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At least 379 records · Page 21Linked to original sources

PubMed2004

Effective nonanatomical endoscopy training produces clinical airway endoscopy proficiency.

We studied the effectiveness of two nonanatomical endoscopic dexterity training models: "Choose the Hole" and Dexter. Effectiveness was assessed in terms of time spent training, subjective rating, performance on an anatomical manikin, and clinical performance on fellow participants who acted as awake subjects. Forty-three anesthesia specialists, trainees, and technicians volunteered. Performances were videotaped, timed, and scored with a Global Rating Scale (GRS) from 1 (very poor) to 5 (clearly superior). The Dexter group spent more time training than the Choose the Hole group (median time [range], 152 min [70-510 min] versus 75 min [17-281 min]; P < 0.01). Subjective ratings were better in the Dexter group. In clinical bronchoscopy, the Dexter group was faster (30.7 s [17.1-43.5 s] versus 36.6 s [22.8-105.1 s]; P = 0.02) and had higher GRS scores (mean [sd]: 3.0 [0.4] versus 2.6 [0.6]; P = 0.04), indicating superior performance. Clinical and manikin performance (GRS scores) were significantly correlated (rho = 0.62; P = 0.0001). Benchmark levels of clinical bronchoscopic performance can be anticipated from bench model performance without a clinical learning curve. Dexter is a more effective model for learning endoscopic dexterity than the Choose the Hole model. Airway topicalization with lidocaine in a dose range consistent with published series (490-980 mg or 7.14-14.77 mg/kg) resulted in a frequent incidence of side effects. No major adverse events occurred.

Bronchoscopy↗

PubMedDate not supplied

A comparison of static and dynamic wrist splints using electromyography in individuals with rheumatoid arthritis.

This study compared strength, dexterity, and the muscle activation of individuals with rheumatoid arthritis (RA) when different splints were worn. Five persons with RA were observed in four splint conditions (none, static, hinged, spiral) during grip, pinch, and dexterity tests by recording muscle activity of eight muscles in the upper extremity using electromyography (EMG). Statistically significant differences were found in clinical tests when hinged (p<0.001) and spiral splints (p=0.02) were worn. Grip strength decreased when hinged splints were worn, whereas two-point pinch increased and dexterity improved on the Nine-Hole Peg Test with the spiral splint. Although no significant EMG differences were found during different splint conditions, wrist muscles were recruited more for grip, and shoulder muscles were used most during pinch and dexterity tests. Individuals with RA who wore splints had decreased grip when wearing hinged splints, but improved pinch and dexterity were found when the spiral splint was worn. Increased use of proximal shoulder muscles was observed during pinch and dexterity tests with and without splints.

Adult↗

PubMed1984

Lithium stimulation of murine hematopoiesis in liquid culture: an effect mediated by marrow stromal cells.

Lithium has previously been observed to stimulate in vitro Dexter culture hemopoiesis with increases in granulocytes, megakaryocytes, and pluripotent stem cells (CFU-S). In the present study, a two-phase murine Dexter culture system was established to study the mechanism of lithium-mediated stem cell stimulation. Different lots of horse sera or fetal calf sera were found to have markedly different effects on Dexter culture growth; given the appropriate sera supplementation, supernatant cells from Dexter cultures established from C57BL/6J mice 3 wk previously were free of stromal-forming capacity, but had stem cells and could grow on 900-950 R irradiated stroma. Conversely, in vitro irradiation (900-950 R) of 3-wk cultures resulted in a stem-cell-free adherent monolayer that could support growth for up to 9 wk in culture. The stroma from Dexter cultures preexposed to lithium chloride (1.0 mmole/liter) for 3 wk, irradiated (900 R), and then refed with 3-wk Dexter supernatant cells has an enhanced capacity to support cell production, CFU-S, and probably granulocyte-macrophage colony-forming cell (GM-CFU-C) production, as compared to stroma not preexposed to lithium. Lithium carryover was ruled out in these experiments. These data indicate that lithium stimulates CFU-S and in vitro granulopoiesis by an indirect effect on a radioresistant adherent stromal cell.

Animals↗

PubMed1998

[Standardization of a motor performance series for measuring fine motor disorders in Parkinson disease].

Some 114 patients with idiopathic Parkinson's disease (not demented, no tremor dominance; mean age: 67.0 years; mean duration of illness: 6.1 years) were subjected to the manual dexterity test "MLS" ("Motorische Leistungs Serie"). A retest was carried out 24 h later with no change in medication. Thus, adequate conditions were present for testing the stability of dimensions of manual dexterity. In addition, data from the initial measurement were normalized (T norms). The correlations of the values from both measurements (retest reliability) underscore the constancy of manual dexterity functions. Subtest show adequate stability of measurement so that they can be used for diagnosing dexterity disturbances in individual patients. Charts listing normal values and critical differences allow intra- and interindividual comparisons. It is thus possible to make statistically sound predictions for individual patients concerning the effectiveness of therapy or progression of illness with respect to manual dexterity. In addition, differences on the left and right sides can be tested for statistic significance.

Aged↗

PubMed2004

Human handedness: is there a difference in the independence of the digits on the preferred and non-preferred hands?

In non-human primates, comparative studies show that greater dexterity is associated with greater independent control over the digits. Studies of humans, however, show no difference in the degree of independent control of single digits on the more dexterous preferred hand and its less dexterous partner. We wondered whether there might be a difference in the degree of independent control on the two hands during performance of functionally relevant tasks. Many object manipulation tasks require the ability to produce and control forces with more than one finger at the same time. We hypothesized that asymmetrical independence, with greater independence on the preferred than the non-preferred hand, would be evident with a task that requires the simultaneous production of force in two digits. We examined digit individuation when subjects produced flexion forces with a single digit in isolation, and simultaneous flexion forces in all ten combinations of two digits. Consistent with previous studies, we found no difference between the individuation of the digits on the preferred and non-preferred hands during force production with single digits in isolation. Similarly, no asymmetry was present when forces were produced by two digits. However, separation of two-digit forces into thumb-to-digit opposition forces and non-opposition forces showed that although there was no difference in individuation between the two hands for non-opposition forces, the digits on the preferred hand were more independent than those on the non-preferred hand for opposition forces. We suggest that this independence asymmetry is not itself the underlying cause of the dexterity differences between the hands, but rather arises from a difference in the capacity for use-dependent reorganization of the motor cortical circuits controlling each hand, and that this difference might underlie the dexterity differences between the hands.

Adult↗

PubMed2001

The performance of master surgeons on standard aptitude testing.

BACKGROUND: Identification of the desired psychomotor abilities of optimal surgical performance, if possible, would be useful in the selection of surgical trainees. The aim of this study was to determine the level of these abilities among endoscopic consultant surgeons held in high regard by their peers. METHODS: Twenty endoscopic consultant "master" surgeons were tested on three aptitude tests: the Gibson Spiral Maze Test (error score measures eye-hand coordination), the Crawford Small Parts Dexterity Test (execution time indicates manual dexterity), and the Space Relations Test (correct scores reflect visuo-spatial ability). Their performance was compared with that of 20 medical students and the reference norm as provided by the tests' manuals. RESULTS: The median scores of master surgeons fell in the 20th, 24th, and 30th percentiles, whereas the scores of medical students fell in the 50th, 20th, and 65th percentile of norm reference for the Gibson Spiral Maze, Crawford Small Parts Dexterity, and Space Relations tests, respectively. The master surgeons enacted significantly fewer errors (Gibson Spiral Maze), had similar execution times (Crawford Small Parts Dexterity), and lower visuo-spatial scores (Space Relations) than medical students. CONCLUSION: The level of eye-hand coordination and manual dexterity of master surgeons was found to be higher than that of the average norm including medical students, while their visuo-spatial ability was lower.

Aptitude Tests↗

PubMed1999

Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial.

BACKGROUND: We investigated the effects of different intensities of arm and leg rehabilitation training on the functional recovery of activities of daily living (ADL), walking ability, and dexterity of the paretic arm, in a single-blind randomised controlled trial. METHODS: Within 14 days after stroke onset, 101 severely disabled patients with a primary middle-cerebral-artery stroke were randomly assigned to: a rehabilitation programme with emphasis on arm training; a rehabilitation programme with emphasis on leg training; or a control programme in which the arm and leg were immobilised with an inflatable pressure splint. Each treatment regimen was applied for 30 min, 5 days a week during the first 20 weeks after stroke. In addition, all patients underwent a basic rehabilitation programme. The main outcome measures were ability in ADL (Barthel index), walking ability (functional ambulation categories), and dexterity of the paretic arm (Action Research arm test) at 6, 12, 20, and 26 weeks. Analyses were by intention to treat. FINDINGS: At week 20, the leg-training group (n=31) had higher scores than the control group (n=37) for ADL ability (median 19 [IQR 16-20] vs 16 [10-19], p<0.05), walking ability (4 [3-5] vs 3 [1-4], p<0.05), and dexterity (2 [0-56] vs 0 [0-2], p<0.01). The arm-training group (n=33) differed significantly from the control group only in dexterity (9 [0-39] vs 0 [0-2], p<0.01). There were no significant differences in these endpoints at 20 weeks between the arm-training and leg-training groups. INTERPRETATION: Greater intensity of leg rehabilitation improves functional recovery and health-related functional status, whereas greater intensity of arm rehabilitation results in small improvements in dexterity, providing further evidence that exercise therapy primarily induces treatment effects on the abilities at which training is specifically aimed.

Activities of Daily Living↗

PubMed1991

[A new test for the functional evaluation of the hand and its contribution to the study of toe transfers: the 5 matches test called "Take Five"].

After studying a series of thumbs reconstructed by 2nd toe transfer, we devised a new dexterity test: the "five matches test" or "Take Five Test" (R.S.). This test consists of the standardised timed and comparative pick-up of 5 identical fine objects (matches), permitting a simple and quick evaluation which objectively quantifies dexterity in fine pinches. The specificity of our test is that it is bilateral and comparative providing a narrow range of normality. In fact, a marked variability of time-scores is found between different individuals of a normal population, making it difficult to determine a "normal dexterity" criterion. But in the same person, there is little variability between two successive experiments or between the dominant and non-dominant hands. Examining a reconstructed hand, we have chosen as the "normal dexterity" criterion the time-score of the contralateral spared hand, timed first. The final score (from 0 to 4 points) is based on the difference between time-scores of the 2 hands (delay tested hand/spared hand). The "Take Five Test" (five matches pick-up test) has largely proven its efficiency in studying a series of thumbs reconstructed by 2nd toe transfer (operated on by V.M.). Fine pinch dexterity is satisfactory in 45% of cases (65% when long digits are spared), scoring at least 2 points (delay less than 4 seconds). The average score is 1.6 pts (range: from 0 to 4). This test could prove the functional value of parameters such as phalangeal mobility and a short delay between injury and reconstruction.

Adolescent↗

PubMed2002

Relationship between skill and outcome in the laboratory-based model.

BACKGROUND: Recent attention has been directed at developing quantitative assessments of surgical skill. This study aims to demonstrate whether objectively measuring differences in manual dexterity has an impact on a simulated surgical procedure. METHODS: Six general surgical trainees performed 5 polytetrafluoroethylene graft to artery anastomoses on a vascular model by using a standardized technique. Manual dexterity was objectively measured with (1) electromagnetic motion analysis: trackers applied to the backs of hands recorded and analyzed both hand movements and procedural time and (2) 4-parameter evaluation of the final product. Outcome parameters were assessed by (1) rate of anastomotic leakage and (2) smallest cross-sectional area of the anastomosis. RESULTS: The 2 objective measures of manual dexterity correlated closely (Pearson coefficient, 0.423; P <.02). Trainees with better manual dexterity scores produced better outcome measures. Those with better motion analysis scores produced anastomoses that leaked less (Pearson coefficient, 0.514; P <.01) and those with higher global evaluation scores had a larger anastomotic cross-sectional area (Pearson coefficient, 0.495; P <.01). Time taken for the procedure did not appear to influence either outcome measure. CONCLUSIONS: There is a significant correlation between objective measures of manual dexterity and the outcome measures in this model. This suggests that the outcome of a procedure can be predicted by measuring surgical skill.

Blood Vessel Prosthesis↗

PubMed2004

The macroanatomy of coronary arteries in donkeys (Equus asinus L.).

The aim of this study was to define the arteries that supply the cardiac muscle in donkeys with regard to their course and possible variations. Six hearts belonging to donkeys of different age and sex constituted the material of the study. Following exposition of the arteries by means of injection of latex coloured with Rotring ink to a. coronaria sinistra and a. coronaria dextra, dissection was performed. The arterial vascularization of the heart in donkeys was determined to be supplied by a. coronaria sinistra and a. coronaria dextra which originate from the aorta. A. coronaria sinistra, measured to be larger than a. coronaria dextra, was determined to have its origin at the aorta, at the level of the free border of valvula semilunaris sinistra, and to extend between truncus pulmonalis and auricula sinistra. The mentioned artery was detected to give off two branches, namely, ramus interventricularis paraconalis and ramus circumflexus sinister which extend in sulcus interventricularis paraconalis and sulcus coronarius, respectively. However, a. coronaria dextra was determined to have its origin at the beginning of the aorta, at the level of valvula semilunaris dextra, and to extend to margo ventricularis dexter between truncus pulmonalis and auricula dexter. This study has revealed ramus interventricularis subsinuosus and ramus circumflexus dexter to intercommunicate by means of anastomosis and to form a. coronaria dexter. Examination of material revealed the absence of anastomosis between r. circumflexus sinister and r. circumflexus dexter. Branches named rami septales, originating from ramus interventricularis paraconalis and ramus interventricularis subsinuosus were determined to supply septum interventriculare. Ramus proximalis atrii sinistri was determined to have its origin at ramus circumflexus sinister whereas ramus proximalis venriculi dextri was determined to stem from the beginning of a. coronaria dextra in the material of this study. However, examination of the cranial and caudal branches of ramus coni arteriosi, revealed the cranial branch to be ramus proximalis ventriculi dextri in a cadaver.

Animals↗

PubMed2006

[The levels of recognition and hand functions of patients with Alzheimer's disease: a pilot study based on the simple test for evaluating hand function].

AIM: The purpose of this study was to analyze the levels of recognition and hand functions of the patients with Alzheimer's disease (AD) based on the Simple Test for Evaluating Hand Function (STEF). METHODS: Forty subjects with AD (AD group) and 20 without AD (control group) in a facility for elderly health care services participated in this study. The AD group consisted of 20 subjects with Clinical Dementia Rating (CDR) 1 and 20 other subjects with CDR2. RESULTS: The results were as follows: Time required for full motion of right hand dexterity was significantly longer in both the CDR1 and CDR2 groups compared to the control group (p < 0.05, p < 0.01). Time required for the control group and CDR1 group were significantly shorter for motion of right hand dexterity compared to the left hand. No significant difference was observed between the times of right and left hand dexterity among subjects of CDR2. The disparity of right-left hand dexterity decreased in the order of control, CDR1 and CDR2. The correlations between the sub-items for CDR scale and the right-left hand disparity were significant in "memory" and "judgment". The right-left hand disparity decreased with the shortened time for left hand motion, as the "memory" or "judgment" scores increased. CONCLUSION: These findings suggest that right hand dexterity speed in patients in the mild AD stage was low when their dominant hand superiority declined. Moreover the decline of dominant hand superiority correlated with the recognition of memory and judgment.

Aged↗

PubMed1999

The skill components of a therapeutic chopsticks task and their relationship with hand function tests.

Chopsticks are the primary tools used for eating and the physical movements of control are familiar to Chinese people. Chopsticks are easy to obtain in most rehabilitative settings. Occupational therapists often guide patients to practice miscellaneous chopsticks tasks to increase hand function in any case. The objective of this study was to investigate the skill components of the therapeutic chopsticks task and their relationship with hand function tests, and to identify clinical value. Eighty normal subjects (41 males and 39 females) whose age ranged from 17 to 26 years old participated in this study. Five standard hand function tests including three dexterity tests [Minnesota Rate of Manipulation Test (MRMT), Purdue Pegboard Test, and O'Connor Tweezer Dexterity Test (OTDT)], and two strength tests (Jamar Handgrip Test, and Pinchometer Test) were chosen to measure the dexterity and strength of hands. Additionally, the Test of Chopsticks Manipulation (TCM) was designed and used to assess the chopsticks manipulation skills. Subjects were tested with all the hand function tests and TCM in a random sequence. Results of six tests were obtained for each subject. Factor analysis showed that the skill components of TCM should be categorized into the "dexterity" component. In addition, a significant relationship (p < 0.05) was only seen between TCM and OTDT, there was no significant correlation between TCM and the other hand function tests. Findings in this study are valuable in setting the rehabilitation programs for patients with dexterity problems.

Adolescent↗

PubMed2005

Synchronized video and motion analysis for the assessment of procedures in the operating theater.

HYPOTHESIS: Objective assessment of surgical skill has recently been shown to be possible through the use of dexterity-based and video analysis systems. The aim of this study was to synchronize these 2 modalities to produce a comprehensive surgical assessment tool. DESIGN: The Imperial College Surgical Assessment Device is a dexterity-based motion analysis device that has been developed in the Department of Surgical Oncology and Technology by the Surgical Computing and Imaging Research Group. Further advances to this system have been made to enable synchronized acquisition of hand kinematics and video from real procedures, and their concurrent analysis. To test the feasibility of the system, 10 laparoscopic cholecystectomies performed by 5 different surgeons on consenting patients were recorded. Analysis focused on the entire procedure and also on specific parts of the operation such as the clipping and cutting of the cystic duct and artery. RESULTS: Dexterity analysis was performed using the objective measures of time, path length, number of movements, velocities, and trajectories. Comparative analysis of a surgeon's dexterity was carried out on the whole procedure and by using the synchronized zoom facility in the software. Kinematic signals revealed rapid changes in velocity caused by alternating between different instruments or occurring after complications such as bleeding. CONCLUSION: This new motion analysis system has been shown to be an effective tool for the comprehensive assessment of operative procedures.

Cholecystectomy, Laparoscopic↗

PubMed1995

Arthritis hand function test: inter-rater reliability among self-trained raters.

OBJECTIVE: The purpose of this project was to examine the inter-rater reliability of the Arthritis Hand Function Test (AHFT), a new instrument for measuring hand strength and dexterity in adults with arthritis. METHODS: Six occupational therapists (two at each of three sites) trained themselves as AHFT administrators using the test manual and training videotape. They recruited 30 adult subjects (10 at each site) with rheumatoid arthritis or osteoarthritis affecting the hands. There were 21 women and 9 men in the sample (mean age, 57.5 years; average time since diagnosis, 14.8 years). Subjects were tested twice, once by each rater from that site. RESULTS: Inter-rater reliability ranged from 0.45 to 0.99 (Pearson r). Because subjects were tested twice, AHFT scores were examined for an order effect. Although scores on all strength items declined by the second test session, and improved for all dexterity items, only the aggregate applied dexterity score showed significant change across all three sites (P = 0.002, 0.001, and 0.031, respectively). CONCLUSIONS: These results suggest the AHFT is a reliable instrument for measuring hand strength and dexterity that requires minimal training on the part of occupational therapist raters.

Arthritis↗

PubMed1992

Psychomotor testing and the ability to perform an anastomosis in junior surgical trainees.

Ten junior surgical trainees underwent objective testing of manual dexterity and visuospatial ability and were required to carry out five consecutive anastomoses on fresh porcine jejunum. Anastomoses were scored by a single observer and a cumulative error score (CES) derived for each procedure. In the first anastomosis there was little correlation between the psychomotor test results and the anastomosis scores. In subsequent trials there were significant negative correlations between aspects of manual dexterity and the CES. Over the five anastomoses there were significant negative correlations between improvement and manual dexterity, but there was a positive correlation between improvement and visuospatial ability (rs = 0.76, P < 0.005). Visuospatial skills are more important than pure motor ability in predicting the capacity to perform an anastomosis and tests of manual dexterity may be misleading in this context.

Adult↗

PubMed1986

Surgical aptitude test for otolaryngology-head and neck surgery resident applicants.

The search for a convenient, rapid manual dexterity examination, which could be used at the time of the otolaryngology resident applicant's interview, led us to assess the following areas: purposeful hand direction, depth perception, tactile discrimination, finger pressure coordination, finger visual tracking of moving objects, spatial visualization, finger strength, speed of movements, fine control precision, finger dexterity, steadiness during movement, steadiness without movement, and neatness. With the astronomical increase in applicants to a limited number of positions in the field of otolaryngology-head and neck surgery, the application of an accurate, efficient manual dexterity assessment at the time of applicant interview is desirable. Presently, dental school applicants are screened by a series of manual dexterity tests. To develop our screening test, we integrated manual performance tests currently in use by private industry, occupational therapists, and dental school admission committees. Thus, applicants who are able to master fine microsurgical and macrosurgical techniques common in our specialty will be preferentially selected.

Aptitude Tests↗

PubMed2006

Experimental muscle pain does not affect fine motor control of the human hand.

Conditions known to cause hand pain, such as arthritis, are often accompanied by impaired dexterity. The aim of this study was to determine whether this association is coincident, or whether pain affects dexterity directly. In the first part of the study, several tests of dexterity based on pegboard skills were compared with a precision-grip-lift task: the correlations between the results of any of these tests were not significant at the 0.01 level. Nineteen subjects were then tested with a modified Purdue pegboard test and the precision grip-lift task, both without pain and during pain induced by injection of 5% hypertonic saline into the first dorsal interosseous muscle of the non-dominant hand. There was no significant difference in the performance of either task when the muscle was painful, indicating that acute experimental muscle pain does not affect dexterity.

Adolescent↗

PubMed2005

The effect of delayed visual feedback on telerobotic surgery.

BACKGROUND: Telerobotic surgery is ideally suited for remote applications in which the instrument control console is stationed separately from the end-effectors at the patient's bedside. However, if the distance between the console and the patient is great enough, a lag effect or latency between end-effector manipulation and the depicted image leads to alterations in movement patterns. The purpose of this study was to determine the effect of visual delay on surgical task performance. METHODS: At an endoscopic skill station, an analogue delay device was interposed between the surgical field and monitor to delay the transmission of visual information, thus mimicking the distance effect of data transmission. Three surgeons with similar laparoscopic experience participated in the laparoscopic knot tying portion of the study, and seven residents participated in the accuracy and dexterity tasks. The time to complete a single throw was recorded in seconds after adding consecutively increasingly time delay in 50 ms increments. Similar time delay increments were added for the accuracy and dexterity tasks, which involved passing a needle through two adjacent circles and passing a small cylinder through a larger one to reproduce two-handed coordination and spatial resolution. Data were presented as the median time to complete each task. RESULTS: For all three tasks, an incremental increase in time delay was associated with a significant (p < 0.001) increase in the time to complete the task. For dexterity, a statistically significant (p <or= 0.05) delay was identified at 0.25 s of delay from control values without delay. A move-and-wait strategy was gradually adopted up to 0.4 s of visual delay. CONCLUSIONS: Compensation for visually delayed image perception occurs on several levels. Initial adaptations include slower end-effector manipulation; late adaptive changes include a move-and-wait strategy. Increased time to perform surgical maneuvers as well as diminished accuracy, diminished dexterity, and increasing fatigue represent additional performance encumbrances evoked by visual time delay. The nuances of both human and digital compensatory mechanisms for visual time delay must be defined and enhanced to maximize the potential for telerobotic surgical applications.

Adaptation, Physiological↗