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PubMed1997

Predictors of decline in manual performance in older adults.

OBJECTIVE: To determine factors that predict decline in manual performance using a multivariate model of determinants of functional limitation. DESIGN: Longitudinal observational study. SETTINGS: Ambulatory general medicine clinics, residences of homebound individuals, and a continuing care retirement community. PARTICIPANTS: Subjects were 485 persons more than 60 years of age and included continuing care retirement community (CCRC) residents (n = 215), chronically homebound older persons (n = 65), and ambulatory older adults (n = 205). Mean age at baseline was 78 years. MEASUREMENT: Independent variables included demographics, physician measures of upper-extremity joint impairment, comorbidities derived from physical examination and chart abstract, self-assessed arthritis pain, depression, and anxiety. The major dependent variable was 2-year decline in timed manual performance below a threshold associated with need for long-term care services. RESULTS: The proportion of subjects who exceed a Timed Manual Performance Test threshold of 350 seconds increased slowly from baseline through Year 4 for all age groups but rose rapidly from Year 4 to Year 6 for the oldest group (> 85 years at baseline). Using a discrete survival model, we found that age, education, grip strength, and psychological status predicted crossing the manual performance threshold within a 2-year period. CONCLUSIONS: The findings, coupled with earlier findings that upper extremity joint impairment predicted both grip strength and manual performance, suggest that joint impairment may be an important risk factor for future functional limitation. Since diminished hand function has been shown to predict dependency, development and testing of interventions to maintain or restore upper extremity joint function and reduce pain would appear to be a high research priority.

Age Factors↗
PubMed1996

Development of muscular endurance and strength from adolescence to adulthood and level of physical capacity in men and women at the age of 34 years.

This study investigated the development of muscular endurance and strength from the age of 16 to the age of 34 and the fitness components at the age of 34 in men and women. A randomly selected group consisting of 220 boys and 205 girls was tested in 1974 and reinvestigated 18 years later. Muscular endurance and strength increased significantly in 4 of the 5 remeasured tests for the men; bench press increased by 58%, two-hand lift by 20%, hand grip by 16% and Sargent jump by 8%. For the women there was a significant increase in bench press and two-hand lift by 25% and 7% respectively, but hand grip and Sargent jump decreased with a few per cent. The hip and trunk flexion test, sit-up, decreased remarkably in both men (58%) and women (78%). At the age of 16 physical capacity was significantly higher in all tests in the men. This was also the situation at the age of 34 except for VO2 max in ml.kg-1.min-1 and muscular endurance in the back muscles. There were no differences in flexibility between men and women except for less flexibility in the hamstring muscles in the men. The result of the balance test was significantly better in the men.

Adolescent↗
PubMed1997

Assessment of hand function in a patient with chronic sensory demyelinating neuropathy.

A 60-year-old man presented with progressive large fiber sensory loss in the right first three fingers and, to a lesser extent, in both fourth and fifth fingers. Electrophysiologic studies were characteristic of chronic sensory demyelinating polyneuropathy, a variant of chronic inflammatory demyelinating polyneuropathy. Plasma exchange was unsuccessful, but intravenous immunoglobulin (IVIG) led to complete recovery of sensation for 2 months, although neurophysiologic abnormalities persisted. A battery of noninvasive tests to measure hand grip strength, tactile sensation at the fingertips, and motor control of prehension during precision grip revealed marked abnormalities in the right hand before IVIG. One month after IVIG, all test results had normalized, but they returned to pretreatment levels after 3 months. Functional evaluation of the hand may be a sensitive method to objectively quantify loss of and changes in cutaneous mechanoreceptor function of the fingers in large fiber sensory neuropathy.

Demyelinating Diseases↗
PubMed2004

The application of an external wrist extension force reduces electromyographic activity of wrist extensor muscles during gripping.

STUDY DESIGN: Experimental repeated-measures study. OBJECTIVE: To investigate the effect of different extension forces applied to the palm of the hand on electromyographic (EMG) activity of the wrist extensor muscles during hand gripping. BACKGROUND: Lateral epicondylitis is usually caused by repetitive wrist extension that leads to an overuse injury. The current theory is that the process of lateral epicondylitis begins with an overuse injury that leads to microtearing of the extensor carpi radialis brevis muscle and occasionally the extensor digitorum communis muscle. Use of an external wrist extension force might reduce muscle activity during gripping. METHODS: Muscle activity was measured using surface EMG while subjects gripped at an intensity of 10%, 20%, and 30% of the maximum voluntary contraction force without, and with, an applied external wrist extension force of 1%, 2%, and 3% of maximum voluntary contraction. RESULTS: Applying an extension force to the palm of the hand reduced EMG activity of the extensor muscles at the same strength generation during hand gripping. The muscles with the most significant reduction in EMG level, the extensor carpi radialis brevis and extensor digitorum communis, are those muscles that are most often involved with lateral epicondylitis. CONCLUSIONS: This study shows that an external extension force reduces EMG activity of the wrist extensor muscles during gripping in healthy volunteers. As the extension force increased, a greater reduction in muscle activity was noted.

Adult↗
PubMed2006

Patterns and correlates of muscle strength loss in older women.

BACKGROUND: The aging process is associated with progressive declines in muscle strength, resulting in functional disability and reduced quality of life. OBJECTIVE: The purpose of this epidemiological study was to examine the age-related loss of grip strength both cross-sectionally and longitudinally and the risk factors associated with the decline in muscle strength in a large population of community-living older women (aged 65-91 years). METHODS: Clinical visits, including physical examinations and lifestyle assessment, were conducted at baseline and biennially afterwards for a total of 10 years of follow-up. The upper-body muscle strength was measured by grip strength using a hand-held dynamometer. RESULTS: The muscle strength decreased cross-sectionally (n = 9,372) as well as longitudinally (n = 5,214), as age increased, and the decline in muscle strength measured during follow-up was greater than that measured cross-sectionally at baseline. The average loss of grip strength during 10 years of follow-up was 5.1 kg, equivalent to a rate of 2.4% decline per year, with the greatest loss seen in the oldest age group (80 years or older). Cross-sectional analysis revealed that the correlates of lower muscle strength included older age, greater weight, greater height loss since age 25 years, lower protein intake, difficulties in functional tasks, and lower physical activity. In longitudinal analysis, older age, baseline strength, weight and height loss during follow-up, difficulties in functional tasks, and lower physical activity were found to be significantly and independently associated with greater loss in grip strength during follow-up. CONCLUSIONS: Cross-sectional and longitudinal analyses of age-related loss of muscle strength yielded different rates of decline. In addition to older age and difficulties in functional tasks, a number of modifiable factors, including weight and physical activity, are associated with increased decline in muscle strength among older women.

Age Factors↗
PubMed1988

Performance-based measurements among elderly drivers and nondrivers.

Although driving is an important ability for maintaining independence in the later years, clinical factors that determine driving status are unknown. Aged male veterans (mean age, 70 years) were recruited from an outpatient clinic (N = 143), including 77 frequent drivers, 41 infrequent drivers, and 25 who drove rarely or not at all. There were 116 (84%) who completed a comprehensive performance-based assessment. There were no significant differences between the three groups in age, formal cognitive testing, or prevalence of stroke history. However, there were significant differences in grip strength, reaction time, static visual acuity, dynamic visual acuity, and peripheral vision. Using stepwise ordinal logistic regression, dynamic visual acuity, nondominant hand grip strength, and total horizontal peripheral visual field were significantly associated with driving frequency (P less than .05), and together explained approximately 45% of the variance. Subtle motor and visual deficits that can be detected by a performance-based assessment may play an important role in determining driving frequency in the elderly.

Activities of Daily Living↗
PubMed2001

Effects of constraint-induced therapy on hand function in children with hemiplegic cerebral palsy.

PURPOSE: The effects of constraint-induced therapy on hand function of the involved upper extremity were examined in three children with hemiplegic cerebral palsy. METHODS: In these case reports, the noninvolved upper extremities of the children were constrained six hours daily for 14 consecutive days. Hand function, strength, sensation, and fingertip force coordination were examined pre- and postintervention. RESULTS: The results indicated that there was an improvement in hand function for two of the three children and an improvement in two-point discrimination threshold values for all children. While there was no consistent change in fingertip force coordination during precision grip across children, one child demonstrated a consistent decrease in duration of temporal phases of fingertip force coordination and two children demonstrated a reorganization of the grip-lift synergy of the involved hand. CONCLUSION AND CLINICAL IMPLICATIONS: Improvement in hand function is not captured by any one measure. The effectiveness of this intervention is promising but may be dependent on the severity of the impairment.

Journal Article↗
PubMed1997

[Review of indications for and results of proximal carpal row resection].

Principles of proximal row carpectomy and results of treatment in 8 patients with pseudoarthrosis of the scaphoid and in 7 patients with inveterate carpal dislocation are presented. Mean follow-up was 5 years. Mean range of movement was 68 degrees, the pain decreased or ceased in 14 patients, grip strength increased 14%.

Adult↗
PubMed2001

An implantable upper extremity neuroprosthesis in a growing child with a C5 spinal cord injury.

OBJECTIVES: To implement a functional electrical stimulation (FES) hand neuroprosthesis called the Freehand System in a growing child with spinal cord injury (SCI) using extra lead wire to accommodate limb growth, and to evaluate the performance of the Freehand System during the subject's maturation. SETTING: Pediatric orthopedic hospital specializing in SCI rehabilitation. SUBJECT: Ten-year-old female patient with a C5 level SCI. METHOD: The Freehand System was implanted. Eight electrodes were implanted to targeted forearm and hand muscles to provide grasp and release function. The lead wire associated with each electrode was pathed subcutaneously up the arm with 4 cm of extra lead distributed throughout the path to accommodate expected limb growth. All leads were attached to a stimulator placed in the upper chest. Measures of lead unwinding, limb growth, stimulated muscle strength, and hand function were made at 6 and 16 months after implant. RESULTS: By 16 months post implant, the upper limb growth plates were closed and humeral and radial bone growth combined was 2.7 cm from the time of surgery. For all eight leads, lead unwinding in the upper arm was approximately 1.2 cm and was comparable to humeral bone growth (1.4 cm). Lead unwinding in the lower arm was also measurable for the two electrodes in hand muscles. Six of eight electrodes maintained grade 3 or better stimulated muscle strength throughout the growth period according to a manual muscle test. Of the two other electrodes, one appeared to have lost function due to depletion of excess lead. However, hand function with FES was comparable at 6 and 16 months post implant suggesting that growth did not negatively impact performance with the FES system. Hand function with FES was improved over voluntary hand function as well. Using the Freehand System, a pinch force of approximately 15 N was achieved compared to 1.3 N of voluntary tenodesis pinch force. Scores on the Functional Independence Measure (FIM) increased by 9 points when FES was used as compared to voluntary function. Improvements occurred primarily in eating and grooming. Independence in writing was achieved only with FES. CONCLUSIONS: For this child, hand function with the Freehand System was sustained over the growth period and was a significant functional improvement over voluntary hand function. By using excess lead wire, the Freehand System was successfully implemented before skeletal maturity, affording the child improved hand function earlier than would be otherwise indicated.

Arm↗
PubMed1998

A randomized biomechanical study of zone II human flexor tendon repairs analyzed in an in vitro model.

To study the effect of dorsally placed flexor tendon repairs on human cadaver tendons, we used the Kessler, Strickland, Robertson, and modified Becker techniques. The strengths of the repairs were tested in a previously described human cadaveric curvilinear model. There were statistically significant increases in dorsal versus volar grasping strength with the Kessler repair (38 N vs 33 N) and the Robertson repair (51 N vs 43 N). There were no differences with the locking Strickland and modified Becker repairs. One may infer that the locking techniques are intrinsically tighter and may not be as susceptible to the different forces between the tensile and compressive surfaces of a dynamic flexor tendon.

Cadaver↗
PubMed2000

Strength of the intrinsic muscles of the hand measured with a hand-held dynamometer: reliability in patients with ulnar and median nerve paralysis.

The aim of this study was to assess the reliability of a technique to measure the strength of the intrinsic hand muscles. Intraclass Correlation Coefficients showed an excellent level of reliability for the comparison of muscle strength between groups of patients. However, for the results of individual patients, the calculated Standard Error of Measurements (10-16%) and the Smallest Detectable Differences for intraobserver (31-36%) and interobserver (37-52%) values indicate that only relatively large changes in strength can be confidently detected with this technique. The results of the present study were compared with those of four previous grip strength studies.

Adolescent↗
PubMed1996

A modified darrach procedure for treatment of the painful distal radioulnar joint.

Controversy exists regarding the best treatment for pain and instability of the distal radioulnar joint. Until recently, the Darrach distal ulnar resection had been the standard procedure for this disorder. The Bowers hemiresection interposition arthroplasty, however, and the Watson matched distal ulna resection have been developed to preserve the styloid attachment of the triangular fibrocartilage complex. This article presents a retrospective chart review of a consecutive series of patients who had painful distal radioulnar joints which were treated with a modified Darrach procedure. This procedure was performed to alleviate the problems of impingement and styloid carpal abutment during grip, and provide stabilization. Fifteen patients (16 wrists) were seen during followup for an average of 37 months after resection arthroplasty of the distal ulna was performed; 6 procedures were revisions. The results were uniformly good with marked alleviation of pain in all but 1 patient. Patients experienced consistent improvement toward pain-free pronation/supination and increased grip strength.

Adolescent↗
PubMed2003

Factors related to thumb pain in physiotherapists.

The aim of this study was to determine whether differences exist between physiotherapists with work-related thumb pain and physiotherapists without thumb pain. Twenty-four physiotherapists with work-related thumb pain (Pain Group) and 20 physiotherapists without thumb or wrist pain (Non-pain Group), who were working at least 20 hours per week in an outpatient musculoskeletal setting, were compared on a number of attributes: generalised joint laxity, hand and thumb strength, height, weight, working environment, hand position and force applied during mobilisation, mobility at individual thumb joints, extent of osteoarthritis at the thumb and radial-sided wrist joints, and demographic data including age, gender and years of experience. All physiotherapists in the Pain Group reported their thumb pain was related to and initially caused by the performance of manual techniques, and 88% had altered their manual techniques because of pain in the thumb. There was extreme variability in hand position and force applied during mobilisation, and a slightly high prevalence of osteoarthritis (22.7%) considering the mean age of the total sample (38.6 years). Statistically significant differences between groups included increased right carpometacarpal joint laxity (6.4%, 95% CI 0.19 to 12.6), decreased right tip pinch strength (0.84 kg, 95% CI 0.01 to 1.68), and lower body mass index (2.0, 95% CI 0.11 to 3.9) for the Pain Group. Other factors were not statistically different between groups. These results indicate that work-related thumb pain affects physiotherapists ability to administer manual treatments, and suggest that decreased stability and strength of the thumb may be associated with work-related thumb pain.

Adult↗
PubMed2002

Handedness is associated with immune functioning and behavioural reactivity in rhesus macaques.

In the present study we examined the relationship among handedness, immune functioning, and behavioural reactivity in rhesus macaques. We used the absolute number of CD4+ (T-helper) and CD8+ (T-suppressor) cells as dependent measures of immune functioning. We derived reactivity profiles from behavioural responses to a threat, and hand preference profiles from a quadrupedal food-reaching test. The results indicate positive correlations between the frequency of right versus left hand reaches and the absolute number of CD4+ cells, and between the frequency of right versus left hand reaches and the degree of human-directed aggression in response to an invasive threat. Immune measures were not associated with the strength of hand preference. These results are consistent with and extend previous findings obtained with rodents to nonhuman primates and provide further support for the view that behavioural lateralisation is associated with immune functioning and behavioural reactivity.

Journal Article↗
PubMed2002

Virtual reality-augmented rehabilitation for patients following stroke.

BACKGROUND AND PURPOSE: Recent evidence indicates that intensive massed practice may be necessary to modify neural organization and effect recovery of motor skills in patients following stroke. Virtual reality (VR) technology has the capability of creating an interactive, motivating environment in which practice intensity and feedback can be manipulated to create individualized treatments to retrain movement. CASE DESCRIPTION: Three patients (ML, LE, and DK), who were in the chronic phase following stroke, participated in a 2-week training program (3 1/2 hours a day) including dexterity tasks on real objects and VR exercises. The VR simulations were targeted for range of motion, movement speed, fractionation, and force production. OUTCOMES: ML's function was the most impaired at the beginning of the intervention, but showed improvement in the thumb and fingers in range of motion and speed of movement. LE improved in fractionation and range of motion of his thumb and fingers. DK made the greatest gains, showing improvement in range of motion and strength of the thumb, velocity of the thumb and fingers, and fractionation. Two of the 3 patients improved on the Jebsen Test of Hand Function. DISCUSSION: The outcomes suggest that VR may be useful to augment rehabilitation of the upper limb in patients in the chronic phase following stroke.

Aged↗
PubMed1995

Thumb reconstruction by micro-vascular techniques.

Sixty-three patients with thumb reconstruction by total or partial toe transfer have been reviewed. Mean age was 25 years. Males (84%) and manual workers (76%) dominated the series. The rate of failure was 3%. Second toe transfer gave a functionally acceptable thumb with 10 mm two point discrimination, 59% of strength in pinching (compared to normal side), 30 degrees of range of flexion but with a flessum deformity (average 27 degrees) and a poor cosmesis score (1.5 on a 5 point scale). Partial toe transfers were useful in amputations at metacarpophalangeal (MP) level and distal to this area. Around MP level, three techniques were available: wrap around, Twisted Two Toes and "bipolar" lengthening. More distally a "custom made" transfer allows to match exactly the defect. All of these techniques save the great toe length. When a pulp was incorporated in the transfer, two point discrimination averaged 9 mm and in the entire series the mean pinch strength was 93% normal and the mean cosmetic score was 3.5 points. Partial toe transfers are preferable in cases with any otherwise normal hand, providing good function and better cosmesis.

Adult↗