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At least 73 records · Page 4Linked to original sources

PubMed2003

Measurement of surgical dexterity using motion analysis of simple bench tasks.

The possibility of using quantitative motion analysis for objective assessment of simple surgical dexterity is investigated using the Imperial College Surgical Assessment Device (ICSAD) with qualitative analysis undertaken by inspection. Bench-top knot tying and suturing skills were performed and examined for the ability to discriminate between surgeons of varying experience. These exercises were found to discriminate significantly between junior and senior surgeons in terms of both time taken and the number of movements required. The relation between time and motion was found to be variable depending on what skill was being undertaken: simple suturing, suturing at depth, or knot tying (1.71 vs. 1.86 vs. 2.36; p = 0.002 for 1 vs. 2; p < 0.001 for others). When the number of movements in a minute (standardized movements per minute) were considered, both groups were found to work at a similar rate, depending on the task, implying that the more experienced surgeon is more economical, performing the same exercise with fewer moves rather than with higher speed. Motion analysis exhibits face and construct validity and is a reliable assessment of simple surgical dexterity. Its use for objective assessment of dexterity and competence should be encouraged.

Clinical Competence↗

PubMed1998

[Cor triatriatum dexter of an adult].

Cor triatriatum dexter is a rare congenital malformation in which a membrane divides the right atrium into two chambers. The membrane represents a persistence of the right sinus venosus valve (RSV). Normally the RSV regresses between the 9th and 15th week of gestation, as the cephalic portion forms the crista terminalis and the caudal portion develops into the Eustachian and Thebesian valve. Any failure in the regression process may result in remnants of RSV as a simple muscle bar, a Chiari-network or a fenestrated or unfenestrated membrane (cor triatriatum dexter). We describe a patient with cor triatriatum dexter in whom diagnosis was made several years after successful valvulotomy procedure for severe congenital valvular pulmonary stenosis.

Adult↗

PubMed2004

Dexterity enhancement with robotic surgery.

BACKGROUND: The aim of this study was to quantify the extent of dexterity enhancement in robotic surgery as compared to laparoscopic surgery. METHODS: Ten surgeons with varying laparoscopic suturing experience were asked to place three sutures on a suture pad. The sutures were placed laparoscopically, robotically with 2-D vision and robotically with 3-D vision. The da Vinci systems Application Programming Interface (API) was used for positional data. A validated motion analysis system was used for data retrieval for the laparoscopic task. Custom software was developed for data analysis. RESULTS: Compared to laparoscopic suturing, when the task was undertaken robotically with 2-D vision there was a 20% reduction in the time taken but this was not significant (p = 0.07). There was a 55% reduction in the path traveled by the right hand (p = 0.01) and a 45% reduction in the path traveled by the left hand (p = 0.008). When the task was undertaken robotically with 3-D vision, there was a 40% reduction in the time taken (p = 0.01). There was a 70% reduction in the path traveled by right hand (p = 0.008) and a 55% reduction by the left hand (p = 0.08). CONCLUSIONS: The presence of wristed instrumentation, tremor abolition, and motion scaling enhance dexterity by nearly 50% as compared to laparoscopic surgery. 3-D vision enhances dexterity by a further 10-15%. In addition, the presence of 3-D vision results in a 93% reduction in skills-based errors.

Clinical Competence↗

PubMed1981

Developmental apraxia of speech and manual dexterity.

A quantitative test of fine motor function was used to compare the dexterity of the right and left hands of normal children and children with developmental apraxia of speech (DAS). The results suggest that the left cerebral hemisphere of children with DAS is not predominantly impaired in regard to motor control of the upper extremities. In neither female nor male children with DAS was the manual dexterity of the right hand less than that of the left. In female but not male children with DAS, manual dexterity of both hands was impaired when compared to the normal control groups. Therefore, DAS is probably not due to a congenital or an acquired defect in Broca's motor speech area or adjacent brain area of the left hemisphere. The basis of this conclusion is discussed.

Apraxias↗

PubMed1999

Is digital dexterity really related to corticospinal projections?: a re-analysis of the Heffner and Masterton data set using modern comparative statistics.

Using a data set of 69 different mammalian species, Heffner and Masterton propose that the longer and deeper the fibres of the corticospinal tract, the greater an animal's digital dexterity. Because of the effects that phylogeny may have upon the extant phenotype of a given species, however, data from a wide range of species can rarely be considered to represent fully independent data points. Using modern comparative statistics, which incorporate phylogenetic information, we reanalysed their data set such that the assumption of independence was not violated. If Heffner and Masterton's hypothesis is correct, then one would expect evidence of strong correlated evolution between corticospinal tract anatomy and digital dexterity once the effects of the phylogenetic relationships between the species in the data set have been removed. The results show that a distinct bias in the number of primate species sampled by Heffner and Masterton significantly affected their findings. Furthermore, once phylogeny has been taken into account, only the length of the corticospinal tract fibres showed a significant relationship with two out of the four behaviours analysed, digital dexterity and hand-eye coordination. Based upon our results we recommend the use of modern comparative statistics for synthesising neural structure and behaviour, rather than examining structure function relationships in an ahistorical context. It is also evident that there is a need for data on the length and depth of the corticospinal fibres for a greater range of species so that the relationship between the corticospinal tract structure and motor behaviour for mammals as a whole can be more readily interpreted.

Animals↗

PubMed2002

Dexterity is not affected by fatigue-induced depression of human motor cortex excitability.

Following a fatiguing muscle contraction, motor evoked potentials (MEPs) evoked by transcranial magnetic brain stimulation remain depressed for many minutes, reflecting a reduction in the excitability of the corticospinal projection. No functional significance has been linked to this observation. We postulated that dexterity would be affected when MEPs are depressed. MEPs were recorded from the first dorsal interosseous muscle of 11 healthy subjects in resting muscles before and after a fatiguing maximum voluntary contraction. This induced significant MEP depression in all subjects. No change in dexterity was seen when MEPs were depressed or at any time point throughout the experiment. We conclude that fatigue-induced MEP depression is not associated with a decline in dexterity.

Adult↗

PubMedDate not supplied

Cor triatriatum dexter in an adult diagnosed by transesophageal echocardiography: a case report.

Cor triatriatum dexter is a rare congenital heart malformation in which a persistent right sinus venosus valve divides the right atrium into two chambers. Before echocardiography, this anomaly has been rarely diagnosed before surgery or death. This is a case of cor triatriatum dexter in an adult with lifelong exertional cyanosis and dyspnea. A definitive diagnosis of cor triatriatum dexter with associated heart defects was best made by transesophageal echocardiography at 47 years of age. Subsequent surgical intervention confirmed all of the echocardiographic findings and successful correction of the defects was performed.

Cor Triatriatum↗

PubMed2003

TYRP1 is associated with dun coat colour in Dexter cattle or how now brown cow?

Tyrosinase related protein 1 (TYRP1), which is involved in the coat colour pathway, was mapped to BTA8 between microsatellites BL1080 and BM4006, using a microsatellite in intron 5 of TYRP1. The complete coding sequence of bovine TYRP1 was determined from cDNA derived from skin biopsies of cattle with various colours. Sequence data from exons 2-8 from cattle with diluted phenotypes was compared with that from non-diluted phenotypes. In addition, full-sib families of beef cattle generated by embryo transfer and half-sib families from traditional matings in which coat colour was segregating were used to correlate TYRP1 sequence variants with dilute coat colours. Two non-conservative amino acid changes were detected in Simmental, Charolais and Galloway cattle but these polymorphisms were not associated with diluted shades of black or red, nor with the dun coat colour of Galloway cattle or the taupe brown colour of Braunvieh and Brown Swiss cattle. However, in Dexter cattle all 25 cattle with a dun brown coat colour were homozygous for a H424Y change. One Dexter that was also homozygous Y434 was red because of an "E+/E+" genotype at MC1R which lead to the production of only phaeomelanin. None of the 70 remaining black or red Dexter cattle were homozygous for Y434. This tyrosine mutation was not found in any of the 121 cattle of other breeds that were examined.

Animals↗

PubMed2000

Evaluating hand surgery in patients with rheumatoid arthritis: short-term effect on dexterity and pain and its relationship with patient satisfaction.

Short-term effect of hand surgery on hand function in activities of daily life (dexterity) and pain were studied in 70 patients with rheumatoid arthritis. Only surgical interventions aimed at improvement of function and/or pain relief were included in the study. Patients were assessed before surgery and 6 and 12 months after surgery. Clinical change in the surgical group was observed in the number of painful and swollen joints, observed dexterity, and pain in the hand. Six months after surgery 74% of the patients showed positive clinical change in hand functioning and/or hand pain. Clinical effects remained stable between 6 and 12 months after surgical assessments. Both change in observed dexterity and pain had an independent impact on the patient's satisfaction with the results of the surgery.

Arthritis, Rheumatoid↗

PubMed1990

Speed and accuracy effects of fingers and dexterity in 5-choice reaction tasks.

In two experiments we studied the influence of dexterity (controls, typists, pianists) and of differences between the five fingers of the dominant hand on speed and accuracy in a 5-choice reaction task. We used five coloured squares (Blue, Green, Yellow, Red, White) as stimuli, randomly varying foreperiods (3-10s) and an intermediate stimulus-response-compatibility. The results reported here were independent of sex, foreperiods, and colour of stimuli. In Experiment 1 (N = 168) with three groups (controls, typists, pianists) thumb and little finger showed significantly shorter reaction times than did index, middle, and ring finger. This difference did not interact with dexterity. Averaged across all the fingers typists and controls did not differ. Pianists showed significantly shorter reaction times than these two groups. Experiment 2 (N = 40) replicated all these findings. In both experiments groups did not differ in speed-accuracy-trade-off. The accuracy of the fingers was independent of dexterity. In all three groups the little finger showed the lowest rate of false alarms and the highest degree of reliability. The frequency distribution of finger confusions in all groups was in accordance with the spatial proximity of fingers: the closer their proximity the higher were the rates of confusion. In addition, these distributions showed an asymmetry across all three groups. The finger next to the 'correct' finger in direction towards the thumb showed the highest false alarm rate in each case.

Adolescent↗

PubMed1993

The effects of various thicknesses of chemical protective gloves on manual dexterity.

This study was conducted to determine the effects on manual dexterity of the thickness of handcovering. Twelve men were timed as they performed five dexterity tests while barehanded and while wearing each of three thicknesses of chemical protective gloves, 0.18 mm, 0.36 mm, and 0.64 mm. The subjects participated in 14 sessions held on consecutive weekdays. Analysis of the data from six sessions spanning the test period yielded significant main effects (p < 0.001) of handwear and of session on all dexterity tests. Mean times were best with bare hands and poorest with the 0.64 mm gloves. Performance with the gloves improved over sessions to the extent that the results with gloves approached or surpassed performance levels achieved with the bare hands during the early sessions. Regression analyses carried out on the data from the last three sessions revealed a linear increase in times to test completion as a function of increases in thickness of the handcovering. The occurrence of damage to the gloves, in the form of punctures and tears, was inversely related to thickness. The findings suggest that selection of the thinnest glove material compatible with protection from the chemical environment and practice working with the handwear will result in relatively efficient manual performance.

Adult↗

PubMed1995

An ergonomic evaluation of dexterity and tactility with increase in examination/surgical glove thickness.

Latex gloves of five different thicknesses (0.21 mm, 0.51 mm, 0.65 mm, 0.76 mm, and 0.83 mm) were manufactured in-house and tested for dexterity and tactility; dexterity and tactility measures with the bare hand were used as control values. Fifteen adult males (mean age = 22.8 years, mean stature = 179 cm, mean body weight = 75.4 kg, mean palm width = 9.9 cm, mean palm depth = 10.9 cm, and mean middle finger length = 9 cm) and five adult females (mean age = 21.2 years, mean stature = 168 cm, mean body weight = 53.6 kg, mean palm width = 8 cm, mean palm depth = 8 cm, and mean middle finger length = 8.3 cm) voluntarily participated. The gloves also were tested for punctures resulting from impact forces encountered during routine hand movements. The results indicated that the latex glove with 0.83 mm thickness successfully resisted routine impact forces and at the same time provided dexterity and tactility comparable to the bare hand. Thinner gloves failed the impact test and punctured. This indicates that it is possible to greatly reduce the incidence of exposure to contaminated body fluids through accidental needlesticks without compromising the preferred hand's capabilities.

Blood-Borne Pathogens↗

PubMed2002

Tactile perception and manual dexterity in computer users.

Recent studies suggest that sensory input generated during highly repetitive tasks can degrade the sensory representation of the hand and eventually lead to sensory and motor problems. In this study, we investigated whether early changes in tactile perception and manual dexterity could be detected in persons exposed to computer tasks. Performance in tests designed to assess tactile perception (grating orientation task for spatial acuity and roughness discrimination) and manual dexterity (grooved pegboard test) was compared between two groups of healthy individuals, matched for age, gender, and experience, who differed in terms of computer habits. One group consisted of frequent users (FU, > 2 h/day, n = 36) and the other of non or occasional users (OU, < 2 h/day, n = 28). Comparison of performance between groups with subjects sorted by gender revealed significant differences (t-test, p < 0.05) in female, but not male, participants. Grating resolution thresholds at the tip on the second and fifth digits were, on average, 40% higher in female FU (n = 13) than in female OU (n = 10) and performance scores on the dexterity test were significantly higher for the left hand. The results of this study indicate that early signs of deterioration in hand function can be present in persons constantly exposed to computer tasks and that these signs are more readily apparent in women than in men. The loss of tactile spatial acuity found in female FU possibly reflect an early consequence of the degraded sensory representation of the hand resulting from constant repetitions of fine motor tasks.

Adult↗

PubMed2003

Tactile spatial acuity in elderly persons: assessment with grating domes and relationship with manual dexterity.

In this study, we sought to better define the limit of spatial resolution at the fingertips of elderly participants (n = 30, age 60-95 years) using an extended set of JVP grating domes, incorporating four new grating dimensions (2.5-, 3.5-, 4.0- and 4.5-mm width). A secondary aim was to examine whether deficits in tactile acuity could be related to hand dysfunction in older adults. Spatial resolution thresholds were determined by the finest grating whose orientation (dominant index finger) could be reported reliably. Manual dexterity was assessed with the Grooved Pegboard Test (GPT). The extended set of domes improved threshold measurements in a majority of participants (21/30). Still, accurate threshold estimates could not be obtained in one third of the participants, mostly in the older age group (8/9, 74-95 years). Grating resolution thresholds at the index finger were strongly correlated (r = 0.66, p<0.01) with dexterity scores derived from the GPT. From these results, we conclude that the 2.5- and 3.5-mm grating domes are suitable additions when assessing spatial acuity at the fingertips of older subjects between 60 and 70 years of age (mean threshold, 2.7+/-0.6 mm). For the older ones, the 4.0- and 4.5-mm domes can improve threshold measurements but interpretation of values can be complicated by the presence of undiagnosed pathologies (e.g., diffuse polyneuropathy) as people advance in age. The strong relationship between grating resolution thresholds and dexterity scores indicates that an impaired spatial acuity at the fingertips may translate into great difficulties in tasks requiring fine manipulations. These findings have important implications for the assessment of hand function in older adults.

Aged↗

PubMed1997

Dwarfism in Dexter cattle is not caused by the mutations in FGFR3 responsible for achondroplasia in humans.

Dexter cattle carry a genetic defect causing a dwarf phenotype in the heterozygotes (Dx+/-), while homozygotes (Dx+/+) are stillborn with extreme shortening of limbs and gross craniofacial defects and are described as 'bulldog' calves. The heterozygous phenotype has been likened to achondroplastic dwarfism in humans (ACH), which has recently been shown to be the result of mutations in the transmembrane region of the fibroblast growth factor receptor 3 (FGFR3) gene. We have sequenced the transmembrane region of bovine FGFR3 from normal Dexter cattle (Dx-/-) and bulldog calves (Dx+/+). The sequence from both is identical and therefore excludes mutations in the trans-membrane region of FGFR3 as the cause of Dexter dwarfism.

Achondroplasia↗

PubMedDate not supplied

Manual dexterity: how does the cerebral cortex contribute?

1. Manual dexterity, of great evolutionary significance to the primates, ranges in complexity from the precise opposition of finger and thumb to Brendal playing Mozart. All dexterity depends on a sustained and rapid transfer of sensorimotor information between the cerebral cortex and the cervical spinal cord. 2. Multiple separate corticospinal neuron populations originate from cortical areas four, the supplementary motor area, anterior cingulate, postarcuate, parietal and insular cortex. Each corticospinal neuron population projects in parallel to all spinal segments, and has a distinctive pattern of terminations. 3. Each corticospinal neuron population has a unique thalamic input which can relay particular sensorimotor information from the sense organs, cerebellum and basal ganglia. The overall structural framework of these sensorimotor pathways, with many parallel corticospinal channels, with interconnections in the cerebral cortex and spinal cord to enable crosstalk between the channels, is that needed for parallel distributed processing, which would enable the very rapid transfer of information between the cerebral cortex and spinal cord needed for any sophisticated use of the hand. 4. Hemisection of the cervical spinal cord in the macaque results in an immediate hemiplegia, with subsequent remarkable although incomplete recovery of hand and finger movements. The only direct corticospinal input to the hemicord caudal to the hemisection, even after 3 years, is the approximately 10% of fibres which cross the midline caudal to the lesion: the fibres 'spared' by the hemisection. A matching 'sparing' of somatosensory input from the paresed limb also occurs. No regeneration of the interrupted pathways has been visualized using modern tracer techniques. 5. Cervical hemisection permanently reduces the number of parallel channels which transmit information between cortex and spinal cord, but does not reduce their cortical origins nor the neuron populations targeted in the spinal cord. We infer that the content of the information that can be transmitted between the cortex and spinal cord is not greatly changed, but the rate of transmission of this information is sharply reduced, and is the 'bottleneck' that limits the complete recovery of dexterity following hemisection. The remarkable recovery that does occur presumably reflects more economic transmission of information by the few spared channels. We guess that this involves substantial synaptic reorganization not visualized by the procedures we have used.

Animals↗

PubMed1989

Manual dexterity as a correlate of dependency in the elderly.

Physical and mental correlates of dependent living were determined in 128 Catholic sisters (nuns), aged 75 to 94 years, who had similar social support systems and lifestyles. The primary a priori hypothesis was that poor manual dexterity would correlate strongly with living in the nursing home. Stepwise discriminant analysis indicated that manual dexterity explained 51% of the variance in the sisters' residential living site (ie, nursing home, retirement home, or living in community). The discriminant analysis equation using manual dexterity predicted living site correctly for 63% of the sisters in the nursing home with a specificity of 99%, a positive predictive value of 96% and negative predictive value of 84%. The addition of age and mental status to the equation improved the prediction only slightly.

Activities of Daily Living↗

PubMed1989

Correlation of manual dexterity and comprehension with oral hygiene and periodontal status in mentally handicapped adults.

Although there is relatively little information concerning the oral health of handicapped adults there is increasing evidence to suggest that their oral condition, particularly periodontal health, is poor. The present investigation involved assessment of 382 handicapped patients attending four different Adult Training Centres in Birmingham. The caries status, oral hygiene, and periodontal conditions were evaluated and the Community Periodontal Index of Treatment Need (CPITN) was calculated. In order to assess the manual dexterity and the comprehension of the trainees a standard test was devised. This consisted of timing each participant in carrying out simple instructions to pick up and position certain common objects. The results indicated high levels of plaque, calculus, and bleeding with a mean CPITN of 7.43. The mean time taken for the manual dexterity and comprehension test was 23.9 seconds with a range from 10 to 80 seconds, S.E.+/- 1.33. This compares with results from 34 "normal" adults of a mean time of 8.2 seconds +/- 1.8 with a range of 6 to 12 seconds. There was no significant correlation between the Manual Dexterity and Comprehension scores and the periodontal indices in the handicapped adults.

Adult↗