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PubMed1999

The Short Version of the Sequential Occupational Dexterity Assessment based on individual tasks' sensitivity to change.

OBJECTIVE: The Sequential Occupational Dexterity Assessment (SODA) is a reliable and valid instrument to measure bimanual hand function in rheumatoid arthritis. Since administering SODA is time-consuming, the aim of this study is to construct a short SODA (SODA-S). METHODS: Dexterity was measured with the SODA twice (with an interval of one year) in 94 patients. Item analyses based on the different SODA tasks were carried out to determine which of the 12 individual tasks were most responsible for the observed changes in dexterity. RESULTS: Six of the 12 SODA tasks were identified as sensitive to change. Based on these 6 tasks, the SODA-S was computed. Internal consistency of the SODA-S is good (Cronbach's alphas at baseline and followup were 0.82 and 0.85, respectively). The correlation between the SODA and SODA-S is 0.92. This means that the information gathered from the SODA-S is almost equal to the information gathered from the full SODA. Norm scores are provided for both instruments. CONCLUSION: The SODA-S is a good alternative to the full SODA in following patient's dexterity in daily practice. However, when evaluating the effect of specific hand treatment, the full SODA may be preferred.

Activities of Daily Living↗

PubMed2004

Silver ring splints improve dexterity in patients with rheumatoid arthritis.

OBJECTIVE: To study the effect of Silver Ring Splints (SRSs) on hand function in patients with rheumatoid arthritis (RA). METHODS: RA patients with stable disease and finger deformities eligible for splinting received 1 or more SRSs. Primary outcome was dexterity, which was measured with the Sequential Occupational Dexterity Assessment (SODA). Secondary outcome measures were self-reported hand function (Dutch Arthritis Impact Measurement Scales 2), hand pain, grip and pinch strength, Disease Activity Score in 28 joints (DAS28), and patient satisfaction. RESULTS: Seventeen patients (median age 65 years; median disease duration 21 years) received a total of 72 SRSs. After 1 year, 48 SRSs were regularly used. Two patients dropped out because of adverse events related to SRSs. In the remaining 15 patients, SODA dexterity scores increased significantly (median 71 at baseline, 81 at 3 months, and 85 at 12 months), Wilcoxon signed ranks test P=0.005 and P=0.026. DAS28 scores did not change at 3 months and improved slightly after 12 months (-0.5; P=0.019). Grip strength, self-reported hand function, and hand pain showed no significant changes. Eleven patients stated they would continue using their splints. CONCLUSION: SRSs can improve dexterity in selected patients with rheumatoid hand deformities. For a satisfactory result, careful patient preassessment and optimal adjustment of SRSs are essential.

Activities of Daily Living↗

PubMed2001

Concurrent validity of the NK hand dexterity test.

BACKGROUND AND PURPOSE: The present study evaluated the concurrent validity of the NK hand dexterity test (NKHDT) by use of three separate analyses: (1) the correlation between the NKHDT and a criterion comparator (Jebson's Hand Function Test (JHFT)); (2) the correlation between both dexterity tests and a patient-rated function questionnaire; and (3) the ability of subscales to differentiate between subjects with and without upper extremity pathology. METHOD: The study population included 40 individuals with a variety of musculoskeletal problems affecting the upper extremity and 10 individuals without any history of upper extremity problems. Both dexterity tests were administered on a single occasion according to a standard protocol. Subjects also completed a rating scale which evaluated self-care, household work, work and recreation on an 0-10-point scale. RESULTS: The validity of the NKHDT was supported in all three analyses because: (1) the correlation between the NKHDT and JHFT subtests was moderate to strong (Pearson's r = 0.47-0.87) and stronger when the objects were more similar in size; (2) both scales correlated to a similar extent with patient-rated function (Pearson's r = 0.34-0.67); and (3) all subscales were statistically different between subjects with and without upper extremity pathology (p < 0.01). CONCLUSIONS: The present study supports the use of the NKHDT as a measure of hand dexterity.

Activities of Daily Living↗

PubMed1998

Risperidone vs. haloperidol on reaction time, manual dexterity, and motor learning in treatment-resistant schizophrenia patients.

BACKGROUND: The present study compared the effects of risperidone vs. haloperidol on reaction time, manual dexterity, and two types of motor learning in a sample of treatment-resistant schizophrenia patients. METHODS: Fifty-six DSM-III-R diagnosed schizophrenia inpatients participated in a randomized, double-blind comparison of risperidone vs. haloperidol. Measures of reaction time, manual dexterity, motor sequence learning, and gross motor learning were administered at baseline, after 4 weeks of fixed-dose medication, and after 4 weeks of flexible-dose medication. RESULTS: The results indicated that patients receiving risperidone showed greater improvement in reaction time and manual dexterity than patients receiving haloperidol. After covarying symptom changes and movement disorder ratings, the results remained significant. The two treatment groups did not differ on either measure of motor learning. CONCLUSIONS: The differences in performance in reaction time and manual dexterity may be due to a specific beneficial effect of risperidone, as opposed to a general reduction in extrapyramidal symptom liability, compared to haloperidol.

Adult↗

PubMed2003

The strength-dexterity test as a measure of dynamic pinch performance.

We have developed a method to quantify the dynamic interaction between fingertip force magnitude (strength) and directional control (dexterity) during pinch with a novel strength-dexterity (S-D) test based on the principle of buckling of compression springs. The test consists of asking participants to use key and opposition pinch to attempt to fully compress springs, in random order, with a wide range of combinations of strength and dexterity requirements. The minimum force required to fully compress the spring and the propensity of the spring to buckle define the strength and dexterity requirements, respectively. The S-D score for each pinch style was the sum of the strength values of all springs successfully compressed fully. We tested 3 participant groups: 18 unimpaired young adults ( 40yr), and 14 adults diagnosed with carpo-metacarpal osteoarthritis (CMC OA) (>or = 36yr). We investigated the repeatability of the S-D test with 74 springs by testing 14 young adults twice on different days. The per-spring repeatability across subjects was >or = 94%. A minimum performance score for young adults was found as they all could compress a subset of 39 springs. Using this subset of springs, we compared the ability of the S-D score vs. maximal pinch force values to distinguish unimpaired hands from those with CMC OA of the thumb. The score for this 39-spring S-D test distinguished between CMC OA and asymptomatic older adults, whereas pinch meter readings did not (p<0.05). We conclude that the S-D test is repeatable and applicable to clinical research. We propose including the S-D test in studies aiming to quantify impairment and compare treatment outcomes in orthopaedic and neurological afflictions that degrade dynamic manipulation.

Adolescent↗

PubMedDate not supplied

Validity of the Dexter Evaluation System's Jamar dynamometer attachment for assessment of hand grip strength in a normal population.

There are several instruments available to measure grip strength, but some instruments are costly, time-consuming to use, or have questionable reliability. The purpose of this study is to examine the concurrent validity of the Dexter Evaluation System with Jamar dynamometer attachment (Dexter) compared with the reference-based criterion of the Jamar adjustable hand dynamometer (Jamar) for measurement of maximal hand grip strength among normal subjects. Sixty-two subjects between the ages of 20 and 50 years, who had no history of hand, arm, shoulder, or neck injuries, were tested with the Jamar in the second handle position and, during the same visit, with the Dexter in the identical position. The Jamar was found to be highly reliable (ICC [3,1] = 0.98) and valid (ICC (2,K) = 0.99) for measuring hand grip strength. In this study, the Dexter was shown to be valid when compared to the Jamar dynamometer for measuring hand grip strength.

Adult↗

PubMedDate not supplied

Development of the Functional Dexterity Test (FDT): construction, validity, reliability, and normative data.

Dexterity tests take time to administer; however, the information obtained is an important component of a comprehensive examination of the hand. This article introduces a dexterity test suitable for use as part of routine examination of the hand. The Functional Dexterity Test (FDT) was developed as a measure of dexterity that takes a minimum amount of time to administer, yet provides information regarding the patient's ability to use the hand for daily tasks requiring a 3-jaw chuck prehension between the fingers and the thumb. The test was developed over 20 years. Interrater and intrarater reliability ranges between good and excellent. Construct validity was confirmed in 2 clinical studies. Preliminary normative data were obtained in 6 samples of convenience. Along with statistical data, this article provides equipment standards and instructions.

Adult↗

PubMed2003

Fine motor dexterity is correlated to social functioning in schizophrenia.

OBJECTIVE: To identify neuropsychological domains, including fine motor dexterity, that are related to social functioning in schizophrenia. METHOD: Thirty-six DSM-IV schizophrenic subjects were assessed using the Purdue Pegboard test, the Modified Wisconsin Card Sorting test, the Tower of London, Schwartz' Reaction Time and Wechsler's Associate Learning and Digit Span tests. Social functioning was measured by the Social and Occupational Functional Assessment Scale. RESULTS: Univariate regression analyses showed that the Purdue Pegboard, the Modified Card Sorting test, the Tower of London and Wechsler's Associate Learning subtest were significantly linked to social functioning. The best fitting multivariate model to explain social functioning included fine motor dexterity and executive functioning. CONCLUSION: Various neuropsychological measures correlated to social functioning, the correlation involving fine motor dexterity being the strongest one. Future studies of the prediction of social functioning in schizophrenia should include fine motor dexterity.

Cognition Disorders↗

PubMed1997

Robotic surgical instruments for dexterity enhancement in thoracoscopic coronary artery bypass graft.

OBJECTIVES: Endoscopically sutured vascular anastomoses are complex, time consuming, and require great dexterity. We decided to evaluate performance enhancement using a robotic device to create sutured coronary artery bypass anastomoses with endoscopic techniques in a plastic model. METHODS: Seven coronary artery bypass anastomoses were endoscopically created in a plastic model using a robotic enhancement technology (Computer Motion, Goleta, CA). Anastomoses were created with a single running suture (7-0 monofilament). Our endpoints were operative time, intraoperative incidents, stability and dexterity of the robotic system, surgeon's fatigue, and anastomotic patency. RESULTS: Operative time was 46+/-12 min (mean+/-SD). There were no intraoperative incidents. Patency was confirmed in all anastomoses. The system's stability and dexterity were high. Surgeon's fatigue was mild. CONCLUSION: The use of robotic enhancement technology leads to an efficient performance of sutured coronary artery bypass anastomoses in a plastic model. The robotic device enhances dexterity, precision, and reduces surgeon's fatigue while preserving the quality of hand suturing.

Clinical Competence↗

PubMedDate not supplied

Dexter: a tool to facilitate impairment ratings.

Calculating impairment in burn patients is crucial to understanding outcome. However, it is rarely reported after burns, presumably because the process of calculating impairment ratings is complicated and tedious. Computerized systems have been developed that facilitate the process, but it has not been established in burn patients that these systems reduce the time required to calculate impairment. We evaluated the Dexter Evaluation and Therapy System by Cedaron Medical Inc (Davis, CA). A sample of 10 manually recorded ratings was compared with 10 performed on the Dexter. Mean time for the manual technique was 65 +/- 35 minutes versus 37 +/- 13 minutes for the Dexter (P < .05, Mann-Whitney). The time taken to perform impairment ratings in burn survivors is significantly reduced by the use of the Dexter system. Time saving occurs primarily at three points: (1) electronic data entry directly from the measuring instruments, (2) compilation of data, and (3) rapid generation of reports.

Adult↗

PubMed2006

Hydrops fetalis associated with pulmonary hypoplasia in Dexter calves.

The occurrence of severe fetal dystocia due to hydrops fetalis associated with pulmonary aplasia in two male and pulmonary hypoplasia in one female Australian Dexter fetuses from two herds is described. Obstetrical intervention by caesarean section was required for delivery of the fetuses, with mortalities in one dam and the 3 calves. Clinical, pathological and genetic features are tabulated to assist in distinguishing pulmonary hypoplasia-associated hydrops fetalis from the more prevalent disorder of chondrodysplasia in Dexter cattle. Anasarca and complete absence or presence of only rudimentary lung tissue in a large thoracic cavity clearly distinguishes this entity from the lesions of Dexter chondrodysplasia that include severe micromelia and abundant lung tissue in a small thoracic cavity with shortened spine and rib cage. Pedigree information suggested that Dexter hydrops may be transmitted in an autosomal recessive manner.

Animals↗

PubMed2003

Finger dexterity, skin temperature, and blood flow during auxiliary heating in the cold.

The primary purpose of the present study was to compare the effectiveness of two forms of hand heating and to discuss specific trends that relate finger dexterity performance to variables such as finger skin temperature (T(fing)), finger blood flow (Q(fing)), forearm skin temperature (T(fsk)), forearm muscle temperature (Tfmus), mean weighted body skin temperature (Tsk), and change in body heat content (DeltaH(b)). These variables along with rate of body heat storage, toe skin temperature, and change in rectal temperature were measured during direct and indirect hand heating. Direct hand heating involved the use of electrically heated gloves to keep the fingers warm (heated gloves condition), whereas indirect hand heating involved warming the fingers indirectly by actively heating the torso with an electrically heated vest (heated vest condition). Seven men (age 35.6 +/- 5.6 yr) were subjected to each method of hand heating while they sat in a chair for 3 h during exposure to -25 degrees C air. Q(fing) was significantly (P < 0.05) higher during the heated vest condition compared with the heated gloves condition (234 +/- 28 and 33 +/- 4 perfusion units, respectively), despite a similar T(fing) (which ranged between 28 and 35 degrees C during the 3-h exposure). Despite the difference in Q(fing), there was no significant difference in finger dexterity performance. Therefore, finger dexterity can be maintained with direct hand heating despite a low Q(fing). DeltaH(b), Tsk, and T(fmus) reached a low of -472 +/- 18 kJ, 28.5 +/- 0.3 degrees C, and 29.8 +/- 0.5 degrees C, respectively, during the heated gloves condition, but the values were not low enough to affect finger dexterity.

Adult↗

PubMed2005

Impaired manual dexterity and neuromuscular dysfunction in patients with hand-arm vibration syndrome.

Manual dexterity and hand functional difficulties in daily life in hand-arm vibration syndrome (HAVS) were investigated in 29 male patients with HAVS and 30 male controls without occupational exposure to hand-arm vibration. Manual dexterity was assessed by measuring the performance time of picking up and transferring 30 red beans, one by one, from one plate to another. Vibrotactile perception thresholds at 125 Hz and grip strength were also examined. Hand functional difficulties in daily life were surveyed with a questionnaire. The HAVS patients had an increased vibrotactile threshold, decreased grip strength, and low performance in transferring beans. Low performances with transfer times over 53 s (2SD from the mean in the controls) were found in 66% of the HAVS patients and 3% of the controls. Bean transfer times in the patients were correlated with an increasing vibrotactile threshold and decreasing grip strength. The transfer times of the patients were also associated with hand functional difficulties such as picking up coins, turning the pages of a newspaper, buttoning clothes, and pouring from a teapot. The patients with a prolonged transfer time over 60 s (3SD from the mean in the controls) were most likely to have hand functional difficulties. The present findings suggest that measurement of the bean transfer time will serve to assess manual dexterity among HAVS patients, and that impaired manual dexterity in patients may be associated with impaired sensory feedback and muscular dysfunction in the fingers and hands.

Arm↗

PubMed2003

A comparison of performance outcomes between the Minnesota Rate of Manipulation Test and the Minnesota Manual Dexterity Test.

This study examined the performance outcomes between two tests of manual dexterity, the Minnesota Rate of Manipulation Test [1] and the Minnesota Manual Dexterity Test (1981). Even though the tests are constructed differently and are different versions of the Complete Minnesota Dexterity tests, both tests utilize the same instruction manual and the same normative data. The researchers measured 233 random participants at a Midwestern international airport and in the student center at a local university in Indiana. Each participant completed three trials of a subtest on both versions of the test. One sample t-tests on difference scores indicated statistically significant differences on outcomes of both subtest comparisons as well as overall test score differences (p < 0.000). These significantly different outcomes on the two tests illustrate the need to establish separate normative data on the latest version of the test, the Minnesota Manual Dexterity Test.

Adolescent↗

PubMed1991

Culture of phenotypically defined hematopoietic stem cells and other progenitors at limiting dilution on Dexter monolayers.

Highly enriched, phenotypically defined hematopoietic stem, Thy-1loLin-Sca-1+, and progenitor cell populations from mouse bone marrow (BM) were tested at limiting dilution for their ability to reconstitute Dexter monolayers. Several classes of BM cells can reconstitute Dexter cultures, first forming discrete "cobblestone" areas which then mature into colonies consisting primarily of maturing myeloid and erythroid cells. Most such colonies have a limited lifespan in culture. Only the Thy-1loLin-Sca-1+ cell fraction gives rise to colonies that survive longer than 3 weeks, which suggests that a limiting-dilution analysis for long-term reconstitution of Dexter cultures can serve as a quantitative measure of stem cell activity. Additional experiments were performed to assess the formation of new progenitor cells in reconstituted Dexter cultures. Again, only cultures seeded with the stem cell-enriched fraction contained expanded numbers of replatable WEHI-3 CM responsive colony-forming cells (CFU-GM). Quantitative analysis indicates that 97% of the replatable CFU-GM of whole BM is contributed by the Thy-1loLin-Sca-1+ cell fraction, again suggesting a potential stem cell-specific assay. Such quantitative in vitro assays might prove useful in characterization and isolation of human stem cells where in vivo assays are lacking.

Animals↗

PubMed1989

Objective comparison of manual dexterity in physicians and surgeons.

Recent interest in the assessment of manual dexterity of surgical residency applicants prompted an investigation of psychomotor skills in surgeons and physicians. The Purdue Pegboard and Minnesota Manual Dexterity tests were given to 57 subjects. Analysis of the data revealed no significant difference in dexterity between medical and surgical residents, suggesting that medical students do not select specialty training programs because of the presence or absence of manual skills. The data also revealed that surgical staffmen performed substantially worse than those in the other groups on some of the tests, possibly because of an older average age. The authors conclude from their data that manual dexterity tests should not be used in assessing candidates for surgical residency training positions.

Aptitude Tests↗

PubMed1979

Dexterity testing and residents' surgical performance.

1. With some exceptions, those who choose ophthalmology as a career may approximate the general population in innate manual dexterity. 2. Many factors other than manual dexterity influence the development of surgical skills by residents. 3. If dexterity testing is to be used, the addition or inclusion of tests for spatial aptitudes may be more helpful than simple dexterity tests alone. The predictive value of such tests for surgical performance would need vertification. 4. The development of a special test directly related to handling surgical instruments, to cutting, and to sewing (the criteria) may be more practical than the ones used in this study.

Aptitude Tests↗

PubMed1997

Manual dexterity and corticospinal connectivity following unilateral section of the cervical spinal cord in the macaque monkey.

The macaque recovers quite rapidly from the immediate severe flaccid hemiparesis that results from unilateral section of the cervical spinal cord (between C3 and C6) and starts to use the impaired hand to pick up objects within about 30 days following the surgery. Within another 60 days, the monkey is quite dexterous; nonetheless, there is a persisting deficit. We used video recording to study the long-term recovery of manual dexterity following unilateral section of the cervical cord in newborn and juvenile monkeys. A reach-and-retrieve manual task was examined. By using a preset oppositional force, opposition of the pads of the index finger and thumb in the vertical plane was needed to retrieve the desired target object. The corticospinal connectivity of each monkey was also examined by using retrograde or anterograde tracers at the end of the experimental period (Galea and Darian-Smith [1997] J. Comp. Neurol., this issue) and was correlated with the manual performance. Manually retrieving an object depends on the coordination of several control processes acting in parallel, including 1) visually guided components, such as directing the arm toward the object, aligning the digits with the target object by pronating the forearm, and preshaping the index/thumb separation to match with the size and shape of the target, and 2) manipulative components that depend on tactual input and that also include independent movements of the digits and the application of the appropriate oppositional forces. The impairment of manual dexterity that persisted after a cervical section, although it was small, involved these processes and was evident in 1) the less direct trajectory used in reaching, 2) the loss of preshaping of the separated index finger and thumb prior to grasping the target object, and 3) a weakening of the oppositional forces that could be developed between the pads of the index finger and thumb. Although, in the accompanying paper, we did not preclude some regeneration of severed corticospinal connections, we did show that, if any such reconstruction occurred, then it was limited. The remarkable but incomplete recovery of dexterity over a period of 6-12 months, therefore, must be achieved by 1) optimizing the transmission of information from the cortex to the spinal cord by the substantially reduced populations of corticospinal neurons and corticobulbospinal projections and/or 2) the effective use of spinal circuitry in regulating the more stereotyped elements of the manual task.

Age Factors↗