Capabilities of Upper Extremity Instrument (CUE)

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Tool Description

  •  measures functional limitation and assesses the amount of difficulty experienced in performing specific actions with one or both arms and hands in individuals with tetraplegia.
  • Questions focus on the individuals’ ability to reach or lift; pull and push with their arms; move and position their arm and wrist; use their hand and fingers; and press with the tip of the index finger.

ICF Domain:

Activity – subcategory: Mobility.

Number of Items:

32 total (15 unilateral – left and right, and 2 bilateral).

Brief Instructions for Administration & Scoring


  • clinician-administered; interview format (can be in-person or over telephone)
  • takes about 30 minutes to complete.

Equipment: None.


  • Responses are given on a 7-point scale representing self-perceived difficulty in performing the action, with scores ranging from 1 (unable to perform) to 7 (can perform without difficulty).
  • Responses are summed to give a total score (ranges from 32 to 124).
  • Left and right arm/hand function can be derived separately.
  • A percent of normal function score is also possible using the following algorithm (total score – 32) / 192 * 100%.


MCID: not established for SCI
SEM: for an SCI sample (n=154, 140M/14F, mean (SD) age: 36.7 (11.1) yrs, tetraplegia):

SEM=12.2 (Marino et al. 1998)

MDC: for an SCI sample (n=154, 140M/14F, mean (SD) age: 36.7 (11.1) yrs, tetraplegia):

MDC=33.8 (calculated from data in Marino et al. 1998)

  • Item by item results of the test are straightforward to interpret.
  • Total scores range from 32 to 124 with higher scores reflecting better function.
  • No cut-points or normative data have been established for the SCI population
  • Published data for the SCI population is available for comparison (see the Interpretability section of the Study Details sheet).



Training Required:



Available from the Spinal Cord Center.

Clinical Considerations

  • The CUE has considerable potential clinical appeal because it reflects hand and/or arm function and scores can be derived for either limb, which is appealing given the number of individuals with incomplete injuries.
  • The method of item generation (discussions with physical and occupational therapists, with patients, colleagues and experts in scale design) would suggest the CUE is likely to be widely accepted with therapists and individuals with an SCI.

Measurement Property Summary

# of studies reporting psychometric properties: 5


  • Internal consistency for the CUE is High (Cronbach’s α=0.96

[Marino et al. 2012]


  • High Spearman’s ρ correlation with GRASSP subtests (All P<.0001):
    Sensation total (R+L): ρ = 0.77
    Strength total (R+L): ρ = 0.76
    Prehension performance total (R+L): ρ = 0.83

(Kalsi-Ryan et al. 2012; n=72, chronic tetraplegia)

  • High correlation with ASIA Upper Extremity Motor Score:
    r = 0.782

(P<.05; Marino et al. 1998; n=154)

  • High correlation with Functional Independence Measure:
    r = 0.738

(P<.05; Marino et al. 1998; n=154)


Effect Size:
Between admission and discharge: 0.92
(Values for CUE Questionnaire; Oleson and Marino 2014; n=46, 42 males, acute inpatient rehab)

Floor/ceiling effect:

  • One item (item-left hand-5) on the CUE had a borderline floor effect.

[Marino et al. 1998]

Ceiling effect: 88%-96% of sample had maximum scores on Push & Pull Items
(Values for CUE Test; Marino et al. 2015; n=50, 36 males, outpatient rehab)


Dr. Janice Eng, John Zhu, Jeremy Mak, Gita Manhas

Date Last Updated:

July 20, 2020

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Download Worksheet:

Worksheet Document




Scored on 7-point scale representing self-perceived difficulty 1 = "Totally limited, can't do at all", 7 = "Not at all limited". Total scores (sum of item scores) range from 32 to 224 with higher scores reflecting better function. Left and right arm/hand function can be derived separately. A percent of normal function score is also possible using the following algorithm ((total score – 32) / 192 * 100%.


Equipment Needed


Marino RJ, Shea JA, Stineman MG. The Capabilities of Upper Extremity Instrument: Reliability and Validity of a Measure of Functional Limitation in Tetraplegia. Arch Phys Med Rehabil 1998;79:1512-21.

Kalsi-Ryan S, Beaton D, Curt A, Duff S, Popovic MR, Rudhe C, Fehlings MG, Verrier MC. The Graded Redefined Assessment of Strength Sensibility and Prehension: Reliability and Validity. Journal of Neurotrauma, 2012; 29: 905-914.

Marino RJ, Patrick M, Albright W, Leiby BE, Mulcahey M, Schmidt-Read M, Kern SB. Development of an objective test of upper-limb function in tetraplegia: The capabilities of upper extremity test. Am J Phys Med Rehabil 2012 Jun; 91(6): 478-486.

Oleson CV, Marino RJ. Responsiveness and concurrent validity of the revised capabilities of upper extremity-questionnaire (CUE-Q) in patients with acute tetraplegia. Spinal Cord 2014 Aug; 52(8): 625-628.

Marino RJ, Kern SB, Leiby B, Schmidt-Read M, Mulcahey MJ. Reliability and validity of the capabilities of upper extremity test (CUE-T) in subjects with chronic spinal cord injury. J Spinal Cord Med 2015 Jul; 38(4): 498-504.