American Society Of Hand Therapists Research Articles

Grip strength measurement in older adults in Taiwan: A comparison of three testing positions

The purpose of this study was to explore the effects of three commonly used positions on grip strength measurement in older people. A total of 249 (113 women, 136 men) older participants, 72.8 ± 6.5 years old, participated in this study. Grip strength (kg) was measured in three positions: (i) the standard posture (sitting, elbow flexed 90°) suggested by the American Society of Hand Therapists; (ii) standing, elbow flexed 90°; and (3) standing, elbow fully extended. One-way repeated measures analysis of variance showed that grip strength was significantly greater in the standing position with the elbow fully extended than in the other two positions. The grip strengths obtained from the three positions were not all comparable in our community-dwelling older adults. Clinicians and researchers need to be cautious when choosing testing position for assessing and interpreting grip strength results obtained from these positions.

A Survey to Determine the Reliability of Dynamometer and Pinch Gauge Dial Readings Among Certified Hand Therapists

Using a cross-sectional descriptive study design, surveys were mailed to 200 randomly selected certified hand therapists of the American Society of Hand Therapists (ASHT) to determine how they document analog dynamometer and pinch gauge dial readings. Three different needle settings for the dynamometer and pinch gauge were presented in picture format. For each instrument, one needle setting was just above a gauge marker, one was just below a gauge marker, and one was set exactly between two gauge markers. A total of 126 out of 200 surveys were returned for a participation rate of 63%. For the dynamometer readings, therapists estimated the exact strength reading between the two gauge markers 78.3% of the time. For the pinch gauge readings, therapists rounded to the nearest dial marker 76.5% of the time when the needle was just above or just below a dial marker and 61.9% of the time they estimated the reading when the needle was placed exactly between two dial markers.

Validade preditiva de equações de referência para força de preensão manual em homens brasileiros de meia idade e idosos

O objetivo deste estudo foi verificar a validade preditiva das equações de referência para predição da força de preensão manual (FPM) em homens brasileiros de meia idade e idosos. Foram avaliados 60 homens com idade de 58,7±8,6 anos (50-84 anos), estatura 168,7±8,0 cm, massa corporal 67,9±13,0 kg e índice de massa corporal 23,7±4,0 kg/m², utilizando equipamento 'padrão-ouro' na avaliação da FPM e seguindo todas as recomendações metodológicas preconizadas pela American Society of Hand Therapists (ASHT). Os resultados do diagrama de Bland-Altman para mão dominante (MD) apresentam um erro médio (viés) de -8,4% (IC95% -51,6-34,7). Já o diagrama de Bland-Altman para mão não dominante (MND) apresenta um erro médio (viés) de 1,4% (IC95% -47,1-49,8). O cálculo de Cronbach's alpha para a MD foi de 0,69 e 0,59 para MND. O coeficiente de correlação intraclasse para MD foi 0,52 (IC95% 31-68) e de 0,42 (IC95% 20-60) para a MND. Concluímos que as equações para predição analisadas neste estudo, para uma população de homens brasileiros de meia idade e idosos, apresentou baixa validade preditiva, o que pode gerar erros de interpretação dos resultados.

Grip Strength: Influence of Head-Neck Position in Normal Subjects

Background: The aim of this study was to investigate whether head-neck (H-N) position affects grip strength in healthy young adults and to find out, which H-N position have the greatest influence on grip strength. Methods: Eighty male and female students volunteered as subjects. The dominant hand was used to apply tension to the lever of a Jamar dynamometer. The data collection procedures followed American Society of Hand Therapists standardized grip-strength testing guidelines, with the except for H-N position. The maximal grip strength was measured at H-N in neutral, rotation to the left and rotation to the right. Result : The results were analyzed using independent ‘t’ test to compare the height and weight between groups. To compare the maximal grip strength between H-N position one-way analysis of variance and Tukey HSD was used. The result showed that maximal grip strength in the right dominant was significantly highest at H-N rotated to left at P Conclusion : The highest maximal grip strength obtained at H-N rotated to left, showed that for accurate assessment and rehabilitation, the H-N should be positioned opposite to the tested extremity which could be due to the influence of ATNR. doi:10.4021/jnr117w

Reliability of the Pinch Strength with Digitalized Pinch Dynamometer

ObjectiveTo examine the intra-rater, inter-rater, and inter-instrumental reliability of the digitalized pinch muscle strength dynamometer.MethodThirty normal subjects were examined for pinch strength, using both the Preston pinch gauge and the digitalized pinch dynamometer. The participants performed all pinch strength tests in the seated position as recommended by the American Society of Hand Therapists (ASHT). Three successive measurements were taken for each hand. The mean of the three trials was used for data analysis. The pinch strength tests performed used a repeated measure design and measurements were taken by each rater.ResultsThe relationship between the Preston pinch gauge and the digitalized pinch dynamometer in pinch strength was reliable (the ICC were 0.821 and 0.785 in rater 1 and rater 2 respectively). The relationship between the first session and second session in pinch strength using the digitalized pinch dynamometer was reliable (the ICC were 0.872 and 0.886 in rater A and rater B respectively). The relationship between rater A and rater B in pinch strength using the digitalized pinch dynamometer was reliable (the ICC was 0.754).ConclusionThe pinch strength measurement using the digitalized pinch dynamometer is reliable within the rater and between raters. Thus, the Preston pinch gauge and the digitalized dynamometer measure grip strength equivalently, and can be used interchangeably.

Grip Strength: Influence of Head-Neck Position in Normal Subjects

Background: The aim of this study was to investigate whether head-neck (H-N) position affects grip strength in healthy young adults and to find out, which H-N position have the greatest influence on grip strength. Methods: Eighty male and female students volunteered as subjects. The dominant hand was used to apply tension to the lever of a Jamar dynamometer. The data collection procedures followed American Society of Hand Therapists standardized grip-strength testing guidelines, with the except for H-N position. The maximal grip strength was measured at H-N in neutral, rotation to the left and rotation to the right. Result : The results were analyzed using independent ‘t’ test to compare the height and weight between groups. To compare the maximal grip strength between H-N position one-way analysis of variance and Tukey HSD was used. The result showed that maximal grip strength in the right dominant was significantly highest at H-N rotated to left at P < 0.05. Conclusion : The highest maximal grip strength obtained at H-N rotated to left, showed that for accurate assessment and rehabilitation, the H-N should be positioned opposite to the tested extremity which could be due to the influence of ATNR. J Neurol Res. 2012;2(3):93-98 doi: https://doi.org/10.4021/jnr117w

Management of Dominant Upper Extremity Injuries: A Survey of Practice Patterns

Study Design Internet survey. Purpose To describe current practice patterns in hand therapy to 1) gain insights into beliefs of certified hand therapists (CHTs) related to initiating a hand dominance transfer, 2) describe CHTs’ clinical decision-making strategies, and 3) describe research priorities related to hand dominance transfer in hand therapy. Participants Five hundred sixty-three members of the American Society of Hand Therapists. Methods The online Internet survey contained 30 questions related to four categories: 1) demographics of clinicians, 2) beliefs about hand dominance transfer, 3) clinical strategies and decision making, and 4) a research agenda related to hand dominance transfer. Data were sorted, compiled, and analyzed descriptively. Results Respondents were primarily occupational therapists working as full-time staff therapists treating between nine and 15 patients per day with orthopedic injuries to the dominant upper extremity caused by trauma. The overwhelming majority of respondents (92.7%) believed that motivation is a factor in the success of the hand dominance transfer. Most respondents (83%) do not directly initiate a hand dominance transfer. The number one reason (64%) for not initiating a dominance transfer is that CHTs believe that their patients will regain full recovery of injured hand over time. If a transfer is initiated, the number one task addressed is handwriting (62%); the most commonly recommended piece of adaptive equipment was the handsfree can opener (63.8%); 72% educate on the risk of overuse injury to the noninjured (intact) limb. Most respondents agreed or strongly agreed that more research needs to be done related to hand dominance transfer, specifically related to return to work rates, interventions using virtual reality, and assessments using neuroimaging technologies. Level of Evidence 3b.

Investigation of the Effects of Resting Time and Trial on the Maximal Grip Strength

Objective: The aim of this study was to investigate the maximal grip strength for the combinations of resting time and trial and to provide guideline of resting time for the maximum gripping task associated with the number of trials. Background: Despite many previous researches for the maximal grip strength, few studies have considered the effect of both trials and rest time on the maximum grip strength. Methods: A total of thirty subjects participated in the study. The average of maximum grip strength was measured using JAMAR hydraulic hand dynamometer. The testing position was same as the position recommended by the American Society of Hand Therapists. The between-subject experimental design has been conducted in this study. Trials(1~20 trials) and rest time(2, 3, and 4min) were considered as independent variables, and the maximum grip strength was considered as dependent variable, respectively, in this study. Results: According to the result of the number of trials, the maximal grip strength decreased gradually as the number of trials increased. The ANOVA result showed that the main effect was significant for both resting time(p＜.0001) and trial(p＜.0001), and the interaction was significant(p＜0.0086). Conclusions: The maximal grip strength decreased gradually as the number of trials increased. Thus, basic guideline of resting time was suggested for the number of trials of maximal grip strength tests in this study.

Força de preensão manual de atletas tenistas avaliada por diferentes recomendações de teste

A avaliação da força de preensão manual (FPM) em tenistas competitivos deve ser realizada devido à assimetria que o jogador pode desenvolver. Para avaliar a FPM, profissionais utilizam dois protocolos diferentes (das Sociedades Americana e Europeia). Os objetivos deste estudo foram comparar a FPM usando a técnica do European Test of Physical Fitness Handbook (Eurofit) e da American Society of Hand Therapists (ASHT), bem como verificar a FPM entre o lado dominante/contralateral e comparar a FPM entre as idades em atletas de tênis da categoria infanto-juvenil. Participaram do estudo 137 tenistas do gênero masculino e 45 do feminino, todos com idade entre oito e 18 anos. Para avaliar a FPM, segundo as recomendações da Eurofit e ASHT, foi utilizado um dinamômetro manual (Jamar). Nenhum dos sujeitos avaliados apresentava qualquer lesão que pudesse comprometer o teste. Os resultados mostram que não há diferença na FPM entre os posicionamentos recomendados pela Eurofit e ASHT para medir a FPM independente do gênero. A curva sigmoide foi a que melhor se adequou para regressão da FPM e idade em ambos os gêneros sendo que para o masculino a FPM tem maior inclinação aos 11 anos, já para o feminino a maior inclinação é aos 10 anos. Além disso, a partir dos 14 anos, o lado dominante dos atletas masculinos apresentou maior FPM que o lado não dominante; contudo, essa assimetria não ocorreu no feminino em qualquer idade até os 18 anos.

Hand Therapist Management of the Lateral Epicondylosis: A Survey of Expert Opinion and Practice Patterns

Lateral epicondylosis (LE) is a common condition. Knowledge on practice patterns underlies identification of knowledge to practice gaps. The purpose was to determine the practice patterns and beliefs of hand therapists in managing LE. The study design used was a descriptive survey. A survey of Certified Hand Therapists and members of the American Society of Hand Therapists was conducted (n=693). Questions were framed around frequency and perceived effectiveness of interventions, examination techniques, outcome measures, and prognostic factors. More than 80% of therapists use education/activity modification, home exercise, LE orthoses, and stretching for both the acute and chronic LE. Therapists perceive education, orthoses and home exercise are the most effective for acute cases, whereas in chronic cases, orthoses dropped to ninth in ranked perceived effectiveness. Grip strength (80%) and numeric pain rating (71%) were the most commonly used outcome measures. Most (>70%) therapists perceived occupation and duration of symptoms are prognostic in terms of resolution of symptoms, whereas compliance with exercise (78%) and work factors are important for return to work. Therapists rely on impairment measures to evaluate hand therapy outcomes in patients with LE. Hand therapists are aligned with a number of recommendations from the available systematic reviews, although the use of outcome measures and optimal definition of education and exercise exhibit evidence to practice gaps. Level of evidence: Level 5.

Palmar Abduction: Reliability of 6 Measurement Methods in Healthy Adults

The aim of the current study was to assess reliability of 6 palmar thumb abduction measurement methods: conventional goniometry, the Inter Metacarpal Distance, the method described by the American Medical Association, the method described by the American Society of Hand Therapists, and 2 new methods: the Pollexograph-thumb and the Pollexograph-metacarpal. An experienced hand therapist and a less-experienced examiner (trainee in plastic surgery) measured the right hands of 25 healthy subjects. Palmar abduction was measured both passively and actively. Means and ranges for palmar abduction were calculated, and intrarater and interrater reliability was expressed in intraclass correlation coefficients, standard errors of measurement, and smallest detectable differences. Mean active and passive angles measured with goniometry resembled values measured with the Pollexograph-thumb method (approximately 60 degrees). Mean angles found with the Pollexograph-metacarpal method were approximately 48 degrees. Mean active and passive distances for the Inter Metacarpal Distance were 64 mm. Mean active and passive distances found with the American Society of Hand Therapists method were 97 to 101 mm, and mean distances found with the American Medical Association method were 67 to 70 mm for active and passive measurements. Intraclass correlation coefficients for the Pollexograph-thumb, Pollexograph-metacarpal, and the Inter Metacarpal Distance indicated good and significantly higher intrarater agreement for active and passive measurements than intraclass correlation coefficients of conventional goniometry, the American Society of Hand Therapists method, and the American Medical Association method, which showed only moderate agreement. For interrater reliability, the same measurement methods were found to be most reliable: the Pollexograph-thumb, Pollexograph-metacarpal, and the Inter Metacarpal Distance. We found that the Pollexograph-thumb, Pollexograph-metacarpal, and the Inter Metacarpal Distance are the most reliable measurement methods for palmar abduction.

Measuring factors affecting grip strength in a Taiwan Chinese population and a comparison with consolidated norms

We inquire whether assessment of an individual's upper limb function may be improved by using specific regional norms rather than consolidated global norms. Grip strengths were measured in a sample of 482 adults across Taiwan, and compared with consolidated norms. To ensure comparable conditions, our procedures were those recommended by the American Society of Hand Therapists (ASHT). Overall the mean grip strength of our sample was significantly (male 25%, female 27%) lower than consolidated norms derived from largely Caucasian populations. We investigated variables that might relate to this divergence. Results of ANOVA and stepwise multiple regression analysis showed that gender, age and palm length were effective predictors in grip strength. A regression equation was derived. When other variables were matched, palm length appeared an important discriminating factor. Further anthropometric and socio-economic factors also need investigation. Specific regional norms should provide more accuracy for ergonomists and health workers assessing an individual's upper limb function, and may avoid errors in appraisal. This paper suggests grip strength values for Taiwan.

A study of grip endurance and strengh in different elbow positions

BackgroundThe aim of our study was twofold. The first was to investigate the optimum position of the elbow while measuring grip endurance. The second was to investigate the optimum position of the elbow while measuring peak grip strength. The American Society of Hand Therapists advocate estimation of grip strength with the elbow flexed at 90° with the subject in the sitting position . As far as we are aware, there have been no reports in English literature regarding studies done to evaluate the position of the elbow while measuring grip endurance. Materials and methodsA total of 45 healthy adults (16 males, 29 females) participated in this study. A computerised handgrip analyser was used to measure the peak strength in the non-dominant hand, followed by measurement of the grip endurance. These measurements were conducted in 90° of flexion and full extension of the elbow for each participant.ResultsMean endurance in flexion was 71.0 N (SD 22.9) and in extension was 68.7 N (SD 27.4). Mean peak grip strength in flexion was 262.8 N (SD 73.1) and in extension was 264.1 N (SD 82.0). T test analysis showed no statistical significance for elbow positions for grip endurance (P = 0.67) and peak gip strength (P = 0.93).ConclusionPractical implications from this study are that grip endurance training can be undertaken with the elbow in 90° of flexion or full extension.

Building Collaborative Partnerships: ASHT Presidential address at the annual meeting, San Antonio, September 2005

Mentoring and collaboration were essential ingredients to start the hand society, to nurture, form, and grow into the Society of today. These relationships continue to ensure the viability of our organization as we explore new directions that will ensure that we as members of American Society of Hand Therapists (ASHT) have the best opportunities to reach and maintain an excellent level of competency as hand therapists. Just as a musician seeks a mentor or guide to develop skill and perfect technique to play an instrument, many of us sought mentors to guide us in developing our advanced skills and critical thinking as hand therapists to provide the excellent care we give to our patients. To take it a step further, the musician then must learn to collaborate with others to form a band, a symphony, or an orchestra in which all of the individual instruments now contribute together to form and create one

2005 Joint Annual Meeting of the American Society for Surgery of the Hand & the American Society of Hand Therapists: Partnerships and Innovations: September 22–24, 2005

2005 Joint Annual Meeting of the American Society for Surgery of the Hand & the American Society of Hand Therapists: Partnerships and Innovations: September 22–24, 2005

Measurement of hand joint range of motion in rheumatoid arthritis: Repeatability and variability

Purpose: To quantify the reliability of range of motion measurements in patients with rheumatoid arthritis, and to see whether a warm-up exercise improves reliabilityMethod, Materials, and Analyses: Eighteen patients (36 hands) with rheumatoid arthritis (per American Rheumatology Association criteria) of variable duration and severity volunteered for the study. Thirty-three patients were required to find a 10-degree difference in the reliability of range of motion measurements. The patients' active hand range of motion was measured on two mornings of the same week, using American Society of Hand Therapists' clinical assessment protocols. Before one set of measurements they completed a 5 minute hand warm up, consisting of opening and closing the hand then repeating figure of eight motions of the wrists. The order of warm-up/no warm-up was alternated. The examiner performed intra-rater reliability assessments prior to the study. The differences between test and retest were calculated and plotted to identify any systematic bias between test and repeat. Paired t-tests were performed to determine the difference between right and left hands, between test and repeat and between warm up and no warm up.Results: The intrarater reliability of the examiner was less than 3 degrees when measuring healthy volunteers. Performing a 5-minute warm up before measuring active range of motion did not increase the reliability of measurements. There was no systematic bias between test and repeat (i.e., from learning effects or fatigue). The reliability of extension motions was greater than that of flexion motions.Conclusion: Overall error was between 10 and 12 degrees when active range of motion was repeated in patients with rheumatoid arthritis.Relevance to Hand Therapy: The reliability of range of motion measurements for patients with rheumatoid arthritis has an error margin of more than 10 degrees, and it is variable depending on the joint and the motion being measured. The wrist and flexion motions of the digits are the least reliable. Purpose: To quantify the reliability of range of motion measurements in patients with rheumatoid arthritis, and to see whether a warm-up exercise improves reliability Method, Materials, and Analyses: Eighteen patients (36 hands) with rheumatoid arthritis (per American Rheumatology Association criteria) of variable duration and severity volunteered for the study. Thirty-three patients were required to find a 10-degree difference in the reliability of range of motion measurements. The patients' active hand range of motion was measured on two mornings of the same week, using American Society of Hand Therapists' clinical assessment protocols. Before one set of measurements they completed a 5 minute hand warm up, consisting of opening and closing the hand then repeating figure of eight motions of the wrists. The order of warm-up/no warm-up was alternated. The examiner performed intra-rater reliability assessments prior to the study. The differences between test and retest were calculated and plotted to identify any systematic bias between test and repeat. Paired t-tests were performed to determine the difference between right and left hands, between test and repeat and between warm up and no warm up. Results: The intrarater reliability of the examiner was less than 3 degrees when measuring healthy volunteers. Performing a 5-minute warm up before measuring active range of motion did not increase the reliability of measurements. There was no systematic bias between test and repeat (i.e., from learning effects or fatigue). The reliability of extension motions was greater than that of flexion motions. Conclusion: Overall error was between 10 and 12 degrees when active range of motion was repeated in patients with rheumatoid arthritis. Relevance to Hand Therapy: The reliability of range of motion measurements for patients with rheumatoid arthritis has an error margin of more than 10 degrees, and it is variable depending on the joint and the motion being measured. The wrist and flexion motions of the digits are the least reliable.

Arthritis: a broader approach

Arthritis: a broader approach

The intertester and intratester reliability of hand volumetrics

The purpose of this study was to examine the intertester and intratester reliability of hand volumetric measurements comparing two different protocols. The first protocol involved three clinicians at an outpatient facility interpreting the manufacturer's volumeter instructions. At the second university site, three testers utilized a modified version of the American Society of Hand Therapists' recommended protocol. Three measurements were taken of each of 30 nonedematous hands per site. Reliability was assessed using only the first measurement and using the mean of the three measurements. Results for both protocols revealed very high intertester reliability (ICC = 0.99) whether using the first measurement or the mean of three measurements. Intratester reliability was also very high (ICC = 0.99) using either protocol. Standard error of measurement values are included and additional variables, which may affect the reliability of hand volumetrics, are discussed. The authors conclude that there is high reliability with volumetric measurements.

Classification of hand splinting.

The terminology in describing splint or orthosis has been reviewed but there is no one single system adopted universally. Joint efforts by doctors, therapists and orthotists had been set up to review the classification of splint. Four ways of classifying hand splints have been introduced: namely, eponym, acronym, descriptive classification system and the classification system proposed by the American Society of Hand Therapists. These systems include the use of rote memory or logical deduction in grouping of splints. This paper describes the advantages and disadvantages of each classification system. Neither one of the systems stands out to be the best. A combination of the advantages of different systems, such as precision and logical deduction, may be an option for developing a new system. Moreover, communication, documentation and other environmental factors should also be considered.

Nathalie Barr Lecture “String of pearls'”: Twenty-five years of learning, observations, and practice in clinical hand therapy: 2001 Nathalie Barr lecture American Society of Hand Therapists, October 20, 2001

The good news about being awarded the Nathalie Barr Lectureship is that it is the highest professional honor bestowed by our society. The bad news is that you have one entire year to think about delivering an address that everyone expects to be insightful, educational, and inspirational. I hope you are not disappointed.