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PubMed1992

One-stage key pinch and release with thumb carpal-metacarpal fusion in tetraplegia.

One-stage key pinch and release with carpal-metacarpal fusion, extensor pollicis longus tenodesis, and motor transfer to flexor pollicis longus were analyzed for functional results in tetraplegic patients. Eighteen patients (21 hands)--all with International Classification OCu:4 hand function or worse--were studied. Average follow-up was 42 months. All patients experienced significant increase in functional ability and thought the surgery was highly beneficial. Average pinch strength was 3.3 kg, whereas it had been nonmeasurable preoperatively. Both activities of daily living and pinch strength correlated with tetraplegic functional level. The patients with higher preoperative functional level had better postoperative activities of daily living scores and pinch strength. Sixteen hands had solid fusions, and patients with fibrous nonunions showed no decrease in pinch strength, pain, or functional limitations when compared with the patients who had solid fusions. Six hands showed degenerative changes at one or more adjacent joints, but this was not related to results.

Adolescent↗
PubMed1996

Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint of the thumb.

We assessed the results of 86 trapeziectomies in 83 patients. Simple excision of the trapezium was performed in 54 thumbs. This was combined with shortening of the abductor pollicis longus tendon in 14 thumbs and with soft-tissue interposition and/or ligamentous reconstruction in 17 thumbs. 88% of the patients were satisfied with the result, 76% had relief of pain and 74% had no functional disability. The subjective results achieved with the three different techniques were similar. Clinical assessment of 57 thumbs revealed no statistical difference in web span, thumb adduction-flexion, key pinch and grip strength between the three operative procedures, nor in comparison with the non-operated contralateral hand.

Adult↗
PubMed1997

Measurement of thumb abduction strength: normative data and a comparison with grip and pinch strength.

Abduction strength of the thumb was measured in normal men (n = 101; age range, 21-94 years) and women (n = 208; age range, 20-97 years). Abduction-strength measurements were conducted concurrently with grip and pinch strength measurements made by well-established clinical methods. Normal values were established and stratified by age and sex. Thumb abduction strength generally correlated with grip and pinch strength. All strength variables at all ages were greater in men than in women. The magnitude of all strength variables was maintained from 20 to 59 years of age, then decreased with increasing age in both men and women. Measurement of thumb abduction strength may prove to be a useful adjunct to the various tests currently used by hand surgeons to assess hand function.

Adult↗
PubMedDate not supplied

Grip strength testing reliability.

The purpose of this study was to investigate the test-retest reliability of isometric grip strength testing using the Jamar dynamometer. Thirty-three subjects, 16 men (mean age = 37.4 years) and 17 women (mean age = 35.5 years), were assessed on two separate occasions using four methods to determine grip strength score. The methods used were (1) the score of one trial, (2) the mean score of two trials, (3) the mean score of three trials, and (4) the highest score of three trials. All five handle positions of the Jamar dynamometer were used during testing. Although still within the limits of acceptability, position 1 was significantly less reliable when compared with the other handle positions. Because the four methods of determining grip strength score were not significantly different in reliability, it was not possible to recommend any method as being more accurate. To analyze curve shape further, grip strength curves for the strongest and weakest men and women were compared by transforming points on the curves into percentages of the maximum value. Transformed curves for both strong and weak subjects were almost identical, indicating that, for this sample, "flattening" of the grip strength curves was a function of weak grip. The present data do not support the use of raw score curve shape as an indicator of sincerity of effort during grip strength testing.

Adult↗
PubMed2000

Muscle performance in an urban population sample of 40- to 79-year-old men and women.

An urban population sample of 40 to 79-year-old men and women was investigated to evaluate the influence of age and activity level on muscle strength and endurance and to establish a reference material. During the investigation 144 persons were tested bilaterally, except for ankle strength, when only the right side was examined. Isometric muscle strength was determined in the knee extensors and flexors. Isokinetic (at 60 degrees/s and at 180 degrees/s) muscle strength was determined concentrically and eccentrically in the knee extensors and flexors. The dynamic and static endurance of the extensors was measured. Isometric strength was determined in the ankle plantar and dorsiflexor muscles. Isokinetic ankle plantar flexion strength was determined concentrically at 60 degrees/s with and without prior eccentric muscle contraction. Hand-grip strength was evaluated with a dynamometer. Walking velocity and the number of heel-rises were recorded. Physical activity level was assessed by questionnaire. Muscle biopsies were taken from the vastus lateralis muscle for histochemical and enzymatic analyses. Walking and the different muscle tests declined with age, and with a slight gender difference. Muscle biopsies showed a trend toward smaller muscle fibers with age. The results of our study can be used as reference material for clinical studies in different age groups.

Adult↗
PubMedDate not supplied

Grip and pinch strength in relation to function in denervated hands.

A study was conducted in the Schieffelin Leprosy Research and Training Centre, Karigiri, Tamil Nadu, from March to September 2000 to find out the relationship between grip and pinch strengths and basic activities of daily living (BADL) in leprosy patients. Sixty-two patients (mean age: 36.1 years) suffering from impairment of motor nerve function in one or both hands were included in the study. Grip strength and pinch strength, namely pulp-to-pulp pinch strength, lateral pinch strength, tripod pinch strength, were measured using a hydraulic hand dynamometer and a pinch gauge. BADL was assessed using Karigiri activities of daily living rating scale. Frequency table, mean, median, range, standard deviation, correlation and multiple regressions were used in analysis. The results showed that there was a highly significant correlation (p < 0.001) between the grip and pinch strength and BADL. Multiple regression analysis showed only tripod pinch strength had a significant, independent influence on the BADL. Other two pinch strengths and grip strength were not significant. These results suggest that there is a significant relationship between the grip and pinch strengths and BADL. The tripod pinch strength is the most important hand strength contributing to the problems in BADL. In a measure of association between impairment and disability, the results revealed that out of 62 patients with physical impairment of the hand, 59 (95.2%) had experienced disabilities. This indicated that, despite impairment, 4.8% do not have any disabilities.

Activities of Daily Living↗
PubMed2003

Comparison of maximal voluntary isometric contraction and hand-held dynamometry in measuring muscle strength of patients with progressive lower motor neuron syndrome.

Context. Maximal voluntary isometric contraction, a method quantitatively assessing muscle strength, has proven to be reliable, accurate and sensitive in amyotrophic lateral sclerosis. Hand-held dynamometry is less expensive and more quickly applicable than maximal voluntary isometric contraction. Objective. To investigate if hand-held dynamometry is as reliable and valid as maximal voluntary isometric contraction in measuring muscle strength in patients with an adult-onset, non-hereditary progressive lower motor neuron syndrome. Design. Two testers performed maximal voluntary isometric contraction and hand-held dynamometry measurements in six muscle groups bilaterally in patients with progressive lower motor neuron syndrome to assess reliability and validity of both the methods. Setting. Outpatient units of an academic medical center. Patients. A consecutive sample of 19 patients with non-hereditary progressive lower motor neuron syndrome (median disease duration 32.5 months, range 10-84) was tested. Outcome measures. Comparison between maximal voluntary strength contractions as measured by hand-held dynamometry and maximal voluntary isometric contraction. Results. Low intra- and interrater variation in all muscle groups were found, intraclass correlation coefficients vary between 0.86 and 0.99 for both methods. Both methods correlated well in all muscle groups with Pearson's correlation coefficients ranged between 0.78 and 0.98. Scatter plots indicated a trend to under-estimate muscle strength above 250 N by hand-held dynamometry as compared with maximal voluntary isometric contraction. Conclusions. For longitudinal evaluation of muscle strength in patients with progressive lower motor neuron syndrome (i.e. between 0 and 250 N), muscle strength can be accurate quantified with both hand-held dynamometry and maximal voluntary isometric contraction. Hand-held dynamometry has the advantage of being cheap and quickly applicable. However, our results indicate that hand-held dynamometry is less sensitive than maximal voluntary isometric contraction in detecting subnormal muscle strength in strong muscle groups (i.e. >250 N), due to limited strength of the tester.

Adult↗
PubMed2001

Responsiveness of the Cochin rheumatoid hand disability scale after surgery.

OBJECTIVE: To assess the responsiveness of the Cochin functional disability scale for the rheumatoid hand after surgery. METHOD: In a prospective study, patients with rheumatoid arthritis (RA) scheduled for surgery of the wrist and/or fingers were evaluated within 48 h before surgery and at least 6 months after surgery. Clinical outcome measures included duration of morning stiffness, total score for tenderness, total score for swelling, visual analogue scale score for pain in the hands and wrists, a score for overall mobility of the wrist and the fingers, grip and pinch strength, the Hand Functional Index (HFI), the Kapandji index and the Cochin scale. Responsiveness was assessed with the paired t-test, the effect size (ES), the standardized response mean (SRM) and the non-parametric Spearman rank correlation coefficient (r(S)). RESULTS: Fifty patients (42 women) were evaluated twice at an interval of 7.16 +/- 2.10 months (mean +/- s.d.) (range 6-15 months). Thirty-six patients (72%) were very satisfied or satisfied with the results of surgery, seven (14%) were not satisfied or dissatisfied and seven (14%) were dissatisfied or very dissatisfied. The Cochin scale score improved at the second visit (P < 0.0001), with SRM and ES values of 0.66 and 0.58 respectively. The correlation of the change in Cochin score with patient overall satisfaction was r(S) = 0.40. Among the impairment measures, grip strength showed the best responsiveness (SRM = - 0.43, ES = - 0.36, correlation with patient overall satisfaction r(S) = 0.46). The change in Kapandji index had the best correlation (r(S) = 0.51) with patient overall satisfaction but its SRM and ES values were low (- 0.19 and - 0.10 respectively). CONCLUSION: The Cochin scale is responsive and appropriate for the assessment of the effects of surgical treatments on disability in RA hands.

Adult↗
PubMed2002

Dance-based aerobic exercise may improve indices of falling risk in older women.

OBJECTIVE: to determine the effect of dance-based aerobic exercise on indices of falling in older women. DESIGN: an exercise intervention trial with participants assigned either to an exercise group or to a control group. SETTING: an exercise hall at a community centre for senior citizens. PARTICIPANTS: thirty-eight healthy women aged 72-87 years, living independently in the community. INTERVENTION: twenty women performed dance-based aerobic exercise for 60 minutes, 3 days a week, for 12 weeks. The exercise included single-leg standing, squatting, marching, and heel touching; and targeted balance, strength, locomotion/agility, and motor processing. MAIN OUTCOME MEASURES: single-leg balance with eyes open/closed and functional reach as balance, hand-grip strength and keeping a half-squat position as strength, walking time around two cones and 3-minute walking distance as locomotion/agility, and hand-reaction time and foot tapping as motor processing. RESULTS: at the pre-test, both exercise and control groups performed similarly in all tests. At the end of the intervention, the exercise group showed significantly greater single-leg balance with eyes closed, functional reach, and walking time around two cones. In contrast, there were no significant improvements in any of the test measures in the control group. CONCLUSIONS: dance-based aerobic exercise specifically designed for older women may improve selected components of balance and locomotion/agility, thereby attenuating risks of falling.

Accidental Falls↗
PubMed2004

Development and evaluation of osmotically controlled oral drug delivery system of glipizide.

Extended release formulation of glipizide based on osmotic technology was developed and evaluated. The effect of different formulation variables, namely, level of solubility modifier in the core, membrane weight gain, and level of pore former in the membrane, were studied. Drug release was found to be affected by the level of solubility modifier in the core formulation. Glipizide release was inversely proportional to the membrane weight but directly related to the initial level of pore former (PVP) in the membrane. Burst strength of the exhausted shells increased with the weight gain of the membrane. On the other hand, burst strength decreased with an increase in the level of pore former in the membrane. Drug release from the developed formulations was independent of pH and agitational intensity, but dependent on the osmotic pressure of the release media. Results of SEM studies showed the formation of pores in the membrane from where the drug release occurred. The numbers of pores were directly proportional to the initial level of pore former in the membrane. The manufacturing procedure was found to be reproducible and formulations were stable after 3 months of accelerated stability studies.

Delayed-Action Preparations↗
PubMed1997

Manual specialisation and tool use in captive chimpanzees (Pan troglodytes): the effect of unimanual and bimanual strategies on hand preference.

Hand preference for tool use was assessed in a sample of captive chimpanzees (Pan troglodytes). Whether the subjects solved the tool task using either a unimanual or coordinated bimanual strategy was manipulated in the chimpanzees. No population-level hand preference was found for tool use when unimanual strategies were used by the chimpanzees. However, a population-level right-hand bias was found when coordinated bimanual actions were required of the chimpanzees. A significant correlation was found in hand use for the two hand preference testing conditions. Neither sex nor rearing was found to significantly affect the direction or strength in hand preference. These results may explain discrepancies in hand preference reported in captive and wild chimpanzees with regard to tool use and other manual activities.

Journal Article↗
PubMed2002

Review of the reliability and validity of myometry with children.

Pediatric occupational therapists and physical therapists often measure muscle strength, and muscle strength frequently is cited as an indicator of function in clinical practice and in research. A reliable measure to quantify strength is necessary to accurately assess muscle strength so the values can be used for comparison, study, and indication of change. The hand-held myometer provides an alternative to traditional methods of manual muscle testing, and its reliability and validity have been examined in adults. The purpose of this review is to summarize the available literature relating to the reliability and validity of the hand-held myometer when used with children and to identify directions for future study in the use of myometers with children.

Child↗
PubMed1990

Influence of simultaneous bilateral exertion on muscle strength during voluntary submaximal isometric contraction.

The influence of simultaneous bilateral exertion on muscle strength was tested under the conditions in which the same or different levels of strength were exerted by the right and left arm (or hand). Isometric muscle strength of elbow flexion, elbow extension and hand grip was studied. Subjects voluntarily exerted 25%, 50%, and 75% of maximal strength based on their subjective judgement without the feedback of the strength actually exerted. Involuntary decrements of muscle strength were caused by the bilateral exertion. Muscle strength of both sides decreased under the condition where the same level of strength was exerted by the right and the left arm (or hand). When different levels of strength were exerted by each arm (or hand), the strength of the weaker side considerably decreased, while the strength of the stronger side did not decrease.

Adolescent↗
PubMed2006

[Specific strength measurement of musculus abductor pollicis brevis in order to objectively evaluate muscle regeneration after carpal tunnel release surgery].

47 patients with a carpal tunnel syndrome were preoperatively examined not only by electrophysical studies (nerve velocity and distal motoric latency) and clinical tests (Phalen's sign, Tinel's sign) but also by measuring the strength of the M. abductor pollicis brevis with a specifically designed strength-testing unit. 30 patients agreed to participate in a voluntary postoperative examination. In the 45 degrees -measurement there was a relative strength loss of the injured hand's thumb of about 25 % in comparison with the healthy hand preoperatively. The postoperative strength disadvantage amounted to only 10 %. Measurement of the strength in the neutral zero method showed a relative strength loss of the injured hand's thumb of 8 % while postoperatively there was even a strength advantage of 9 % in comparison with the thumb of the healthy hand. Both methods showed a relevant and significant postoperative strength increase of the injured hand's thumb. We could prove a significant correlation (p = 0.03) of the neutral zero strength measurement and the distal motoric latency of the median nerve. Furthermore, we could show a trend for a correlation between the neutral zero strength measurement and the median motoric velocity. In conclusion, it can be said that the special strength measurement of the M. abductor pollicis brevis is an important parameter to objectively evaluate the motoric symptomatology in carpal tunnel syndrome patients.

Adult↗
PubMed2005

Creatine supplementation for weak muscles in persons with chronic tetraplegia: a randomized double-blind placebo-controlled crossover trial.

BACKGROUND AND OBJECTIVES: Creatine supplementation improves muscle strength in some patient populations with neurologic disorders. The purpose of this study was to determine whether creatine supplementation improves muscle strength and endurance in weak upper limb muscles in persons with tetraplegia, and whether it improves function. METHODS: Outpatients with tetraplegia and mild wrist extensor weakness were randomized to receive either creatine or placebo in a double-blind crossover design. During creatine supplementation, participants were loaded with 10 g orally twice per day for 6 days, then maintained on 5 g daily until undergoing testing. Main outcome measures, performed at baseline, after placebo, and after creatine supplementation, included maximal voluntary wrist extensor isometric contraction strength (MVC), endurance times for 5 submaximal wrist extensor contractions, and the Grasp and Release Test for hand function. RESULTS: Eight individuals (7 men, 1 woman) with tetraplegia met inclusion criteria and completed all study phases. The mean age of participants was 48 years, and 7 of 8 had C6 motor level injuries. There were no significant differences in MVC, endurance times, or hand function for creatine vs placebo. CONCLUSION: Creatine does not improve MVC and endurance of weak wrist extensors and does not improve hand function in individuals with tetraplegia.

Cervical Vertebrae↗