Hand Function Test Research Articles

Evaluation of Hand Function Using Relative Motion Extension Concept (with or Without Night Wrist Orthosis) or Dynamic Extension Orthosis for Extensor Tendon Injuries in Zones 4–6—A Randomized Controlled Trial

This study aimed to compare outcomes of early active motion (EAM) using the relative motion extension (RME) approach to outcomes of early passive motion (EPM) with a dynamic extension orthosis (DEO) and to evaluate whether the RME-only approach is equivalent to the RME-plus approach. Fifty adults were randomized into one of the three intervention groups receiving the DEO, RME only, or RME plus orthosis. The score of the Jebsen–Taylor hand function test (JTHFT) without writing and QuickDASH at T1, all measures of mobility at T1 and T2, and grip strength were better in the RME-only and RME-plus group compared to the DEO group, whereas the values of Patient Evaluation Measure (PEM) at T1 and T2, as well as QuickDASH score at T2, orthosis adherence, and the patient’s comfort while wearing the orthoses did not statistically significantly differ among the three groups. The RME concept after extensor tendon injuries in zones 4–6 is superior to the DEO protocol in terms of earlier regain of hand function. The DEO and RME protocols were equivalent regarding patients’ adherence and satisfaction with the orthosis. We found no differences in the RME-plus and RME-only protocols, indicating the safe use of the RME-only protocol in single extensor tendon injuries in zones 4–6.

Effects of home-based virtual reality upper extremity rehabilitation in persons with chronic stroke: a randomized controlled trial

BackgroundUpper extremity rehabilitation in persons with stroke should be dose-dependent and task-oriented. Virtual reality (VR) has the potential to be used safely and effectively in home-based rehabilitation. This study aimed to investigate the effects of home-based virtual reality upper extremity rehabilitation in persons with chronic stroke.MethodsThis was a single-blind, randomized, controlled trial conducted at two centers. The subjects were 14 outpatients with chronic stroke more than 6 months after the onset of the stroke. The participants were randomly divided into two groups. The intervention group (n = 7) performed a home rehabilitation program for the paretic hand (30 min/day, five days/week) using a VR device (RAPAEL Smart Glove™; NEOFECT Co., Yung-in, Korea) for four weeks. The control group (n = 7) participated in a conventional home rehabilitation program at the same frequency. All participants received outpatient occupational therapy once a week during the study period. The outcome measures included the Fugl-Meyer Assessment of upper extremity motor function (FMA-UE), Motor Activity Log-14 (MAL), Jebsen-Taylor Hand Function Test (JTT), and Box and Block Test (BBT) scores.ResultsAll 14 participants completed the study. Compared to the control group, the intervention group showed more significant improvements in FMA-UE (p = 0.027), MAL (p = 0.014), JTT (p = 0.002), and BBT (p = 0.014). No adverse events were observed during or after the intervention.ConclusionCompared to a conventional home program, combining a task-oriented virtual reality home program and outpatient occupational therapy might lead to greater improvements in upper extremity function and the frequency of use of the paretic hand.Trial registration: This study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trial Registry in Japan (Unique Identifier: UMIN000038469) on November 1, 2019; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000043836.

Abstract TP108: Virtual Reality Smart Glove May Improve Hand and Arm Function After Stroke

Introduction: Upper extremity impairment is common after stroke. The Neofect Smart Glove is a novel virtual reality-based portable rehabilitation system that may help restore hand and arm function. Objective: To assess the effect of the Smart Glove on functional recovery and total dose of rehabilitation among subacute and chronic stroke patients with upper extremity impairment. Design: Multi-center, prospective, randomized, open-label, blinded-endpoint (PROBE) phase 2 trial consisting of a 12-week active treatment period followed by a 12-week follow-up period. Methods/Interventions: Patients in the intervention group were instructed to use the Smart Glove for at least one session per day for at least 5 days per week in addition to their usual care during the 12-week active treatment period. Patients in the control group received their usual care only. Outcomes: The change from baseline to week 12 in the Jebsen-Taylor Hand Function Test (JTHFT) was the primary efficacy outcome and the change in the Upper Extremity Fugl-Meyer Assessment (UE-FMA) was secondary. Feasibility was assessed by determining the total dose of rehabilitation. Statistics: Differences between treatment arms were compared using analysis of covariance (ANCOVA) in the overall population and, separately, in the subset of patients with mild to moderate upper extremity impairment (baseline JTHFT ≤ 500). Results: During the 12-week active treatment period, there were no differences between the intervention (n = 18) and control (n = 24) groups in the change in the JTHFT (median -64 vs. -69 sec, P = 0.88), the change in the UE-FMA (median 8 vs. 8 points, P = 0.61), or the total dose of rehabilitation (median 1434 vs. 584 min, P = 0.18) (Figure 1). Among the subset of patients with mild to moderate symptoms (baseline JTHFT ≤ 500, n = 31), Smart Glove assignment was associated with a greater improvement in the JTHFT (median -72 vs. -40 sec, P = 0.01) and a greater dose of rehabilitation (median 1739 vs. 510 min, P = 0.04) during the active treatment period (Figure 2). There was a trend toward a greater improvement in the UE-FMA (median 10 vs. 8 points, P = 0.15). Conclusion: While the trial did not show a benefit in the overall study population, Smart Glove use was associated with enhanced recovery of hand and arm function and a higher dose of rehabilitation among patients with mild to moderate upper extremity impairment, suggesting that the Smart Glove may be an effective treatment in this population.

Clinical utility of extracorporeal shock wave therapy in restoring hand function of patients with nerve injury and hypertrophic scars due to burns: a prospective, randomized, double-blinded study.

Joint contractures and nerve injuries are common after hand burns. Extracorporeal shock wave therapy (ESWT) is effective not only for the regeneration of various tissues, including scar tissues, but also for reducing pain and pruritus in patients with burns. Researchers have attempted to explore the effects of ESWT on hand dysfunction caused by nerve injury following burns. The authors evaluated the effects of ESWT (compared to sham stimulation) on hands with nerve injury and hypertrophic scars and, thereby, on hand function. The current study was a double-blind randomized controlled trial involving 120 patients. The ESWT parameters were as follows: energy flux density, 0.05-0.30mJ/mm 2 ; frequency, 4Hz; 1000-3000 impulses per treatment; and 12 treatments, one/week for 12 weeks. Outcome measures were as follows: 10-point visual analog scale for pain, Jebsen-Taylor hand function test, grip strength, Purdue Pegboard test, ultrasound measurement of scar thickness, and skin characteristics before and immediately after 12 weeks of treatment. No significant intergroup difference was noted after the initial evaluation ( P >0.05). More significant improvements were found in the ESWT group than in the sham group in terms of the VAS score ( P =0.004), extension ROMs of hand joints ( P =0.02), the JTT scores (writing, small, and light) ( P <0.001, P <0.001, and P =0.002), and skin characteristics (melanin, skin distensibility, and biologic skin elasticity) ( P =0.004, P <0.001, and P <0.001). Other measured outcomes did not differ between the two groups after the treatment. The authors identified the clinically beneficial effects of ESWT in promoting hand function, improving scarring, and alleviating scarring-related pain, thereby highlighting its advantages in improving hand function that has been impaired due to nerve injury and hypertrophic scars after burns.

Comparison of Writing Speed, Letter Size, and Upper Extremity Muscle Activation in Stroke Patients Using Two Writing Aids: Evaluation with the Jebsen–Taylor Hand Function Test

Currently, writing aids for upper extremity rehabilitation in stroke patients are not developed with consideration of biomechanical characteristics, making it difficult to achieve proper support effects. Therefore, in this study, we conducted a comparative analysis to examine how the use of two types of writing aids affects writing speed, letter size, and upper extremity muscle activation based on hand function and electromyography assessments in 12 stroke patients. Hand function was assessed using the Jebsen–Taylor hand function test, while writing ability (writing speed and letter size) was measured using the Korean alphabet writing test. Muscle activity was recorded using surface electromyography from both the paralyzed side (PS) and nonparalyzed side (NPS). The results showed that writing speed was significantly slower and horizontal letter sizes were larger on the PS. Additionally, muscle activation patterns on the PS were significantly influenced by the design of the writing aids, suggesting that the aids’ design affects compensatory movements and muscle function. These findings emphasize the importance of personalized rehabilitation tools that cater to the individual needs of stroke patients. Future research will focus on developing customized writing aids based on biomechanical data to better support rehabilitation goals.

The The relationship between injury severity, grip strength and functionality in traumatic hand injuries

Purpose: This study aimed to investigate the relationship between injury severity and functionality in traumatic hand injuries.Methods: Forty-four patients with traumatic injuries to the hand were included. Patients who were grouped as minor, moderate, and severe-major by Modified Hand Injury Severity Score (mHISS) score, were evaluated with grip strength, lateral grip strength, and Sollerman Hand Function Test (SHFT) at the 4th and 12th weeks. Among the functional scales, The Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and the Patient-Rated Hand and Wrist Evaluation (PRWHE), Health Assessment Questionnaire (HAQ) were used.Results: According to the patients’ total mHISS score, 27.2% were classified as having minor injuries, 43.1% as having moderate injuries, and 29.4% as having serious-major injuries. The first 4 weeks of the rehabilitation period showed a statistically significant increase in both grip strength and SHFT scores. Furthermore, grip strength and SHFT scores were significantly lower across all mHISS groups, with greater reductions observed in the group with more severe injuries. A significant positive correlation was observed between the total mHISS score and PRWHE, DASH, and HAQ scores in all follow-ups. As the severity score increased, functionality worsened.Conclusion: Assessing the severity of injury and functionality in these patients allows for effective management of treatment and rehabilitation, ultimately improving their functional status and general health.

G.T.A.R.A. (Grip/Grasp Training with Active Range of Motion Activities Using Guitar): A Randomized Controlled Trial Using Guitar Lessons for Restoring Hand Function among Patients with Unilateral Hand Impairment.

To determine the effects of guitar lessons (intervention group) in comparison to conventional occupational therapy (OT) sessions (control group) on hand function of chronic stroke patients with unilateral hand impairment. This randomized controlled trial enrolled 34 chronic stroke patients with unilateral hand impairment. Participants were grouped randomly into intervention (guitar lessons) and control (conventional occupational therapy) groups. Each group participant underwent a total of eight consecutive therapy sessions, twice weekly for an hour each session, at the designated treatment rooms in the Department of Rehabilitation Medicine of the Philippine General Hospital. Pre- and post-treatment evaluations were done to assess range of motion, grip and pinch strength, and hand functions. Satisfaction surveys were answered at the end of the 8-therapy session. Improvements in hand function were assessed through measurement of range of motion (ROM), grip and pinch strength, and with the use of Beery-Buktenica Developmental Test of Visual-Motor Integration, Jebsen-Taylor Hand Function test, and Purdue Pegboard Test of Manual Dexterity. In this study, the comparison of actual change of passive range of motion (ROM) of the impaired hand from pre- to post-treatment between control and intervention groups showed no statistically significant difference. No statistically significant difference between groups were also observed for the active ROM of the impaired hand. Comparison of function of the impaired hand pre- and post-treatment between control and intervention groups showed no statistically significant difference except for an observed greater improvement with the control group in motor coordination (median [IQR] 0 [-1 to 0] vs 1 [1 to 5], p = 0.004), tip (median [IQR] 0.33 [0 to 0.75] vs 1 [0.58 to 1.5], p = 0.006), and 3-jaw (median [IQR] 0.5 [0 to 0.92] vs 1.08 [0.41 to 2], p = 0.043) pinch strength.In evaluating the satisfaction of participants in both groups, higher mean scores were observed in the control group. No statistically significant difference in most of the questions in the satisfaction survey in both groups.All participants in both groups displayed 100% compliance in attending onsite treatments. Despite not showing statistically significant difference between groups (p = 0.721), an 11.8% tendency for better compliance is found in the intervention group. The specific guitar lesson created and performed in this study as used by 17 participants of the intervention group have brought about improvement in hand function that is comparable with those who underwent traditional occupational therapy. This may be most helpful in areas with limited access to rehabilitation facilities and occupational therapy services. This may also be used as a continuing activity of chronic stroke patients at home to help improve hand function.

Psychometric Validation of the In-Hand Manipulation Assessment (IHMA)

ObjectiveTo determine the inter-rater reliability, and criterion and discriminant validity of the In-Hand Manipulation Assessment (IHMA) with patients after stroke. DesignParticipants were videotaped, completing the IHMA and scored by two blinded assessors to determine the inter-rater reliability. Stroke participants also completed the Jebsen-Taylor Hand Function Test, and healthy participants completed the Nine Hole Peg Test to determine the validity of the IHMA. SettingCommunity and hospital settings. Participants46 participants with 22 healthy young adults, 14 healthy older adults and 10 people with stroke. InterventionNot applicable. Main Outcome MeasuresNot applicable ResultsThe inter-rater reliability of the IHMA was good (for all participants: Intra-Class Correlation Coefficient = .78 – .98, p ≤ .001; for stroke participants: Kappa statistics = .70 - 1.00 (p ≤ .001). The IHMA demonstrated good discriminant validity between the healthy young adults and healthy older adults for time and completion scores (ps = .012 and ≤ .001). The criterion validity of the IHMA was moderate to good when compared with the Nine Hole Peg Test (r = - .45 – .84), but no significant correlation was found with the Jebsen-Taylor Hand Function Test. Modifications to the IHMA tasks and instructions were made based on the performance of participants to improve its clinical utility with people after stroke. ConclusionThe IHMA demonstrated good inter-rater reliability, good discriminant validity and moderate to good criterion validity with the Nine Hole Peg Test. The proposed modifications to the IHMA will enhance its administration.

Results of innervated digital artery perforator flap and direct-flow homodigital flap application in fingertip soft tissue amputations

ObjectiveThe purpose of this study is to compare the results of the innervated digital artery perforator (IDAP) flap and the direct-flow homodigital flap as reconstruction methods for fingertip soft tissue amputations. This issue is important in hand surgery, and we aim to identify the method that provides the best functional and cosmetic outcomes.MethodsBetween 2020 and 2022, 32 patients with fingertip amputations were reconstructed by the same surgeon using two different methods. The patients were retrospectively divided into two groups: those who underwent IDAP (n = 14) and those who had a direct-flow homodigital flap (n = 18). We compared the groups in terms of defect size, cold intolerance, venous congestion, Sollerman hand function test scores, Seddon sensory test scores, and follow-up periods, as well as flap viability, flexion contracture, and static two-point discrimination (s2PD).ResultsOf the 32 patients (26 men, 6 females; age: mean 28.72 ± 11.5 years), the injuries were caused by different mechanisms, including sharp (57.1% IDAP), crush (75% IDAP) and entanglement (66.7% homodigital). The average area of tissue loss was approximately 2.70 ± 1.37 cm², while the average s2PD measurement was approximately 4.94 ± 1.04 mm. Postoperatively, the Seddon sensory test results for the homodigital flap group were S4 (61.5%), S3 (23.1%), S3+ (7.7%), and S2 (7.7%), compared to the IDAP group, which showed S4 (57.9%), S3+ (21.1%), and S3 (21.1%). Complications occurred in five patients, though no flap loss or revision was required. The postoperative mean Sollerman hand function scores were higher for the homodigital group than for the IDAP group, with values of 75 ± 2.64 and 73 ± 3.34, respectively. Although not statistically significant, the results numerically suggest that the IDAP flap is better in terms of sensory recovery and hand function compared to the homodigital flap (p > 0.05).ConclusionsThis is the first investigation to compare direct-flow flaps with IDAP. The average follow-up period for patients who underwent homodigital surgery was also shorter than that of the IDAP group. Furthermore, the mean postoperative two-point discrimination and postoperative Sollerman function score were higher in patients who had homodigital surgery.

Amelioration of Focal Hand Dystonia via Low-Frequency Repetitive Somatosensory Stimulation.

Dystonia presents a growing concern based on evolving prevalence insights. Previous research found that, in cervical dystonia, high-frequency repetitive somatosensory stimulation (RSS; HF-RSS) applied on digital nerves paradoxically diminishes sensorimotor inhibitory mechanisms, whereas low-frequency RSS (LF-RSS) increases them. However, direct testing on affected body parts was not conducted. This study aims to investigate whether RSS applied directly to forearm muscles involved in focal hand dystonia can modulate cortical inhibitory mechanisms and clinical symptoms. We applied HF-RSS and LF-RSS, the latter either synchronously or asynchronously, on forearm muscles involved in dystonia. Outcome measures included paired-pulse somatosensory evoked potentials, spatial lateral inhibition measured by double-pulse somatosensory evoked potentials, short intracortical inhibition tested with transcranial magnetic stimulation, electromyographic activity from dystonic muscles, and behavioral measures of hand function. Both synchronous and asynchronous low-frequency somatosensory stimulation improved cortical inhibitory interactions, indicated by increased short intracortical inhibition and lateral spatial inhibition, as well as decreased amplitude of paired-pulse somatosensory evoked potentials. Opposite effects were observed with high-frequency stimulation. Changes in electrophysiological markers were paralleled by behavioral outcomes: although low-frequency stimulations improved hand function tests and reduced activation of dystonic muscles, high-frequency stimulation operated in an opposite direction. Our findings confirm the presence of abnormal homeostatic plasticity in response to RSS in the sensorimotor system of patients with dystonia, specifically in inhibitory circuits. Importantly, this aberrant response can be harnessed for therapeutic purposes through the application of low-frequency electrical stimulation directly over dystonic muscles. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

UPPER EXTREMITY SELECTIVE VOLUNTARY MOTOR CONTROL IN CHILDREN WITH UNILATERAL CEREBRAL PALSY AND ITS ASSOCIATION WITH UPPER EXTREMITY FUNCTIONS

Purpose: The study aimed to define the upper extremity selective voluntary motor control (SVMC) in children with unilateral Cerebral Palsy (CP). It was also aimed to investigate the relationship between upper extremity SVMC and upper extremity functions. Methods: Twenty-four children diagnosed with unilateral CP, aged between 6 and 18, were included in the study. The Quality of Upper Extremity Skills Test (QUEST) assessed the upper extremity functions. Manual dexterity was measured using the Jebsen-Taylor Hand Function Test (JTT) timed tasks. The SVMC of the upper extremity was measured using the Selective Control of Upper Extremity Scale (SCUES) using the videotape recording method. Results: Statistically significant decreases in SCUES scores from shoulder to fingers were recorded using the Page statistical test for trend (p

Realizing computer vision rehabilitation assessment tests & evaluation applications for mobile devices

Upper extremity impairments are a common consequence of stroke, necessitating thorough rehabilitation monitoring and kinematic assessments to facilitate motor recovery. The Box and Block Test (BBT) and Sollerman Hand Function Test (SHFT) are two widely utilized and recommended tools for objectively measuring upper limb dexterity and evaluating fine motor skill rehabilitation in patients. However, these tests rely on specific equipment and therapist attendance, making the process time-consuming and clinic-dependent. This paper introduces a computer vision-based hand rehabilitation assessment suite specifically designed for mobile devices, such as smartphones and tablets, which serves as a virtual alternative to traditional methods while also incorporating an interactive exergame. Our application faithfully integrates the original tests’ guidelines and procedures into an engaging computer vision experience, utilizing advanced technologies like MediaPipe Hands for precise hand and finger tracking. This innovative solution obviates the need for additional computer peripherals such as smart gloves or VR headsets, as well as physical equipment like wooden boxes and blocks, relying solely on the built-in camera of everyday mobile devices. In addition, we address several technical challenges encountered in our approach and outline future directions for score normalization and feature expansion, ensuring the continued improvement and efficacy of our hand rehabilitation assessment suite.

A home-based hand rehabilitation platform for hemiplegic patients after stroke: A feasibility study

BackgroundPatients with stroke often experience weakened upper limbs, making daily tasks difficult to perform. Although rehabilitation devices are available, patients often relapse post-discharge due to insufficient practice. We present a home-based hand telerehabilitation intervention using the iManus™ platform comprising a sensorized glove, a mobile app for the patients, and a therapist portal for monitoring patient progress. ObjectivesThis research aimed to examine the feasibility, safety, and effectiveness of a home-based telerehabilitation intervention in improving hand function for individuals with mild stroke. A qualitative approach was also used to explore users' experiences, perceived benefits, and challenges associated with using the platform in a home setting. MethodsIn this single-case study, we delivered a hand telerehabilitation intervention to a chronic stroke patient with impaired hand function using the iManus™ platform. The intervention consisted of 40 home sessions over eight weeks. We assessed feasibility through user adherence and feedback obtained using a System Usability Scale (SUS) and a semi-structured interview with the participant and their informal caregiver. Safety was evaluated by monitoring pain levels using the Visual Analog Scale (VAS), and efficacy was determined by observing the changes in the fingers’ range of motion using the iManus™ platform and clinical outcomes measures, namely the Fugl-Meyer Assessment (FMA) and Jebsen Taylor Hand Function Test (JTHFT). ResultsOur participant completed all the assigned sessions, with each averaging 20 min. Usability scored 77.5 out of 100 on the SUS. User feedback from the interviews revealed improved mobility and control over therapy as benefits, indicating room for improvement in the intervention's adaptability and functionality. During the intervention, the participant noted no pain increase, and the telerehabilitation platform recorded range of motion improvements for all finger and wrist joints, excluding wrist extension. The FMA scores were 43 at T0, 53 at T1, and 56 at T2, while the JTHFT scores were 223 at T0, 188 at T1, and 240 at T2. ConclusionsThis single case study demonstrated the preliminary feasibility, safety, and efficacy of a novel home-based hand intervention for stroke survivors. The participant showed improved hand functions, good adherence to the program, and reported satisfaction with the intervention. However, these results are based on a single-case study, and further large-scale studies are needed before any generalization is recommended.

The effect of horse riding simulator on upper extremity skills, trunk control and functionality in cerebral palsy: a randomized controlled trial

Purpose The aim of this study was to investigate the effect of horse riding simulator on upper extremity skills, trunk control and functionality in cerebral palsy (CP). Materials and methods This randomized controlled trial included total 32 CP, 16 in horse riding simulator group (HRSG) and 16 in control group (CG). ABILHAND-Kids, Jebsen-Taylor Hand Function Test (JTHFT), Gross Motor Function Measurement-sitting dimension (GMFM-B), Trunk Control Measurement Scale (TCMS), Pediatric Evaluation of Disability Inventory (PEDI) were evaluated before and after procedure. Results It was observed that there were improvements in both groups for ABILHAND-Kids scores after intervention, but the change in HRSG was significantly higher (p < 0.001). For all parameters of JTHFT (except writing dominant, non-dominant, turning cards-dominant), there was a significant difference between groups in favor of HRSG (p < 0.001-0.002). There was no change in GMFM-B values with intervention for both groups (p > 0.05). There were significant changes in favor of HRSG group in terms TCMS-Total (p = 0.003). There were significant changes in HRSG compared to CG for PEDI (pPEDI-Self-care<0.001, pPEDI-Mobility<0.001, pPEDI-Social function=0.016, respectively). Conclusions It has been found that HRS in addition to conventional physiotherapy have positive effects on upper extremity skills, trunk control and functional abilities in daily life in the rehabilitation process of CP. The study protocol is registered on ClinicalTrials.gov (Identifier: NCT05518370).

Transcranial direct current stimulation–induced changes in motor cortical connectivity are associated with motor gains following ischemic stroke

Understanding the response of the injured brain to different transcranial direct current stimulation (tDCS) montages may help explain the variable tDCS treatment results on poststroke motor gains. Cortical connectivity has been found to reflect poststroke motor gains and cortical plasticity, but the changes in connectivity following tDCS remain unknown. We aimed to investigate the relationship between tDCS-induced changes in cortical connectivity and poststroke motor gains. In this study, participants were assigned to receive four tDCS montages (anodal, cathodal, bilateral, and sham) over the primary motor cortex (M1) according to a single-blind, randomized, crossover design. Electroencephalography (EEG) and Jebsen-Taylor hand function test (JTT) were performed before and after the intervention. Motor cortical connectivity was measured using beta-band coherence with the ipsilesional and contralesional M1 as seed regions. Motor gain was evaluated based on the JTT completion time. We examined the relationship between baseline connectivity and clinical characteristics and that between changes in connectivity and motor gains after different tDCS montages. Baseline functional connectivity, motor impairment, and poststroke duration were correlated. High ipsilesional M1–frontal–temporal connectivity was correlated with a good baseline motor status, and increased connectivity was accompanied by good functional improvement following anodal tDCS treatment. Low contralesional M1–frontal-central connectivity was correlated with a good baseline motor status, and decreased connectivity was accompanied by good functional improvement following cathodal tDCS treatment. In conclusion, EEG-based motor cortical connectivity was correlated with stroke characteristics, including motor impairment and poststroke duration, and motor gains induced by anodal and cathodal tDCS.

Psychometric Properties of Jebsen Taylor Hand Function Test in an Italian Population with Parkinson's Disease.

Assessment of upper limb function is critical in the rehabilitation process of people with Parkinson's Disease (PD), and universally validated outcome measures are needed to allow comparisons across the practice. Moreover, the study of psychometric properties of the same tool on different clinical populations guarantees the possibility of reliably evaluating the same rehabilitation treatment in people with different clinical conditions. The aim of this research was to evaluate the psychometric characteristics of the Italian adaptation of the Jebsen Taylor Hand Function Test (JTHFT) in individuals with PD. The reliability and validity of the test were assessed in accordance with international standards. Internal consistency was measured using Cronbach's alpha, and test-retest reliability was determined via the intraclass correlation coefficient (ICC). The construct validity and cross-cultural validity of the test were evaluated using Pearson's correlation coefficient with three assessment tools on upper limb function, independence, and quality of life, with hand grip power measured by a dynamometer and an Italian pangram. Finally, responsiveness after a one month of rehabilitation treatment was measured using the Wilcoxon rank test. Fifty-two Italian people with PD were recruited. Cronbach's alpha values ranged from 0.556 (non-dominant hand) to 0.668 (dominant hand); ICC values ranged from 0.754 to 0.988. Construct validity showed that several statistically significant correlations were detected. Wilcoxon's test showed that the assessment tool can detect a change in this population after treatment. The JTHFT is a reliable, valid, and respondent tool to evaluate the upper limb and hand functionalities in PD patients. It should be added to the toolkit for measuring upper limb performance in this population, adding value to clinical evaluation and ensuring comparable results for different clinical populations and different countries.

Effects of virtual reality-based robot therapy combined with task-oriented therapy on upper limb function and cerebral cortex activation in patients with stroke.

This study aimed to investigate the effects of virtual reality (VR)-based robot therapy combined with task-oriented therapy on cerebral cortex activation and upper limb function in patients with stroke. This study included 46 patients with hemiplegia within 1 year of stroke onset. Patients were divided into an experimental group (n = 23) and a control group (n = 23) using a computer randomization program. The experimental group received VR-based robot and task-oriented therapies, whereas the control group received only task-oriented therapy. All participants received interventions for 40 minutes per session, 5 times a week, for 8 weeks. For the pre- and post-evaluation of all participants, the Fugl-Meyer Assessment for the upper extremity, manual function test, motor activity log, and Jebsen-Taylor Hand Function Test were used to evaluate changes in upper limb function and motor-evoked potential amplitudes were measured to compare cerebral cortex activation. In comparison to the control group, experimental group demonstrated an improvement in the function of the upper limb (P < .01) and activation of the cerebral cortex (P < .01). The combined intervention of VR-based robot and task-oriented therapies is valuable for improving upper limb function and cerebral cortex activation in patients with stroke.

Efficacy of personalized rTMS to enhance upper limb function in subacute stroke patients: a protocol for a multi-center, randomized controlled study.

Repetitive transcranial magnetic stimulation (rTMS) is widely used therapy to enhance motor deficit in stroke patients. To date, rTMS protocols used in stroke patients are relatively unified. However, as the pathophysiology of stroke is diverse and individual functional deficits are distinctive, more precise application of rTMS is warranted. Therefore, the objective of this study was to determine the effects of personalized protocols of rTMS therapy based on the functional reserve of each stroke patient in subacute phase. This study will recruit 120 patients with stroke in subacute phase suffering from the upper extremity motor impairment, from five different hospitals in Korea. The participants will be allocated into three different study conditions based on the functional reserve of each participant, measured by the results of TMS-induced motor evoked potentials (MEPs), and brain MRI with diffusion tensor imaging (DTI) evaluations. The participants of the intervention-group in the three study conditions will receive different protocols of rTMS intervention, a total of 10 sessions for 2 weeks: high-frequency rTMS on ipsilesional primary motor cortex (M1), high-frequency rTMS on ipsilesional ventral premotor cortex, and high-frequency rTMS on contralesional M1. The participants of the control-group in all three study conditions will receive the same rTMS protocol: low-frequency rTMS on contralesional M1. For outcome measures, the following assessments will be performed at baseline (T0), during-intervention (T1), post-intervention (T2), and follow-up (T3) periods: Fugl-Meyer Assessment (FMA), Box-and-block test, Action Research Arm Test, Jebsen-Taylor hand function test, hand grip strength, Functional Ambulatory Category, fractional anisotropy measured by the DTI, and brain network connectivity obtained from MRI. The primary outcome will be the difference of upper limb function, as measured by FMA from T0 to T2. The secondary outcomes will be the differences of other assessments. This study will determine the effects of applying different protocols of rTMS therapy based on the functional reserve of each patient. In addition, this methodology may prove to be more efficient than conventional rTMS protocols. Therefore, effective personalized application of rTMS to stroke patients can be achieved based on their severity, predicted mechanism of motor recovery, or functional reserves. https://clinicaltrials.gov/, identifier NCT06270238.

The Bead Maze Hand Function Test for Children.

There is a need for a pediatric hand function test that can be used to objectively assess movement quality. We have developed a toy-based test, the Bead Maze Hand Function (BMHF) test, to quantify how well a child performs an activity. This is achieved by assessing the control of forces applied while drawing a bead over wires of different complexity. To study the psychometric properties of the BMHF test and understand the influence of age and task complexity on test measures. A cross-sectional, observational study performed in a single visit. Clinical research laboratory. Twenty-three participants (ages 4-15 yr) were recruited locally. They were typically developing children with no illness or conditions that affected their movement. Interventions/Assessments: Participants performed the BMHF test and the Box and Block test with both hands. Total force and completion time were examined according to age and task complexity using a linear mixed-effects model. We calculated intraclass correlation coefficients to measure interrater reliability of the method and estimated concurrent validity using the Box and Block test. Total force and completion time decreased with age and depended on task complexity. The total force was more sensitive to task complexity. The Box and Block score was associated with BMHF completion time but not with total force. We found excellent interrater reliability. A familiar toy equipped with hidden sensors provides a sensitive tool to assess a child's typical hand function. Plain-Language Summary: We developed the Bead Maze Hand Function (BMHF) test to determine how well a child performs an activity with their hands. The BMHF test is a toy equipped with hidden sensors. Twenty-three typically developing children with no illnesses or conditions that affected their hand movement participated in the study. We asked the children to perform the BMHF test with both hands. Our study found that occupational therapists can reliably use the BMHF test to assess a child's hand function.

Investigating the utility of HR-pQCT for the assessment of joint space and bone mineral density in hand osteoarthritis

ObjectiveOsteoarthritis affects joints of the hand and is radiographically characterized by joint space narrowing and changes in volumetric bone mineral density (vBMD). High-resolution peripheral computed tomography (HR-pQCT) allows for three-dimensional analysis of joint space width (JSW) changes but has yet to be applied to hand OA (HOA). The purpose of this study was to assess the utility of HR-pQCT in quantifying JSW and vBMD changes in HOA. DesignThe 2nd and 3rd distal interphalangeal (DIP2, DIP3) and trapeziometacarpal (TMC) joints of 20 women (10 controls, 10 HOA) were scanned using HR-pQCT. The Diseases of the Arm, Shoulder, and Hand (DASH) questionnaire and the Jebsen Hand Function Test (JHFT) were obtained. Radiographs were scored using the Eaton-Littler classification. We assessed between-group differences in HR-pQCT outcomes, and relationships between HR-pQCT outcomes and patient and radiographic characteristics. ResultsJSW maximum (JSW.Max) was higher in OA patients in the DIP2 (OA median [interquartile rage]: 2.07 mm [1.90–2.18], controls: 1.88 mm [1.84–1.89]) and DIP3 joints (OA: 2.01 mm [1.89–2.24], controls: 1.86 mm [1.82–1.95]). DIP3 JS volume was higher in OA (30.36 mm3, 19.35–34.57 mm3, controls: 17.05 mm3, 15.53–18.52 mm3). DASH scores were positively associated with DIP2 JSW asymmetry (JSW.AS), and JHFT times were positively associated with DIP3 JSW.Max, JSW.AS, and proximal DIP2 vBMD. Worsening radiographic TMC OA was associated with first metacarpal vBMD, JSW minimum, JSW.Max, and JSW.AS. ConclusionsThese preliminary findings suggest that HR-pQCT may be useful in investigating JS changes in HOA and warrants further investigation.