The Dexter Endoscopic Dexterity Trainer improves fibreoptic bronchoscopy skills: preliminary observations.
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Anesthesiology↗
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Repeatability of grip strength and dexterity tests and the effects of age and gender.
OBJECTIVES: Users of hand-held vibratory tools report reductions in grip strength and manual dexterity. This study quantified the test-retest repeatability of grip strength and manual dexterity tests, investigated effects of gender and age, and determined normative measures in different subject groups. METHODS: A total of 72 subjects in four groups (both genders and two age ranges) participated: men and women aged 18 to 25 years and 45 to 55 years. Grip strength was measured with a hand-held dynamometer, and dexterity measured with the Purdue pegboard. We assessed repeatability using one subject group (18 to 25-year-old men) who attended over three successive weeks. RESULTS: Repeated measures of grip strength were correlated for both hands and for each combination of weekly tests (P=0.01), and there were no significant changes in strength over weeks. Repeated measures of dexterity were correlated in both hands (P=0.01) for all test combinations, except between weeks 1 and 3 in the non-dominant hand (P=0.15). Further analysis suggested an improvement in dexterity, consistent with a practice effect. In both age groups, grip strength of the men was significantly greater than that of the women (P<0.01), but there were no gender differences in dexterity scores (P>0.1). There were no significant effects of age for either grip strength or dexterity (P>0.1). CONCLUSIONS: Both tests showed sufficient repeatability, with no age effect on either grip or manual dexterity (between approximately 20 to 55 years), although a decline in grip and dexterity is expected at greater ages. Dexterity scores were similar in both genders for the groups studied. Grip strength was greater in men. Occupational effects might exist for both tests, irrespective of any occupational disorder, and might be reflected in increases or decreases in grip strength and dexterity.
Adolescent↗
Comparing the level of dexterity offered by latex and nitrile SafeSkin gloves.
An increase in the occurrence of latex allergy has been concurrent with the increasing use of latex gloves by laboratory and healthcare workers. In recent years nitrile gloves have been used to replace latex gloves to prevent latex allergy. Nitrile gloves offer a comparable level of protection against chemical and biological agents and are more puncture resistant. However, if manual dexterity is compromised by nitrile gloves to a greater degree than latex then this may increase the risk of sharps injuries. The Purdue pegboard test, which measures both gross and fine finger dexterity, was used to test the dexterity levels of two glove types used at HPA CEPR; Kimberly-Clark SafeSkin nitrile and latex laboratory gloves. There was a statistically significant 8.6% increase in fine finger dexterity provided by latex compared with nitrile SafeSkin laboratory gloves but no difference in gross dexterity between the glove types. There was no significant relationship between glove dexterity and age or gender. The selection of glove size was influenced by the digit length of participants. Moreover, those with longer, thinner fingers appeared to have an advantage when using nitrile SafeSkin gloves. The level of dexterity provided by latex and nitrile SafeSkin gloves for tasks on a gross dexterity level are comparable and health workers will benefit from the non-allergenic properties of nitrile. For tasks requiring fine finger dexterity nitrile SafeSkin gloves may impede dexterity. Despite this, the degree of restriction appears to have a negligible impact on safety in this study when compared with the risk of latex sensitization and subsequent allergy. In addition to glove material, working practices must also take into account glove size, fit, grip and thickness, as these factors can all influence dexterity.
Adult↗
Predictors of changes in observed dexterity during one year in patients with rheumatoid arthritis.
OBJECTIVE: To determine which disease-related variables predict loss of dexterity in patients with rheumatoid arthritis (RA). METHODS: A random sample of 94 RA patients was measured twice 1 yr apart. Dexterity, or hand-related disability, was measured with the Sequential Occupational Dexterity Assessment (SODA). The SODA measures dexterity in activities of daily life based on the observation of standardized tasks. Impairment of the hands, disease activity, pain and self-reported functioning were additionally assessed. RESULTS: After 1 yr, observed dexterity was significantly decreased. Change in dexterity was predicted by impairment of the hands at baseline. Changes in dexterity were related to changes in grip strength, disease activity indicators, self-care, depressive mood and cheerful mood. An increase in the number of swollen joints was most strongly correlated with a decrease in dexterity, even after controlling for impairment at baseline. CONCLUSION: It was concluded that even in patients with longer disease duration, observed dexterity declines gradually.
Activities of Daily Living↗
Abnormal muscle activation characteristics associated with loss of dexterity after stroke.
The aim of this study was to characterise the abnormalities of muscle activation which underlie low dexterity after stroke. A broad definition of dexterity was adopted, where loss of dexterity refers to an inability to coordinate muscle activity in the performance of a motor task (i.e. dexterity was not confined to manual dexterity). EMG of biceps brachii and triceps brachii were monitored from 16 people after stroke and 10 neurologically normal controls as they performed a tracking task requiring coordinated elbow flexion and extension. Weakness could not interfere with performance since the task was designed to require minimal strength. Stroke subjects were assigned to a low (n=10) or high (n=6) dexterity group based on their performance. Spatiotemporal aspects of biceps and triceps EMG were analysed. Low dexterity performance after stroke was characterised by excessive biceps muscle activation (P=0.002) and decreased coupling of muscle activation to target motion (P=0.002). In this study, we could rule out weakness, slowness of muscle activation, excessive co-contraction and spasticity as causes of these abnormalities. Therefore, the loss of dexterity after stroke can be seen as a specific negative impairment which can exist independently of other motor impairments and reflects a loss of skill in generating spatial and temporal muscle activation patterns which conform with environmental demands.
Aged↗
Behavioral coping and physical functioning: the effect of adjusting the level of activity on observed dexterity.
OBJECTIVE: To assess the relationship between behavioral coping and dexterity in rheumatoid arthritis (RA) after controlling for disease activity, impairment of the hands, and pain. METHODS: A random sample of 109 patients with RA was assessed twice within one year. Dexterity, disease activity, and impairment of the hands were measured using observational methods. Pain and coping with RA were assessed using self-report instruments. RESULTS: Correlational findings showed that "decreasing activity" to cope with pain was negatively related to dexterity. "Pacing" as a way of coping with limitations was positively related to dexterity. Both relations were significant after controlling for duration of disease, impairment of hands, disease activity, and pain. "Decreasing activity" as a way of coping with pain was related to a decrease in dexterity in the subsequent year, after controlling for baseline measurements of dexterity, impairment, and disease activity as well as measurements of current disease activity and pain. "Pacing" as a way of coping with limitations was unrelated to subsequent changes in dexterity, after controlling for the above mentioned variables. CONCLUSION: Behaviorial coping is related to current and subsequent levels of dexterity. Therefore, it is concluded that more attention should be given to behaviorial coping in both research and clinical practice.
Adaptation, Psychological↗
A biographical sketch of Lewis Dexter.
Dr. Lewis Dexter was an outstanding cardiovascular physiologist and clinician, a respected teacher and scientist, and, most importantly, a fine human being. During his life, he brought the cardiac catheter from the laboratory to the patient and trained several generations of cardiologists. Dexter's laboratory was the first to elucidate the pathophysiologic alterations present in many forms of congenital heart disease, including atrial septal defects, patent ductus arteriosus, tetralogy of Fallot, ventricular septal defects, and pulmonic stenosis. Subsequent work in Dexter's laboratory led to the 1st measurements of pulmonary capillary wedge pressure and to the precise calculation of stenotic valve areas from hemodynamic parameters measured during cardiac catheterization. During a teaching exercise, Dexter demonstrated that exercise with a cardiac catheter in the heart was safe and produced clinically important data, by having a cardiac catheter inserted in himself. Over the years, many significant pathophysiologic studies that explored pulmonary embolism, valvular heart disease, right and left ventricular function, and pulmonary hypertension were published from Dexter's laboratory. But Lewis Dexter was more than a brilliant researcher "Lew" was very close to his fellows and students, whom he considered extensions of his family Dexter was a remarkable teacher, a compassionate physician, and a scrupulously honest investigator. Dr Lewis Dexter had a major impact on modern medicine and was one of the great cardiologists of the 20th century.
Cardiology↗
[An assessment of the influence of the severity of Dupuytren's contracture on the dexterity of the hand before and after surgery].
It seems to evident that deformation of the hand as a result of Dupuytren's contracture should cause weakness and overall functional impairment of the hand, and an increase of range of motion of the fingers as a result of the operation should effect in improvement of these parameters. The objective of this study was to investigate the effect of extension loss of fingers, number of fingers involved and age of the patients on the power and dexterity of the hand, as well as influence of the age of the patients and recovery of extension of the fingers on the power and dexterity of the hand after surgery for Dupuytren's contracture. 54 patients in an age range 32-83 years (mean 60) with the disease lasting av. 5 years underwent subtotal fasciectomy. Total extension loss of the fingers and total grip strength were measured and dexterity of the hand was assessed with DASH questionnaire prior to surgery. Patients were followed-up for 1 year and assessments were repeated at 1, 3 and finally at 12 months. Median values of measured variables at presentation were as follows: extension loss 80 degrees, total grip strength 41 kG, and DASH score 54. At 12 months median extension loss decreased to 10 degrees (stat. sign.), DASH score to 32 (stat. sign. improvement of dexterity) and grip strength decreased slightly to 40 kG. An analysis of the relationship between the variables showed that severity of the contracture (expressed as an extension loss) had no effect on dexterity of the hand but had significant influence on deterioration of the total grip strength. Number of fingers involved did affect neither dexterity nor power of the hand. Age of the patients did not influence subjective feeling of dexterity of the hand, however, older patients experienced lesser functional benefit from the operation, than younger patients. An increase of extension of the fingers following surgery had significant beneficial effect on subjective improvement of the dexterity of the hand, but had not effect on the increase of power of the hand.
Adult↗
Finger dexterity and hand function: effect of three commercial wrist extensor orthoses on patients with rheumatoid arthritis.
OBJECTIVE: To investigate the effect of 3 commercial wrist orthoses on finger dexterity and hand function of patients with rheumatoid arthritis (RA). METHODS: Forty-two patients with definite RA participated in the cross-over study comparing 3 styles of commercial wrist orthoses. Finger dexterity and hand function of the dominant hand were assessed while splinted and unsplinted, at the initial session and after 1 week of intermittent orthosis use. Finger dexterity was assessed using two subtests from the Purdue Pegboard Test (Purdue) and hand function was assessed using the Jebsen-Taylor Hand Function Test (Jebsen-Taylor). RESULTS: Both finger dexterity and hand function were reduced by splinting; men and women were affected similarly. There was no difference in finger dexterity or hand function afforded by the 3 orthoses. Results on both the Purdue and Jebsen-Taylor tests showed a significant learning effect across time. CONCLUSIONS: The 3 commercial wrist orthoses studied reduce dexterity similarly and significantly. When commercial wrist orthoses are to be used during tasks that require maximum dexterity, this reduction should be weighed against the known benefits of splinting.
Activities of Daily Living↗
Technical performance: relation between surgical dexterity and technical knowledge.
Technical performance consists of surgical knowledge, judgment, and dexterity. Although assessment of surgical dexterity is now possible, assessing technical knowledge and its relation to dexterity has not been elucidated. Surgeons of varying experience were recruited to the skills laboratory to undertake three assessments: simple surgical dexterity (at 14 stations scored by motion analysis), an operating room equipment examination, and a novel error analysis. The scores were correlated, and p < 0.05 was deemed to be significant. Thirty surgeons were recruited; and construct validity was exhibited in all areas. Correlations were shown to exist between the two knowledge examinations (Spearman's rho = 0.39). Correlations existed between all dexterity task parameters and the equipment examination, whereas they existed for only 15 of the 28 parameters of the error examination and were always weaker. The stronger correlations between dexterity and instrument and operating room (OR) equipment reflect greater surgical experience and time spent in the OR. The weaker correlations between the error analysis and dexterity suggest that these skills are learned at different times. The identification of common surgical errors should be more formally taught to ensure greater uniformity.
Anastomosis, Surgical↗
Chondrodysplasia in Australian Dexter cattle.
OBJECTIVE: To describe the occurrence of chondrodysplasia in Australian Dexter cattle. DESIGN: A pathological and genetic case report. PROCEDURE: Congenital lethal chondrodysplasia was studied in two female Dexter foetuses aborted mid to late gestation. Clinicopathological findings including histological changes in limb bones, and analysis of pedigree information were evaluated. RESULTS: Characteristic features of congenital lethal chondrodysplasia (Dexter bulldog) include abortion, disproportionate dwarfism, a short vertebral column, marked micromelia, a relatively large head with retruded muzzle, cleft palate and protruding tongue and a large abdominal hernia. Histological changes in limb bones are consistent with failure of endochondral ossification. Dexter chondrodysplasia is considered to be inherited in an incompletely dominant manner with the homozygous form producing the congenital lethal condition. A preliminary minimum estimate of heterozygote frequency is 19% within the registered Australian Dexter herd, based on analysis of the contribution of three obligate heterozygotes whose semen has been widely used by artificial insemination in Australia. CONCLUSION: Dexter chondrodysplasia is present in Australian cattle and further cases of the homozygous form, congenital lethal chondrodysplasia, are likely to occur. RECOMMENDATION: It is requested that spleen and liver tissue from bulldog foetuses and blood from their parents be collected to assist research into Dexter chondrodysplasia.
Abortion, Veterinary↗
Rhythmic variations in pain, stiffness, and manual dexterity in hand osteoarthritis.
OBJECTIVE: To explore circadian variation in pain, stiffness, and manual dexterity in patients with hand osteoarthritis (OA). METHODS: Twenty one patients with hand OA, as defined by ACR criteria (17 women, four men, mean age 62.2 years, range 52-74 years) self rated pain and stiffness on separate 10 cm horizontal visual analogue scales and performed bead intubation coordinometry (BIC) six times each day (on waking up, at bedtime, and every four hours in between) for 10 consecutive days. Each series (using data with the trend removed if there was a significant trend) was analysed for circadian rhythmicity by a cosine vector technique (single cosinor). With individual data expressed as the percentage of the mean, group rhythm characteristics at period 24 hours were summarised for each variable by population mean cosinor analysis. RESULTS: Individual analyses identified significant circadian rhythms at p<or=0.05 for pain (n=15/21), stiffness (n=16/20), and dexterity (n=18/21), and a significant circadian rhythm on a group basis was identified for pain (p=0.013), stiffness (p<0.001), and dexterity (p<0.001). Pain was least at 1610 and stiffness at 1618. Peak dexterity occurred in mid-afternoon at 1548 and occurred within the 95% confidence interval of least pain (1312-1800) and stiffness (1520-1732). CONCLUSIONS: Dexterity was influenced by the patient's level of pain or stiffness, which changed systematically throughout the day. Similar results have been previously reported in 14 patients with rheumatoid arthritis where peak dexterity occurred at 1544 and at 1528 in 14 age and sex matched healthy controls. The predictability of rhythmic variation in pain, stiffness, and dexterity has implications for scheduling activities of daily living and for timing antirheumatic drug treatment.
Aged↗
Brain size is not correlated with forelimb dexterity in fissiped carnivores (Carnivora): A comparative test of the principle of proper mass.
To test the hypothesis that brain size and forelimb dexterity are positively correlated, the relative brain size of 41 species of fissiped (terrestrial) carnivores (Order: Carnivora) was examined with respect to their forelimb use during feeding. With the use of a newly derived dexterity index, the forelimb dexterity executed by each of the species was calculated as a single, continuous variable which was then regressed against the residuals of brain size. To account for confounding effects of phylogenetic inertia, the analysis was performed with independent contrasts analysis using a speciational model of evolutionary change (i.e. equal branch lengths). The results suggest that relative brain size and isocortex size are not correlated with the dexterity of the proximal or distal segments or a combination of the two (total forelimb dexterity). The presence of species with widely different brain sizes and similar dexterities, and vice versa, suggests that an increase in the amount of neural substrate might not be necessary for the production of finely coordinated forelimb movements. It is suggested that this outcome is representative of the plasticity of both mammalian brain size and behavior and that variations in brain size and forelimb dexterity could be linked to disparate ecological and phylogenetic factors which act in concert to promote or constrain neural development and behavior in different species.
Animals↗
Effect of muscle length on strength and dexterity after stroke.
OBJECTIVE: The effect of muscle length on strength and dexterity after stroke was investigated. The aim was to determine if poor function at a particular muscle length could be attributed solely to differential weakness at this joint angle or whether an additional problem of differential dexterity exists. DESIGN: This descriptive research study measured elbow flexor and extensor strength as well as dexterity at three elbow joint angles: 30 degrees , 60 degrees and 90 degrees flexion. Dexterity was measured independently of strength. SUBJECTS: Fifteen (seven female, eight male) chronic stroke patients (mean age 67 years) who could actively flex and extend their affected elbow participated. Ten neurologically normal control subjects (mean age 67 years) acted as controls. MAIN OUTCOME MEASURES: Strength was measured as peak elbow flexor and extensor torque at three angles; and dexterity was measured as coherence for slow and fast tracking also at three angles. RESULTS: Dexterity was not affected by muscle length but strength was and this finding was the same for both stroke and controls. While the magnitude of the torque-angle curves was not significantly different between stroke and controls, the shape of torque-angle curves was altered after stroke so that both the elbow flexors (p < 0.05) and extensors (p < 0.05) tested weaker in the testing position where they were shortest. CONCLUSION: Since there was no differential loss of dexterity, it appears that differential loss of strength, especially in the shortened range, may explain the clinical observation of poorer function at one muscle length than another after stroke. Specific training to strengthen the muscles in these ranges is therefore of clinical importance for rehabilitation.
Aged↗
Sequential occupational dexterity assessment (SODA): a new test to measure hand disability.
Measuring hand-related disability poses a problem due to a lack of validated tests. This report introduces the sequential occupational dexterity assessment (SODA), a test that measures bimanual dexterity in daily life. The design of the SODA is described. Validity and reliability of the SODA are demonstrated in a sample of patients with rheumatoid arthritis (RA), in whom impairment of the hands may cause serious disability in daily life. Good reliability was found, as measured by internal consistency, test-retest correlation, and interrater stability. Validity was established by relating the SODA to a number of other variables. Current disease activity was only weakly related to the SODA score. Impairment of the hands is more strongly related to dexterity than to current disease activity. However, dexterity could vary considerably in patients with similar degrees of impairment. Pain during the SODA proved to be more important for dexterity than general level of pain. Considerable variation was found in self-reported and observed dexterity. It was concluded that the SODA may guide the therapist in making decisions about hand therapy. The use of the SODA allows standardized evaluation of the effects of hand surgery on bimanual dexterity.
Activities of Daily Living↗
Measuring normal hand dexterity values in normal 3-, 4-, and 5-year-old children and their relationship with grip and pinch strength.
After surgery for trauma or correction of congenital anomaly, hand function is difficult to evaluate in children because there are no reference norms on children 3 to 5 years old. The purpose of this study was to determine whether reproducible normative values for hand dexterity and grip and pinch strength could be obtained in young children using simple tests that could be administered quickly within the attention span of a 3- to 5-year-old. The Functional Dexterity Test (FDT), a pegboard test validated for adults and older children, seemed to meet our requirements for dexterity. The FDT was administered to a convenience sample of normal children in a prekindergarten school who were grouped according to age: 3-year-olds (n = 17), 4-year-olds (n = 24), and 5-year-olds (n = 22). Hand dominance was determined. The task was demonstrated by 1 of the 2 testers. The child was asked to turn the pegs over in the pegboard without using the free hand or balancing the peg against the chest. Both hands were tested. Grip and pinch strengths were measured in both hands in a consistent manner. All the children were tested with the arm at the side and the elbow at 90 degrees. A dynamometer was used for grip strength and a pinch meter was used to measure key (lateral) and tripod pinch strengths. Means and SDs were calculated for each age group, and the dependent values of dexterity, strength, and dominance were correlated. Dexterity and strength scores were significantly different by age group. A good FDT score in the dominant hand was predictive of a good score in the nondominant hand. Grip and pinch strength correlated poorly with functional dexterity. The normative values established in this study for children in the 3- to 5-year-old range can be referenced for disability estimates and establishing goals for children after surgery or hand injury.
Age Factors↗
Impaired dexterity of the ipsilateral hand after stroke and the relationship to cognitive deficit.
BACKGROUND AND PURPOSE: Previous research has reported impaired hand function on the "unaffected" side after stroke, but its incidence, origins, and impact on rehabilitation remain unclear. This study investigated whether impairment of ipsilateral dexterity is common early after middle cerebral artery stroke and explored the relationship to cognitive deficit. METHODS: Thirty patients within 1 month of an infarct involving the parietal or posterior frontal lobe (15 left and 15 right hemisphere) used the ipsilateral hand in tests that simulated everyday hand functions. Performance was compared with that of healthy age-matched controls using the same hand. Standardized tests were used to assess apraxia, visuospatial ability, and aphasia. RESULTS: All patients were able to complete the dexterity tests, but video analysis showed that performance was slow and clumsy compared with that of controls (P<0.001). Impairment was most severe after left hemisphere damage, and apraxia was a strong correlate of increased dexterity errors (P<0.01), whereas reduced ipsilateral grip strength correlated with slowing (P<0.05). The pattern of performance was different for patients with right hemisphere damage. Here there was no correlation between grip strength and slowing, while dexterity errors appeared to be due to visuospatial problems. CONCLUSIONS: Subtle impairments in dexterity of the ipsilateral hand are common within 1 month of stroke. Ipsilateral sensorimotor losses may contribute to these impairments, but the major factor appears to be the presence of cognitive deficits affecting perception and control of action. The nature of these deficits varies with side of brain damage. The effect of impaired dexterity on functional outcome is not yet known.
Aged↗
Loss of strength contributes more to physical disability after stroke than loss of dexterity.
OBJECTIVE: The major contributors to physical disability after stroke are considered to be the negative impairments of loss of dexterity (defined here as loss of the ability to co-ordinate muscle activity in the performance of any motor task) and loss of strength. The aims of this study were: (1) to determine the relative contributions of strength and dexterity to function during recovery after stroke; and (2) to determine the predictive value of initial strength, dexterity and function on long-term function after stroke. DESIGN: A longitudinal descriptive study. SETTING: The inpatient and outpatient rehabilitation departments of two metropolitan hospitals. SUBJECTS: Twenty-two patients undergoing rehabilitation after acute stroke participated. MAIN OUTCOME MEASURES: Strength and dexterity of the elbow flexors and extensors were measured, along with arm function, at 3, 5, 7, 9, 11, 15, 19, 23 and 27 weeks after stroke. RESULTS: Standard multiple linear regression analysis demonstrated that strength and dexterity in total contributed significantly to function at all times (r2 = 0.66-0.82, p < 0.0001). Furthermore, strength always made an additional separate contribution to function (r2 = 0.05-0.26, p < 0.05). Function at week 3 was the best clinical predictor of function at week 27 (r2 = 0.55, p < 0.001). CONCLUSIONS: Loss of strength is a more significant contributor than loss of dexterity to physical disability after stroke. This suggests that, where significant weakness is present, exercise designed to increase strength will be required to decrease disability.
Aged↗