Evaluation of the hand-to-mouth task as a representative measure of functional feeding in typically developing children: A cross-sectional study.

BACKGROUND: Assessment of upper extremity function in children often relies on observation of activities of daily living. The hand-to-mouth position is commonly used to represent feeding ability, however, it is unclear whether it captures the joint kinematics required during actual feeding tasks. PURPOSE: To determine joint angle differences in feeding tasks compared with bringing the hand to the mouth and to establish normative joint angle data during feeding tasks. STUDY DESIGN: Cross-sectional motion capture assessment of 25 typically developing children ages 6-18 years (average 11.8 ± 3.3 years). METHODS: Each participant performed five feeding tasks: hand to mouth, eating a sandwich, eating a small food item, and use of a utensil (fork and spoon). One trial per task was collected for each arm. Joint angles were quantified with customized software. Two-way repeated-measures MANOVAs (α = 0.05) compared joint angles between hand-to-mouth position and each feeding task, with task and limb (dominant/nondominant) as within-subject factors. Wilks' lambda was used when multivariate normality assumptions were satisfied, Pillai's trace was used when assumptions were violated. Significant multivariate effects were followed by univariate analyses to identify specific joint angle differences. RESULTS: For both dominant and nondominant limbs, significant differences were observed between the hand-to-mouth position and all feeding tasks (p < 0.05). The sandwich position showed the largest number of angles with significant differences compared with the hand-to-mouth position. The small food item task demonstrated the fewest differences across limbs, although it required greater forearm supination. CONCLUSIONS: The hand-to-mouth position does not universally represent the joint kinematics required across feeding tasks in children. Eating a small food item most closely approximated hand-to-mouth kinematics, while eating a sandwich was the most disparate. These findings support the need for task-specific assessment of upper extremity function related to feeding.