated using a 3-, 4-, or 5-point scoring system or based on a criterion defined by an individual, which requires 30 min to complete. The scores of different parts of this questionnaire can be reported separately and used in children with MACS 1-5 [14, 42].

3.2.5. Pediatric Motor Activity Log (PMAL)

It is a parent-oriented tool designed by Taub et al. in 2004 [92] to determine the extent of the affected upper limbs of children with hemiplegic cerebral palsy in daily life activities, aged from 7 months to 8 years [50, 92]. This tool employs two 6-point criteria to evaluate the performance of 22 different activities and determine how often and how well the affected upper limb is used during daily activities [26]. Studies have not reported how to select the items in this questionnaire. However, this tool has been designed based on the Motor Activity Log Test, which is specific to adults with stroke [26]. PMAL is a semistructured interview whose items include unilateral functioning tasks such as turning a doorknob and pulling a toy with a rope. The investigations conducted using the Rasch analysis on the items of this test have not confirmed the construct validity and reliability of this instrument and have led to the construction of revised versions by different researchers [89].

Wallen et al. first introduced the revised version of PMAL in 2009 under the title Revised PMAL (PMAL-R). Compared to the original version, this version has 22 items on the quality of movement (how well) and 21 items on the amount of the use (how often) of the affected upper extremities and benefits from three scoring criteria. Moreover, unlike the initial version, which is a semistructured interview and is conducted by the therapist, it is a self-administered scale that is fully completed by the parent. Completing this questionnaire takes 5–15 min, and it can be used for children aged 19 months to 7 years [26, 50]. Uswatte et al.’s version is another revised version of this questionnaire that was introduced in 2012 under the title PMAL-R [52]. Unfortunately, this version is also known as the revised version of Wallen (PMAL-R). However, the two revised versions have different numbers of items, scoring criteria, and implementation methods. Therefore, when extracting information using PMAL, one should take into account sufficient accuracy about the version used [89]. PMAL-R has 22 items like the original version and uses 6-point scale. This version can be used in the age range of 2–8 years and can be conducted as a semistructured interview within 30 min [26, 52]. In any case, the psychometric properties of the two revised questionnaires have been examined and confirmed in children with cerebral palsy, but it should be kept in mind that these characteristics are specific to the revised versions and cannot be generalized to the original questionnaire [53].

3.2.6. N_HPT

This is a quick and simple tool to measure fine dexterity skills. This test is a standard and normative test, which was designed by Kellor in 1971 [56] and consists of a rectangular base with a container, 9 holes (1 mm in diameter and 15 mm in depth), and 9 nails (7 mm in diameter and 32 mm in length). During the test, the client must remove nine nails from the container as quickly as possible, insert them into the holes, and then return the nails to the container one by one. The implementation time is recorded as the result of the test and is calculated separately for each hand [57, 65]. This test can be used for individuals aged 4–94 years [8].

3.2.7. Shriners Hospital for Children Upper Extremity Evaluation (SHUEE)

The SHEE is a video-based assessment tool that was developed in 1996 at Shriners Children’s Hospital with the aim of evaluating upper limb function in children with hemiplegic cerebral palsy. This assessment consists of two main sections, each focusing on different aspects of upper limb performance. The first section examines the active and passive range of motion of the upper limb joints, from the shoulder to the fingers, along with the degree of spasticity, assessed using the Modified Ashworth Scale. Additionally, this section evaluates the child’s performance in seven selected activities of daily living and identifies treatment priorities determined by the child and their family. The second section consists of three components—spontaneous use analysis, dynamic positional analysis, and grasp-and-release analysis—which together provide a comprehensive evaluation of how the child utilizes the affected hand in different conditions. In the spontaneous use analysis component, the frequency and extent of the child’s use of the affected hand during daily activities, without encouragement, are assessed using a six-point scale ranging from zero, indicating no use at all, to five, representing optimal use. The dynamic positional analysis component evaluates the alignment and control of different segments of the hand and arm, including the thumb, fingers, wrist, forearm, and elbow, during the performance of 16 specific motor tasks. Each segment is rated on a four-point scale, where zero indicates severe misalignment and three represents optimal positioning. Finally, in the grasp-and-release analysis component, the child’s ability to grasp and release objects is assessed in three different wrist positions—flexed, neutral, and extended—where each position is scored between zero and one. Scoring for this assessment is based on the clinician’s analysis after reviewing a recorded video of the child, providing valuable insights into the effective use of the affected hand in daily activities. Additionally, this tool facilitates monitoring functional changes over time or in response to therapeutic interventions. The final scores are expressed as a percentage of the maximum possible score. The SHEE is freely available, requires no specialized training, and can be completed in a short amount of time [58]. This evaluation can be used for children with cerebral palsy who are aged 3–18 years [30].

3.2.8. Bruininks–Oseretsky Test of Motor Proficiency-2 (BOTMP-2)

This test is the second version of the BOTMP-2 and was designed and introduced in 2005 by Bruininks et al. [60] to examine the fine and gross motor skills of people aged 4–21 years. This test has 53 items that evaluate the function of people in 4 main parts, including fine manual control (with two subsets of fine motor precision and fine motor integration), manual coordination (manual dexterity and upperlimb coordination), body coordination (bilateral coordination and balance), and strength and agility (strength, running speed, and agility). In this test, the age range and the number of items have increased compared to the original test, and the implementation of some items has become easier [60]. This test is one of the most common tests used to measure the upper extremity function of children with cerebral palsy, which can be purchased and implemented based on its instructions. This test has two long and short forms, and depending on the type selected, it can be administered in 15–60 min [28].

3.2.9. Peabody Developmental Motor Scales-Second Edition (PDMS-2)

This measure is the revised version of the PDMS, which was developed for children from birth up to 71 months of age. The first version of PDMS was introduced in 1983 by Rhonda Folio and Rebecca Fewell, and the second version was introduced in 2000 by the same authors [93, 94]. This version, compared to the first one, provides a wider, more accurate, and more comprehensive evaluation of motor function [63]. Like the first version, it is a norm-oriented and standardized tool that examines children’s motor skills in two subsets: gross and fine motor [95]. The gross part of this tool assesses children’s gross motor skills in four subsets of reflexes, stationary, locomotion, and manipulation of objects, and its upper limb part assesses children’s fine motor skills in two parts: grasping and visuomotor integration, which consist of 26 and 72 items, respectively [64]. PDMS-2 is a paid tool that therapists can use individually by reading its booklet [6]. It takes 20–30 min to perform the upper extremity part of this test, and therapists measure the upper extremity skill through games and daily activities tailored to the child’s age [63]. In this assessment, each item is graded on a 3-point scale of 0, 1, and 2 [96]. The raw scores of each part are summed and converted into a standard form, so it is possible to categorize the motor function into seven categories: 1: very superior, 2: superior, 3: above average, 4: average, 5: below average, 6: poor, and 7: very poor [97].

3.2.10. Movement Assessment Battery for Children (MABC)

It is a standard and widely used test to evaluate children’s motor skills. It was specifically designed in 1992 by Henderson et al. to diagnose children with mild to moderate motor disorders [69, 96]. The test includes four sets of age-related items. In each set, 8 questions evaluate the overall movement, 3 questions on upper extremity dexterity, 2 questions on ball manipulation skills, and 3 questions on static and dynamic balance. The questions on the upper extremity dexterity are scored from 0 to 5, and the dexterity set has 15 points, which can be expressed as a percentage. In this test, a lower score indicates better performance [98]. This test can be used for children aged 4–12 years [71].

3.2.11. Caregivers Functional Use Survey (CFUS)

It is a standard questionnaire to measure the views of the parents of hemiplegic cerebral palsy children about the extent and manner of using the affected upper extremity in daily life activities. This survey has a different number of items depending on the version used. In 2006, Charles et al. used the 14-item version of this questionnaire, which mainly considers the functioning of the affected limb in bilateral activities [99]. However, Gordon et al. introduced the 20-item version of this questionnaire in 2007. In this version, 10 activities exclusively evaluate the one-handed skills, and the other 10 skills assess hand function in bilateral activities. Each item is rated on a 6-point Likert scale (0–5), which evaluates the extent and manner of upper extremity function of children in two parts. In this questionnaire, the average scores of unilateral or bilateral activities can be calculated and reported separately, or the combined scores of the two parts can be used together [72]. CFUS can be used for children with cerebral palsy aged 3.5 to 15.5 years [13].

3.2.12. Assessment of Children’s Hand Skills (ACHSs)

This tool was first designed and introduced by Chien et al. in 2010 for healthy and disabled children [74]. Based on the observation of children’s performance in the real environment, the efficiency of using the upper extremities is determined in real-life situations. For this purpose, the test considers 22 activities with different levels of difficulty. These activities reflect the usual occupations of children in areas related to school and education (8 items), daily activities (6 items), and play and recreation (8 items). Then, to increase the client-oriented dimension, in a part of the questionnaire, parents’ views are asked regarding the activities that can create a suitable challenge for the child as well as the suitable environment for observing these activities. Based on the parents’ responses, the therapist selects 2 or 3 out of 22 activities (not all) and observes the child’s performance in each activity for 5–10 min at most. During the observation, the therapist determines the efficiency of using the upper limb for each of the hand skills based on a 6-point Likert scale (1: very inefficient to 6: very efficient). This test includes 20 hand skills, which can be divided into six categories: manual gesture (1 item), body contact hand skills (1 item), adaptive skilled hand use (5 items), arm-hand use (7 items), bimanual use (3 items), and general quality (3 items). It takes 20–30 min to perform this criterion-referenced test, and its scores can be reported in three forms: raw, percentage, or converted using Face Rasch software [76, 78]. This measure can be used for children with cerebral palsy who are aged 2–12 years [76].

3.2.13. Canadian Occupational Performance Measure (COPM)

It is an individual client-centered measure designed by Law et al. in 1990 [79] to detect clients’ changes in “self-perception” in occupational performance. This measure examines occupational performance in three areas, including personal care, productivity, and leisure time, and is performed in five phases. In the first phase, the therapist asks the client to think about a day in their life and specify the things they need, want, or are expected to do, but are unable to do, do not do, or the way they do them does not satisfy them. Then, in the second phase, clients are asked to rate each activity according to its importance in their lives, based on a 10-point Likert scale, from 1 as the least important to 10 as the most important. In the third phase, using the obtained information, the clients are requested to choose the five most important problems. The fourth and fifth phases of this measure are done by re-evaluating the questionnaire and calculating its score. For each of these problems, the client determines the level of usual performance and the level of satisfaction with the implementation of that activity on a 10-point Likert scale from 1 as the lowest to 10 as the highest. The calculation of changes in this questionnaire is done by determining the total score, which is calculated by adding up performance or satisfaction scores for all problems and dividing them by the number of problems, and changes greater than or equal to 2 are reported as significant [8, 82, 100]. This measure needs to be purchased and takes 30–45 min to complete [86]. COPM can be used for individuals aged 7 years and older [8].

3.2.14. Goal Attainment Scaling (GAS)

This criterion was first designed in 1960 by Kirusek and Sherman for use in the mental health domain. However, its modified version can be used for all ages and diagnoses. GAS is a semistructured interview with a 5-point scale (from −2: much worse than expected to +2: much better than expected) to determine the progress and access of people to their goals during the treatment period. In this scale, problem areas are identified and weighted based on their importance and difficulty and selected for treatment. The goals at this stage should be chosen in such a way that they are accessible and determined completely based on SMART principles [84]. The use of this criterion does not require special training, although it is recommended to be administered by experienced therapists [86].