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PubMed2002

Predictive factors of manual dexterity and cognitive performance at 17 years: a 10-year longitudinal study in a rural area of France.

Studies of predictive factors of manual dexterity in adolescents and young adults are lacking. The present longitudinal study reports the relationship between cognitive and behavioural assessments at age 7 years and the schooling, cognitive performance, and manual dexterity at age 17 years. The participants were 65 schoolchildren, 30 boys and 35 girls, from a rural area in France. Assessment at age 7 years included the McCarthy scales and questionnaires measuring the behavior of the child, completed by the mother, the teacher, and the assessing psychologist. Assessment at age 17 years included schooling situation (whether they were in high school or not), cognitive testing (WAIS-R, Trail Making, Verbal Fluency, Cancel H, Stroop, Memory Assessment Scales), and manual dexterity testing (dynamometer, Finger Tapping, Santa Ana Test, Purdue Pegboard). After controlling for effects of parental education and IQ, a negative teachers' rating of children's behaviour and abilities in first-grade (7 years) was correlated with early cessation of schooling, but also, unexpectedly, with higher scores for manual dexterity at 17 years. Manual dexterity was not related to cognitive performance at 17 years. It is suggested that the relationship between manual and cognitive performance varies during development. Although manual exploratory behaviour is an important correlate of early cognitive development, manual dexterity is probably not related to later academic performance.

Achievement↗

PubMed1996

Grip strength and finger dexterity across five styles of commercial wrist orthoses.

OBJECTIVE: Five styles of commercial static wrist extensor orthoses were compared to determine whether any style, or styles, afforded better power grip strength or finger dexterity. Because wrist extensor orthoses are intended for use during functional tasks, their influence on hand function is of great importance. METHOD: Twenty-three right-hand-dominant women without upper extremity dysfunction participated in this crossover study. Dominant-hand finger dexterity and power grip strength were evaluated while wearing each of five commercial orthoses-Kendall-Futuro #33 (Futuro), AliMed Freedom Long (AliMed Long), AliMed Freedom Short (AliMed Short), Smith & Nephew Rolyan D-Ring (Rolyan), and LMB Wrist Rest (LMB)--and while using the dominant hand without an orthosis (free hand). Finger dexterity was assessed with the unimanual subtest of the Purdue Pegboard. Grip strength was assessed with a Jamar hydraulic dynamometer. RESULTS: Four of the study orthoses (Futuro, AliMed Short, Rolyan, and LMB) afforded finger dexterity that did not differ significantly from that of the free hand. The AliMed Long orthosis slowed finger speed when compared with the speeds afforded by both the LMB orthosis and the free hand. The Rolyan orthosis permitted a power grip strength that was not significantly different from the free hand. The other four commercial orthoses reduced grip strength when compared with the strength observed when wearing a Rolyan orthosis and when gripping with a free hand. CONCLUSION: The five styles of commercial orthoses affect power grip and finger dexterity differently. When power grip or finger dexterity are priorities, differences among the orthoses furnish grounds for initial suggestions, although medical needs and patient preference should be the overriding factors in the final selection of an orthosis.

Adult↗

PubMed1992

Lithium stimulation of HPP-CFC and stromal growth factor production in murine Dexter culture.

We have previously reported that the addition of lithium chloride (LiCl) to murine Dexter cultures results in increased numbers of progenitor and mature hematopoietic cells of the granulocyte, macrophage, and megakaryocyte lineages. We now report the effect of various levels of LiCl on the high proliferative potential colony-forming cell (HPP-CFC) in Dexter culture and on the induction of growth factors from Dexter stromal cells. LiCl (4 mEq/L) stimulated supernatant HPP-CFC for the first 4 weeks of culture (150-275%), and stimulated stromal HPP-CFC at week 3 (170-222%). Higher levels of lithium (8 and 12 mEq/L) selectively stimulated supernatant HPP-CFC, macrophage, and eosinophil production, whereas granulocytes and granulocyte-macrophage colony-forming cells (CFU-C) were inhibited. mRNA expression was evaluated from week 4 Dexter cultures that received a pulse or continuous exposure to lithium and had received either 0 or 1,100 cGy irradiation. Four mEq/L LiCl stimulated increased expression of G-CSF, GM-CSF, IL-6, and, in the nonirradiated stroma continuously exposed to lithium, CSF-1 mRNA. In general, the higher levels of lithium stimulated increased mRNA expression for these same growth factors. mRNA for the recently described Steel factor was decreased with increasing levels of lithium added to either normal or irradiated stroma. Bioassays of conditioned medium (cm) from irradiated cultures against the FDC-P1 and T1165 cell lines indicated cytokine activity, which was blocked by antibodies to GM-CSF and IL-6, respectively. Altogether these data show that lithium stimulates Dexter HPP-CFC, and this stimulation appears to be mediated by multiple growth factors that are induced from stromal cells.

Animals↗

PubMed1996

Laparoscopic-assisted colectomy with the dexterity pneumo sleeve.

UNLABELLED: The dexterity pneumo sleeve is designed to provide abdominal access for the surgeon's hand while preserving pneumoperitoneum during laparoscopy. The first experience using the dexterity pneumo sleeve in colorectal surgery is reported. METHODS: Four patients with diverticulitis and one with a dolichocolon had manually assisted laparoscopic sigmoid colectomy with the dexterity pneumo sleeve. RESULTS: Assistance of the left hand, introduced through the dexterity device proved to be extremely helpful in identifying the plane of dissection in one patient with a large diverticular mass and in another with a colovaginal fistula. Mean operative time was 109 minutes, blood loss was 80 ml, and length of incision was 7.5 cm. Flatus reoccurred at the second postoperative day, bowel movement occurred on the third day after surgery, and patients were discharged after 4.8 days. CONCLUSIONS: With the dexterity pneumo sleeve, the tactile sensation is regained, which makes laparoscopic-assisted colectomy safer and faster.

Blood Loss, Surgical↗

PubMed1999

Mechanisms of recovery of dexterity following unilateral lesion of the sensorimotor cortex in adult monkeys.

The mechanisms of recovery of manual dexterity after unilateral lesion of the sensorimotor cortex in adult primates remain a matter of debate. It has been proposed that the cortical zone adjacent to the lesion may take over part of the function of the damaged cortex. To investigate further this possibility, two adult (4-5 years old) macaque monkeys were trained to perform a natural precision-grip task to assess hand dexterity. Intracortical microstimulations (ICMS) were used to map the hand area in M1 on both hemispheres. Ibotenic acid was then injected intracortically to damage the representation in M1 of the preferred hand. Subsequent histological analysis indicated that the hand representation in M1 was indeed lesioned, but, due to a spread of ibotenic acid, the lesion encroached a significant extent of the hand representation in the primary somatosensory cortex. A few minutes after infusion of ibotenic acid, there was a complete loss of dexterity of the preferred hand, which lasted for 1-2 months. Later, a progressive functional recovery of the affected hand took place over a 3- to 4-month period, reaching a stable level corresponding to 30% of the pre-lesion behavioral score. ICMS remapping, conducted nine months after the lesion, revealed that stimulation of the intact or lesioned M1 did not induce any visible movement of the recovered hand. The M1 hand representation on the intact hemisphere was similar to that observed before the lesion. Transient inactivation of the M1 hand/arm areas or of the dorsal and ventral premotor cortical areas (PM) on both hemispheres was undertaken by using microinjections of the GABA-agonist muscimol. Inactivations of M1 had no effect. Inhibition of PM in the damaged hemisphere suppressed the recovered manual dexterity of the affected hand. These results suggest that PM plays a significant role in the incomplete functional recovery of hand dexterity following unilateral damage of the sensorimotor cortex in adult monkeys.

Animals↗

PubMedDate not supplied

Validity and reliability of the dexter hand evaluation and therapy system in hand-injured patients.

This study compares measurements obtained using the Dexter Hand Evaluation and Therapy System with those obtained using manual goniometers and grip and pinch dynamometers. Intrarater and inter-rater reliabilities for each tool were also examined. Repeated digit range of motion and strength measurements were performed on 30 subjects who had prior upper extremity injuries. Three therapists performed all measurements on each subject three times, using both Dexter and manual instruments. Analyses of variance (ANOVAs) and intraclass correlation coefficients (ICCs) were used to assess concurrent validity and therapist reliability. The findings show that the computerized Dexter finger goniometer and grip and pinch dynamometers provide measurements that are statistically similar to those of their manual counterparts. The ANOVA results for concurrent validity showed no significant differences between mean measurement values across therapists for the Dexter tools compared with the manual tools (p> or =0.54). In addition, no significant differences were found among or between the therapists' measurements. The range of ICCs for intrarater and inter-rater reliability for all four tests was 0.86 to 0.99. However, a two-way ANOVA revealed a therapist effect during pinch strength measurements (p< or =0.05), suggesting the need for same-therapist and same-tool measurements until the Dexter pinch dynamometer has been further evaluated.

Adult↗

PubMedDate not supplied

Reliability of the NK dexterity board.

The NK computerized hand evaluation system includes a dexterity board that can be used to measure patients' ability to manipulate small, medium, and large objects. This study evaluated the test-retest reliability of the NK dexterity test. Thirty-seven healthy subjects aged 20 to 54 years completed two occasions of dexterity testing. Each occasion included bilateral dexterity tests consisting of two trials of each of three subtests. Intraoccasion intraclass correlation coefficients (ICCs) indicated fair to excellent reliability (ICC, 0.53-0.86). Interoccasion ICCs tended to be lower and ranged from 0.39 to 0.83, depending on the subtest. Reliability tended to be higher with the dominant hand than with the nondominant hand. Improvements in equipment design and alternative testing protocols may be needed to ensure consistently excellent reliability in dexterity scores with this test.

Adolescent↗

PubMed2002

Acquisition and maintenance of endoscopic skills: developing an endoscopic dexterity training system for anesthesiologists.

The acquisition and maintenance of essential psychomotor skills that are only required sporadically is a significant problem in medical training and practice. It is of particular relevance to anesthesiologists with regard to fiberoptic intubation, a technique that may be under-utilized despite its central role in the management of the difficult airway. Dexterity deficit due to current training models, dexterity decay due to lack of practice, and situational stress related to the clinical environment may combine to impede effective training and confident use of endoscopes in airway management. We describe an educational resource (Dexter), which has been developed to overcome these problems. Dexter is a nonanatomical, endoscopic dexterity training system designed to encourage practice and help establish and maintain a state of procedural readiness, even if clinical exposure to difficult airway situations is sporadic.

Anesthesiology↗

PubMed2002

Motor outcome after subcortical stroke: MEPs correlate with hand strength but not dexterity.

OBJECTIVE: Motor evoked potential (MEP) amplitude and threshold are predictors of functional outcome in the early stages after stroke, and improvement in these parameters usually accompanies motor recovery. The aim of this study in patients with subcortical stroke was to determine whether there is a correlation between MEP amplitude and threshold and the degree of recovery of strength and dexterity in the affected hand. METHODS: MEP amplitude and threshold were measured on the affected and unaffected sides in 23 patients who had suffered a subcortical ischaemic stroke up to 23 years previously. Grip strength was measured using a hand-held dynamometer and dexterity was assessed using a modification of the McCarron test battery. RESULTS: Grip strength correlated with both MEP amplitude and threshold (r=0.49 and r=-0.54, respectively, P<0.05), whereas the McCarron score for motor dexterity did not correlate significantly with either of these MEP parameters. CONCLUSIONS: Grip strength and dexterity correlate differentially with MEP parameters of excitability and conduction in the corticospinal pathway after recovery in patients with subcortical stroke. Grip strength is dependent on restoration of corticospinal excitability and conduction whereas additional factors such as cortical reorganization may underlie recovery of motor dexterity.

Adult↗

PubMed1998

Dexterity in adult monkeys following early lesion of the motor cortical hand area: the role of cortex adjacent to the lesion.

Infant monkeys were subjected to unilateral lesions of the motor cortex (mainly its hand representation). After maturation, they showed normal use of the contralateral hand for global grip movements. However, as compared with the ipsilateral hand, precision grip tasks requiring relatively independent finger movements were performed with less dexterity, particularly if adjustments of the wrist position were necessary. The purpose of this study was to investigate mechanisms which may be responsible for the rather well, although not complete, preservation of manipulative behaviour of these adult monkeys. To this end, the hand representations were mapped bilaterally with intracortical microstimulation in the mature monkeys, and the dexterity of both hands assessed quantitatively in a precision grip task. The behavioural effects of reversible inactivations of the primary (M1) and supplementary (SMA) motor cortical areas were then tested. The following were found. (i) The hand contralateral to the lesion exhibited subtle but significant dexterity deficits, as compared with the ipsilateral hand; the deficit was essentially for complex movements requiring dissociation of the thumb-index finger pinch from the other digits, involving also an arm rotation. (ii) Reversible inactivation of the M1 hand representation in the intact hemisphere dramatically impaired dexterity of the opposite hand without affecting the ipsilateral hand (contralateral to the early lesion). (iii) A relatively complete hand representation was found to occupy a new territory, medial to the old lesion. (iv) The role of this new displaced representation was crucial for the preserved dexterity of the opposite hand, as evidenced by its functional inactivation. In contrast, inactivation of both SMA cortices did not interfere with the manipulative behaviour. It is thus concluded that the preserved functional capacity of manipulations with the hand opposite the early lesion can be essentially attributed to a cortical reorganization around the old lesion. Under the present experimental conditions, contributions from either the SMA or the intact M1 appear not to be crucial.

Animals↗

PubMed2001

Change in strength and dexterity after open carpal tunnel release.

Few studies have documented the long-term recovery of hand function after open carpal tunnel release surgery. Grip strength and manual dexterity were measured before and every five weeks up to 25 weeks after open carpal tunnel release in a sample of 11 affected wrists. Dexterity scores prior to surgery were substantially (nearly 3sd) below normative levels. There was a significant (t10=5.45, P<0.001) 37% decrease in grip strength immediately following surgery. Trend analysis of the data indicated a significant second order pattern for the decrease and recovery of grip strength, and a significant linear pattern of recovery of dexterity following surgery. The strength and dexterity tests were effective in documenting changes in function in recovery from open carpal tunnel release surgery, but grip strength and dexterity in these subjects only recovered to pre-operative levels at 25 weeks.

Carpal Tunnel Syndrome↗

PubMed1993

Hand dexterity in hospital personnel with multiple needlestick injuries.

OBJECTIVE: To test the hypothesis that multiple needlestick injuries in hospital employees may be due to intrinsic deficits in hand dexterity. DESIGN: A case-control study comparing employees with multiple reported needlestick injuries to those with none. Hand dexterity was tested using the Purdue Pegboard Test, a standardized validated test of hand dexterity. SETTING: A 300-bed, acute care teaching hospital. PARTICIPANTS: Fifteen hospital employees who sustained four or more injuries were compared to 19 controls. RESULTS: No differences were detected in hand dexterity between the case and control groups. CONCLUSIONS: While employees with multiple needlestick injuries accounted for 85% of reported injuries, underlying factors responsible for injuries in this high-risk subgroup do not include measurable deficits in hand dexterity.

Case-Control Studies↗

PubMed2003

Correlation between impaired dexterity and corticospinal tract dysgenesis in congenital hemiplegia.

One of the most devastating consequences of early corticospinal lesions is the impaired dexterity that results in a noticeable deficit while manipulating small objects. One purpose of the present study was to investigate the extent to which a deficit in the coordination of fingertip forces when grasping and lifting an object between the thumb and index finger could account for the impaired dexterity in patients with congenital hemiplegia (CH). A second objective was to examine whether, in these patients, deficits in skilled hand movements are correlated with the importance of structural damage to the corticospinal tract. The scaling and coordination of fingertip forces during precision grip was investigated in 16 CH patients (aged 8-19 years) and 16 age- and sex-matched control subjects. Proprioception, stereognosis, pressure sensitivity and motor upper limb function (including digital and manual dexterity) were also assessed quantitatively. The structural damage of the corticospinal tract was estimated by measuring the cross-sectional area of cerebral peduncles with MRI and by calculating an index of symmetry between the two peduncles. In CH patients, a large number of parameters measured during the grip-lift task were significantly different when compared with those found in control subjects. Among those, the duration of the preloading and loading phases was significantly longer in CH patients. In addition, both the dissimilarity and time-shift between the profiles of the grip and load force rates, quantified with the cross-correlation method, were also significantly larger in CH patients; the time-shift was strongly correlated with impaired dexterity. These findings suggest that impaired dextrous finger movements in CH patients may specifically result from their inability to ensure a precise synergy between fingertip forces while manipulating an object. Finally, the finding that the time-shift also correlated with the corticospinal tract dysgenesis, as estimated with the cerebral peduncle asymmetry, argues in favour of a critical role of the corticospinal system in the temporal coordination between different muscles involved in dextrous hand movements. Both digital and manual dexterity were also altered in the non-paretic hand of CH patients. This deficit may reveal the contribution of the lesioned hemisphere to the control of ipsilateral skilled finger movements.

Adolescent↗

PubMed1994

Dexterity testing as a predictor of oral care ability.

OBJECTIVE: To examine a spectrum of elderly people to determine if hand function/dexterity measures can predict oral care ability. DESIGN: A series of dental, hand function, and dexterity measures were assessed by blinded examiners. Plaque scores were used as the criterion standard to assess plaque removal ability. PATIENTS: A convenience sample of 52, predominately male, elderly patients were recruited from the patient population of the Portland Veteran Affairs Medical Center and a community nursing home. Entry into the study required that the patient be able to give consent, be age 65 or older, have a minimum of six contiguous teeth or a minimum of 12 teeth total, be medically stable, have grossly adequate vision, and be able to hear and understand spoken instructions. OUTCOME MEASURES: The primary outcome measure was plaque score, as defined by the Turesky modification of the Quigley-Hein index. This was related to four dexterity tests (Jebsen-Taylor Hand Function test, Nine-hole Peg test, Box and Block test, Toothbrushing Ability test), a grip strength measure, and a cognitive measure (Allen Cognitive Level Test). RESULTS: Oral hygiene was significantly impaired among institutionalized elderly compared with outpatient elderly (P < 0.001), as was dexterity (P < 0.001). All dexterity tests correlated significantly with plaque score (Spearman rho: 0.49-0.77; P < 0.000). Forward stepwise regression analysis identified the Toothbrushing Ability Test (P < 0.0001) and the time spent brushing (P = 0.007) as the most significant predictors of plaque score. CONCLUSIONS: Results suggest oral hygiene ability is decreased among long term care residents, that dexterity tests can help identify patients unable to perform adequate oral self-care, and that these tests could be used to estimate brushing ability among elderly compromised patients.

Aged↗

PubMed2005

Practice reduces motor unit discharge variability in a hand muscle and improves manual dexterity in old adults.

A steadiness-improving intervention was used to determine the contribution of variability in motor unit discharge rate to the fluctuations in index finger acceleration and manual dexterity in older adults. Ten healthy and sedentary old adults (age 72.9 +/- 5.8 yr; 5 men) participated in the study involving abduction of the left index finger. Single motor unit activity was recorded in the first dorsal interosseus muscle before, after 2 wk of light-load training (10% maximal load), and after 4 wk of heavy-load training (70% maximal load). As expected, the light-load training was effective in reducing the fluctuations in index finger acceleration during slow shortening (0.25 +/- 0.12 to 0.13 +/- 0.08 m/s(2)) and lengthening contractions (0.29 +/- 0.10 to 0.14 +/- 0.06 m/s(2)). Along with the decline in the magnitude of the fluctuations, there was a parallel decrease in the coefficient of variation for discharge rate during both contraction types (33.8 +/- 6.8 to 25.0 +/- 5.9%). The heavy-load training did not further improve either the fluctuations in acceleration or discharge rate variability. Furthermore, the manual dexterity of the left hand improved significantly with training (Purdue pegboard test: 11 +/- 3 to 14 +/- 1 pegs). Bivariate correlations indicated that the reduction in fluctuations in motor output during shortening (r(2) = 0.24) and lengthening (r(2) = 0.14) contractions and improvement in manual dexterity (r(2) = 0.26) was directly associated with a decline in motor unit discharge rate variability. There was a strong association between the fluctuations in motor output and manual dexterity (r(2) = 0.56). These results indicate that practice of a simple finger task was accompanied by a reduction in the discharge rate variability of motor units, a decrease in the fluctuations in motor output of a hand muscle, and an improvement in the manual dexterity of older adults.

Action Potentials↗

PubMed2003

Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke.

BACKGROUND AND PURPOSE: To improve the accuracy of early postonset prediction of motor recovery in the flaccid hemiplegic arm, the effects of change in motor function over time on the accuracy of prediction were evaluated, and a prediction model for the probability of regaining dexterity at 6 months was developed. METHODS: In 102 stroke patients, dexterity and paresis were measured with the Action Research Arm Test, Motricity Index, and Fugl-Meyer motor evaluation. For model development, 23 candidate determinants were selected. Logistic regression analysis was used for prognostic factors and model development. RESULTS: At 6 months, some dexterity in the paretic arm was found in 38%, and complete functional recovery was seen in 11.6% of the patients. Total anterior circulation infarcts, right hemisphere strokes, homonymous hemianopia, visual gaze deficit, visual inattention, and paresis were statistically significant related to a poor arm function. Motricity Index leg scores of at least 25 points in the first week and Fugl-Meyer arm scores of 11 points in the second week increasing to 19 points in the fourth week raised the probability of developing some dexterity (Action Research Arm Test >or=10 points) from 74% (positive predictive value [PPV], 0.74; 95% confidence interval [CI], 0.63 to 0.86) to 94% (PPV, 0.83; 95% CI, 0.76 to 0.91) at 6 months. No change in probabilities of prediction dexterity was found after 4 weeks. CONCLUSIONS: Based on the Fugl-Meyer scores of the flaccid arm, optimal prediction of arm function outcome at 6 months can be made within 4 weeks after onset. Lack of voluntary motor control of the leg in the first week with no emergence of arm synergies at 4 weeks is associated with poor outcome at 6 months.

Acute Disease↗

PubMed2000

Recovery of ipsilateral dexterity after stroke.

UNLABELLED: BACKGROUND AND PURPOSE; Previous work indicated that patients within 1 month of parietal or posterior frontal damage are often abnormally slow or clumsy when using the ipsilateral hand for dexterity tasks. This article reports a 6-month follow-up study to assess recovery and the impact on functional outcome. METHODS: Twenty-four patients (80%) were available for follow-up. They used the ipsilateral hand on a dexterity test that simulated everyday hand function. Weakness and ideomotor apraxia were also assessed. Performance was compared with that of healthy age-matched control subjects using the same hand. Rating scales for self-care and dexterity in everyday life were completed by patients and carers. RESULTS: Significant recovery had occurred on all measures, but patients with left hemisphere damage remained impaired on the dexterity test, with 7 patients (58%) scoring below the normal range. Five of these were apraxic. Reports of everyday functioning did not reflect this impairment, but there were inconsistencies in these reports, which raised doubts as to their accuracy. CONCLUSIONS: Ipsilateral dexterity shows recovery during the first 6 months, but there may be persistent impairment related to apraxia after left hemisphere stroke. It appears that the impact of this on functional outcome is typically small compared with the large effect of severity of contralateral paresis. It may be a significant factor in some cases, however, and direct observation of everyday functioning would be needed to clarify more subtle effects on outcome.

Aged↗

PubMed2003

Changes in manual dexterity following short-term hand and forearm immersion in 10 degrees C water.

BACKGROUND: Following accidental immersion in cold water, the chance of survival through the initial short-term period may depend on manual dexterity for survival tasks. We aimed to study the time course of impairment of manual dexterity during the initial stages of immersion. METHODS: We investigated gross (manipulating harness buckles) and fine (Purdue Pegboard Assembly) manual dexterity of 11 male and 15 female subjects with either no immersion (Control) or after immersion of right and left hand and forearm in 10 degrees C water for 30, 120, and 300 s. Exposure lengths were presented in a counter-balanced order in a single session. RESULTS: Mean local skin temperature decreased significantly with cold-water immersion, with the amount of cooling proportional to the length of exposure. Buckle test times increased significantly from 9.1 +/- 3.0 s during Control to similar values of 19.5 +/- 11.1 s and 18.14 +/- 12.1 s after 120 and 300 s of immersion. Pegboard scores were significantly lower at 40.2 +/- 7.6 pieces following 300 s of immersion compared with Control and 30 s values of 49.0 +/- 6.4 and 47.2 +/- 6.9 pieces, respectively. CONCLUSIONS: It is concluded that fine and gross manual dexterity were rapidly and progressively impaired with short-term cold-water immersion. Therefore, efforts must be made to protect the hands/forearms from cold and to ensure survival equipment manipulation requires as little dexterity as possible.

Adolescent↗