Impaired Hand Research Articles

Validity of the modified sphygmomanometer test for the assessment of tip pinch strength in Parkinson's disease

BackgroundThe tip pinch is one of the most delicate and precise movement of the hand, and it is used to manipulate small objects, commonly observed in the activities of daily living of any individuals. Individuals with Parkinson Disease (PD) with impaired manual dexterity, manipulative skills, and hand weakness have an important barrier for activities of daily life. However, the dynamometer usually used for measuring the tip pinch have a high cost, so, validate a sphygmomanometer can make this assessment more accessible. ObjectiveTo investigate the validity of the modified sphygmomanometer test in the evaluation of tip pinch strength when compared to the gold standard. Methods50 individuals with idiopathic PD took part in the study. The muscle strength of tip pinch on the dominant and non-dominant side was measured by the modified sphygmomanometer test and the gold standard, the dynamometer. Concurrent validity was analyzed using Pearson's correlation coefficient. Results50 individuals diagnosed with idiopathic PD, mean age of 67 ± 8.0 years, 68% male, mean time of diagnosis in months of 84 ± 66 and Hoehn and Yahr mean of 2.5 ± 0.6. There was a significant correlation of moderate magnitude between the modified sphygmomanometer test and the dynamometer in dominant side (r = 0.44; p < 0.01) and non-dominant side (r = 0.48; p < 0.01). ConclusionThe modified sphygmomanometer test showed adequate validity for assessing the muscle strength of the tip pinch in individuals with PD.

Integration of a Passive Exoskeleton and a Robotic Supernumerary Finger for Grasping Compensation in Chronic Stroke Patients: The SoftPro Wearable System.

Upper-limb impairments are all-pervasive in Activities of Daily Living (ADLs). As a consequence, people affected by a loss of arm function must endure severe limitations. To compensate for the lack of a functional arm and hand, we developed a wearable system that combines different assistive technologies including sensing, haptics, orthotics and robotics. The result is a device that helps lifting the forearm by means of a passive exoskeleton and improves the grasping ability of the impaired hand by employing a wearable robotic supernumerary finger. A pilot study involving 3 patients, which was conducted to test the capability of the device to assist in performing ADLs, confirmed its usefulness and serves as a first step in the investigation of novel paradigms for robotic assistance.

Laterality judgement task in people affected by leprosy

Leprosy is characterized by the involvement of the skin and peripheral nerves. This involvement can be presented by sensory, motor, and autonomic changes. Impaired hand sensibility may decrease the information that reaches specific areas of the central nervous system, resulting in changes in perception. During the laterality judgment task (or the ability to distinguish between left and right), an indivudual observes an image of a hand, performs a mental body rotation and compares the image with their body reprsentation in the brain, wich requires integrating sensory inputs with the sensory and motor systems. Objective: This study compared the performance on the left/right judgment task between people with nerve damage caused by leprosy and asymptomatic controls. Materials and Methods: Patients performed a task using the software Recognise®. Results were compared with those of a control group, comprising healthy individuals. Results: The study included 33 participants, of whom 20 were patients with leprosy (patient group) and 13 were healthy individuals (control group). The mean rate of correct responses by the patient group was 70% for the right hand and 62% for the left hand. The mean rate of correct responses by the control group was 83.4% for the right hand and 83.8% for the left hand. Conclusion: Patients demonstrate changes in body configuration, resulting in an influence of proprioceptive information on the subject’s current posture. These results may imply the presence of changes to the representation of the hand area in the brain’s sensory cortex.

Upper Limb Pathology in Children with Mucopolysaccharidoses

Background. Despite the success in the treatment of children with mucopolysaccharidoses (MPS) as a result of the widespread of enzyme replacement therapy and hematopoietic stem cells transplantation, orthopedic manifestations continue to be a significant problem, while the pathology of the upper limbs in children with MPS is not sufficiently represented in the literature. The aim of this studywas to analyze orthopedic and neurological manifestations in the upper extremities of children with mucopolysaccharidosis based on a sequential case series. Materials and Methods. We carried out a comprehensive analysis of clinical and radiological involvement of the upper extremities in 49 patients with MPS. Results. The most common complaints reated to the upper extremities were difficulties in the daily activities (dressing, self-care, playing), impairment of the fine motor skills, and muscle weakness. The most frequent clinical manifestations related to the upper extremities were limited active shoulder abduction, impaired hand grip, flexion contractures of the elbow joint, ulnar deviation of the hand. All patients with MPS types I, II, and VI had limited active and passive extension and flexion of the metacarpophalangeal and interphalangeal joints. In patients with MPS IV, hypermobility of the hand joints prevailed. We noticed minimal presence of typical clinical manifestations related to compression of the median nerve secific for carpal tunnel syndrome. The majority of patients showed a decrease in tendon and periosteal reflexes. The most pronounced decrease in muscle strength was observed in to extensors (elbow, fingers) and shoulder abductors, which may contribute to the predominant formation of a flexion pattern of contractures. On radiographs of the hand, the “melting sugar” symptom and shortening of the metacarpal bones were observed in most patients. Conclusion.Clinical and radiological manifestations related to the upper extremities take place in all types of the mPS, and lead to functional disorders that complicate daily life and self-care. Upper limb pathology in children with MPS requires earlier detection and more active treatment after comprehensive risk assessment.

Determination of the optimal cutoff values and validity of the Purdue Pegboard Test

Introduction The Purdue Pegboard Test (PPT) is crucial for assessing fine dexterity of patients with hand injury. Determining the PPT cutoff value is needed to distinguish patients with impaired hand dexterity from those with unimpaired hand dexterity. The aim of this article is to examine the construct validity of PPT and to determine its cutoff values for patients with hand injuries. Method The PPT and Disabilities of Arm Shoulder and Hand Questionnaire Turkish version (DASH-T) were used to measure hand dexterity. To examine construct validity, we measured the correlation between PPT and DASH-T. The cutoff values were determined using the receiver operating characteristic (ROC) curve generated with sensitivity and 1-specificity. We recruited 101 patients with hand injury and 162 healthy participants. Results Correlation between all subtests of PPT and DASH-T were weak ( r = −0.282; −0.473: p&lt;0.05). The cutoff value for the assembly subtest of PPT was 24.5. The range of area under the curve (AUC) values for PPT subtests was good to excellent (AUC: 0.82–0.92). Conclusion The current study demonstrates that PPT is a valid instrument for measuring hand dexterity in patients with hand injury. Results also suggest that PPT distinguished the patients with impaired hand function from those with unimpaired hand dexterity.

Impaired hand function and performance in activities of daily living in systemic lupus erythematosus, even in patients achieving lupus low disease activity state (LLDAS).

ObjectiveThe aim was to examine hand function and performance in activities of daily living (ADL) in patients with SLE vs healthy controls, and any associations with demographic and disease-related characteristics.MethodsHand function (grip strength, pinch strength and dexterity) and ADL performance were evaluated in 240 patients with SLE and 122 age- and biological sex-matched healthy controls. Grip strength, pinch strength and dexterity were measured by Jamar dynamometer, pinch gauge and Purdue pegboard test, respectively. Self-reported ADL performance was assessed by disabilities of the arm, shoulder and hand (DASH) and HAQ. Regression analysis was performed to assess the determinants of hand dysfunction.ResultsAll hand function and ADL performance variables were significantly impaired in the entire SLE cohort and the subgroup of patients achieving lupus low disease activity state (LLDAS; n = 157) compared with healthy subjects (P < 0.05). Joint pain, often underestimated in SLE, was the major determinant of hand function and ADL performance in multiple regression models. In addition, age was correlated with grip strength and Purdue scores, gender with grip strength, arthritis with DASH and HAQ, and use of immunosuppressives with DASH, HAQ and grip strength. Likewise, in patients in LLDAS, painful joints were correlated with DASH and HAQ, age with grip strength and Purdue (P < 0.001), gender with grip strength, and immunosuppressives with HAQ and grip strength.ConclusionHand function and performance of daily activities are significantly impaired in SLE, even in patients who achieve LLDAS, suggesting the need for their evaluation and management in clinical practice.

Longitudinal fMRI measures of cortical reactivation and hand use with and without training after sensory loss in primates

In a series of previous studies, we demonstrated that damage to the dorsal column in the cervical spinal cord deactivates the contralateral somatosensory hand cortex and impairs hand use in a reach-to-grasp task in squirrel monkeys. Nevertheless, considerable cortical reactivation and behavioral recovery occurs over the following weeks to months after lesion. This timeframe may also be a window for targeted therapies to promote cortical reactivation and functional reorganization, aiding in the recovery process. Here we asked if and how task specific training of an impaired hand would improve behavioral recovery and cortical reorganization in predictable ways, and if recovery related cortical changes would be detectable using noninvasive functional magnetic resonance imaging (fMRI). We further asked if invasive neurophysiological mapping reflected fMRI results. A reach-to-grasp task was used to test impairment and recovery of hand use before and after dorsal column lesions (DC-lesion). The activation and organization of the affected primary somatosensory cortex (area 3b) was evaluated with two types of fMRI – either blood oxygenation level dependent (BOLD) or cerebral blood volume (CBV) with a contrast agent of monocrystalline iron oxide nanocolloid (MION) – before and after DC-lesion. At the end of the behavioral and fMRI studies, microelectrode recordings in the somatosensory areas 3a, 3b and 1 were used to characterize neuronal responses and verify the somatotopy of cortical reactivations. Our results indicate that even after nearly complete DC lesions, monkeys had both considerable post-lesion behavioral recovery, as well as cortical reactivation assessed with fMRI followed by extracellular recordings. Generalized linear regression analyses indicate that lesion extent is correlated with the behavioral outcome, as well as with the difference in the percent signal change from pre-lesion peak activation in fMRI. Monkeys showed behavioral recovery and nearly complete cortical reactivation by 9–12 weeks post-lesion (particularly when the DC-lesion was incomplete). Importantly, the specific training group revealed trends for earlier behavioral recovery and had higher magnitude of fMRI responses to digit stimulation by 5–8 weeks post-lesion. Specific kinematic measures of hand movements in the selected retrieval task predicted recovery time and related to lesion characteristics better than overall task performance success. For measures of cortical reactivation, we found that CBV scans provided stronger signals to vibrotactile digit stimulation as compared to BOLD scans, and thereby may be the preferred non-invasive way to study the cortical reactivation process after sensory deprivations from digits. When the reactivation of cortex for each of the digits was considered, the reactivation by digit 2 stimulation as measured with microelectrode maps and fMRI maps was best correlated with overall behavioral recovery.

The Role of Patient-reported Outcomes and Medication Adherence Assessment in Patient-focused Drug Development for Solid Organ Transplantation.

The Role of Patient-reported Outcomes and Medication Adherence Assessment in Patient-focused Drug Development for Solid Organ Transplantation.

CHAD: Compact Hand-Assistive Device for enhancement of function in hand impairments

Hand-assistive devices are used to help post-stroke victims encumbered with hand impairments perform activities of daily living (ADL). Unlike robotic rehabilitation devices used in restricted medical conditions for designated periods, hand-assistive devices are designed to be portable and to be used for extended periods by individuals engaging in ADL. Several hand-assistive device designs have been proposed. With these, designers have focused on key elements, such as size, weight, motion profile of the fingers, and generated grip/pinch force. In this paper, we propose a unique compact hand-assistive device (CHAD) that incorporates most of these design parameters, but with less trade-offs. CHAD consists of a single unit worn on the patient’s forearm, which includes all necessary components. It is compact and does not compromise functionality. The novelty of this design can be found in the use of a unique cable-driven mechanism. This mechanism uses dual linear actuators to achieve the flexion of both the index and the middle fingers via the pull of tendon-like structures originating in two selected interphalangeal joints. This permits the numerous necessary sequences in the motion profiles of the digits. The thumb is also made able to flex with a single linear actuator. Finger extensions, in contrast, are achieved passively via adjustable flexible rubber cords joined to the dorsal side of the glove. Experimental results demonstrate that CHAD generates sufficient force and motion profiles for the comfortable execution of ADL. Additionally, CHAD produces a grip and pinch motion profile similar to that of a natural hand and does not force unwanted muscle activities.

Development and feasibility of a soft pneumatic-robotic glove to assist impaired hand function in quadriplegia patients: A pilot study

One of the common disorders in people with quadriplegia is having a weak grip strength that can affect activities of daily living (ADL). This study presents the design of a soft robotic glove via pneumatic actuators and feasibility according to a range of motion (ROM) of proximal interphalangeal (PIP) joint and user friendly.The soft robotic glove includes a neoprene cockup, two pumps, a controller that adjusts the pressure of the pumps, two-direction parts, and two silicone tubes placed on an index and middle fingers. A total of seven subjects (2healthy, 5quadriplegia patients) participated in this project. Performance of the device was verified through assessment in healthy participants first and then spinal cord injury (SCI) participants. The device evaluated the range of motion (ROM) of a proximal interphalangeal (PIP) joint. Then, subjects completed a satisfaction questionnaire.Results showed the ROM of the PIP joint (p value = 0.042) increased by using the robotic glove. The average score of the satisfaction questionnaire was 4.24 which was beyond the desirable threshold. In conclusion, the glove obtained ROM requirements to the grip usual objects and underlined the potential for assisting SCI participants in ADLs. Providing motion in all fingers should be investigated and developed in the future.

Hand's Functional Status of Children with Rheumatoid Arthritis in Everyday Activities: A Cross-Sectional Study

Objective: Rheumatoid Arthritis [RA] is a chronic, systemic, autoimmune disease on an unknown aetiology. It leads to the progressive destruction of joints. It also warrants difficulties in performance of Activities of Daily Living(ADL). This study aimed at determine relationship between activities of daily living [ADL] and functional status of the hand. Methods: This Crossectional Study was conducted at Romatology Department Children Hospital and Sheikh Zayed Hospital Lahore from June 2018 to December 2018. Convenient sampling technique helped in the collection of data. A hand function questionnaire and the Barthel Index were the contributary data collection methods. Rheumatoid Arthritis [RA] patients selected were those experiencing functional impairment in hands, having difficulty in performing ADL. Results: The patients who were able to perform the hand function test were independent in their daily life activities. Whereas, those who were not able to perk the test were dependent on their daily life activities. Conclusion: It was found that children with RA had a significant association between performing the ADL and functional status of hand. Key Words: Activities of Daily Living [ADL], Rheumatoid Arthritis [RA] How to cite: Ikram A.H., Ahad A.W., Huma Fazlia. Hand's functional status of children with rheumatoid arthritis in everyday activities: a cross-sectional study Esculapio. 2021.17(01): 9-14

Greater Reduction in Contralesional Hand Use After Frontoparietal Than Frontal Motor Cortex Lesions in Macaca mulatta.

We previously reported that rhesus monkeys recover spontaneous use of the more impaired (contralesional) hand following neurosurgical lesions to the arm/hand representations of primary motor cortex (M1) and lateral premotor cortex (LPMC) (F2 lesion) when tested for reduced use (RU) in a fine motor task allowing use of either hand. Recovery occurred without constraint of the less impaired hand and with occasional forced use of the more impaired hand, which was the preferred hand for use in fine motor tasks before the lesion. Here, we compared recovery of five F2 lesion cases in the same RU test to recovery after unilateral lesions of M1, LPMC, S1 and anterior portion of parietal cortex (F2P2 lesion – four cases). Average and highest %use of the contralesional hand in the RU task in F2 cases were twice that in F2P2 cases (p < 0.05). Recovery in the RU task was closely associated with volume and percentage of lesion to caudal (new) M1 (M1c) in both F2 and F2P2 lesion cases. One F2P2 case, with the largest M1c lesion and a large rostral somatosensory cortex (S1r) lesion developed severe contralesional hand non-use despite exhibiting some recovery of fine motor function initially. We conclude that the degree of reduced use of the contralesional hand is primarily related to the volume of M1c injury and that severe non-use requires extensive injury to M1c and S1r. Thus, assessing peri-Rolandic injury extent in stroke patients may have prognostic value for predicting susceptibility to RU and non-use in rehabilitation.

Tyneside Pegboard Test for unimanual and bimanual dexterity in unilateral cerebral palsy: association with sensorimotor impairment.

We explored the psychometric properties of the recently developed Tyneside Pegboard Test (TPT) for unimanual and bimanual dexterity in children with unilateral cerebral palsy (CP) and investigated the impact of sensorimotor impairments on manual dexterity. In this cross-sectional study, the TPT was assessed in 49 children with unilateral CP (mean age 9y 8mo, SD 1y 11mo, range 6-15y; 30 males, 19 females; 23 with right unilateral CP). All participants additionally underwent a standardized upper limb evaluation at body function and activity level. We investigated: (1) known-group, concurrent, and construct validity and (2) impact of sensorimotor impairments including spasticity, grip force, stereognosis, and mirror movements using analysis of covariance, Spearman's rank correlation (r), and multiple linear regression (R2 ) respectively. TPT outcomes significantly differed according to the Manual Ability Classification System (p<0.001, known-group validity). Relationships were found between the unimanual TPT tasks and the Jebsen-Taylor Hand Function Test (r=0.86-0.88, concurrent validity). Bimanual TPT tasks were negatively correlated with the Assisting Hand Assessment, ABILHAND-Kids, and Children's Hand-use Experience Questionnaire (r=-0.38 to -0.78, construct validity). Stereognosis was the main determinant influencing all tasks (p<0.001, R2 =37-50%). Unimanual dexterity was additionally determined by grip strength (p<0.05, R2 =8-9%) and mirror movements in the more impaired hand (p<0.05, R2 =4-8%). Bimanual dexterity was also explained by mirror movements in the more impaired hand (p<0.01, R2 =10-16%) and spasticity (p=0.04, R2 =5%). The TPT is a valid test to measure unimanual and bimanual dexterity in unilateral CP. The results further emphasize the importance of somatosensory impairments in children with unilateral CP. What this paper adds The Tyneside Pegboard Test is valid for measuring unimanual and bimanual dexterity in unilateral cerebral palsy. Children with poorer manual ability show worse unimanual and bimanual dexterity. Stereognosis is the main predictor of both unimanual and bimanual dexterity. Stronger mirror movements in the more impaired hand result in worse bimanual dexterity.

Characteristics of the severely impaired hand in survivors of stroke with chronic impairments

ABSTRACT Background Diminished sensorimotor control of the hand is one of the most common outcomes following stroke. This hand impairment substantially impacts overall function and quality of life; standard therapy often results in limited improvement. Mechanisms of dysfunction of the severely impaired post-stroke hand are still incompletely understood, thereby impeding the development of new targeted treatments. Objective To identify and determine potential relationships among the mechanisms responsible for hand impairment following stroke Methods This cohort study observed stroke survivors (n = 95) with severe, chronic hand impairment (Chedoke-McMaster Hand score = 2–3). Custom instrumentation created precise perturbations and measured kinematic responses. Muscle activation was recorded through electromyography. Strength, spasticity, muscle relaxation time, and muscle coactivation were quantified. Results Maximum grip strength in the paretic hand was only 12% of that achieved by the nonparetic hand, and only 6 of 95 participants were able to produce any net extension force. Despite force deficits, spastic reflex response of the finger flexor evoked by imposed stretch averaged 90.1 ± 26.8% of maximum voluntary activation, relaxation time averaged 3.8 ± 0.8 seconds, and coactivation during voluntary extension exceeded 30% of maximum contraction, thereby resulting in substantial net flexion. Surprisingly, these hypertonicity measures were not significantly correlated with each other. Conclusions Survivors of severe, chronic hemiparetic stroke experience profound weakness of both flexion and extension that arises from increased involuntary antagonist activation and decreased voluntary activation. The lack of correlation amongst hypertonicity measures suggests that these phenomena may arise from multiple, potentially independent mechanisms that could require different treatments.

Tintelingen in de handen, wat nu?

Tingling hands, what is wrong? A patient was sent to the physical medicine and rehabilitation department for advice and electromyography because of paraesthesia and functional impairment of the left hand. Such complaints are a frequent reason for seeking medical consult. Based on the most frequent causes of paraesthesia of the hand, this article aims to provide a tool to draw up a list of the most probable diagnosis and differential diagnosis through anamnesis and clinical examination.

Correction to Scarpina et al. (2020).

In this single-case study, the Circles-Lines Coupling Task was administered to a left-parietal-brain-damaged individual. The cerebral lesion caused a central proprioceptive loss, relative to the impaired right hand, when out of the visual control. For the 1st time in literature, we sought to investigate whether the movement of the unaffected hand induced an efficient coupling effect on the movement of the affected one. The bimanual task was performed in the presence and absence of visual input. The patient's performance was compared with that of healthy controls. We observed the traditional bimanual coupling effect in healthy controls. Moreover, we also replicated the effect when they performed the task blindfolded. In the case of the patient, both hands showed the typical ovalization of the line trajectory when the task was performed in visual modality. It is interesting that when the patient performed the task blindfolded, the trajectories of the impaired right hand seemed to be not influenced by the concomitant circular movement of the spared left hand. The movement of the unaffected hand induced a bimanual coupling effect on the movement of the affected one only when the visual input was available. In absence of a visual feedback, the aberrant proprioceptive information might preclude the emerging of bimanual coupling, even in the case of a preserved motor intentionality and planning. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Interhemispheric Parietal-Frontal Connectivity Predicts the Ability to Acquire a Nondominant Hand Skill.

Introduction: After chronic impairment of the right dominant hand, some individuals are able to compensate with increased performance with the intact left nondominant hand. This process may depend on the nondominant (right) hemisphere's ability to access dominant (left) hemisphere mechanisms. To predict or modulate patients' ability to compensate with the left hand, we must understand the neural mechanisms and connections that underpin this process. Methods: We studied 17 right-handed healthy adults who underwent resting-state functional connectivity (FC) magnetic resonance imaging scans before 10 days of training on a left-hand precision drawing task. We sought to identify right-hemisphere areas where FC from left-hemisphere seeds (primary motor cortex, intraparietal sulcus [IPS], inferior parietal lobule) would predict left-hand skill learning or magnitude. Results: Left-hand skill learning was predicted by convergent FC from left primary motor cortex and left IPS onto the same small region (0.31 cm3) in the right superior parietal lobule (SPL). Discussion: For patients who must compensate with the left hand, the right SPL may play a key role in integrating left-hemisphere mechanisms that typically control the right hand. Our study provides the first model of how interhemispheric functional connections in the human brain may support compensation after chronic injury to the right hand.

Evaluation of Optical and Radar Based Motion Capturing Technologies for Characterizing Hand Movement in Rheumatoid Arthritis-A Pilot Study.

In light of the state-of-the-art treatment options for patients with rheumatoid arthritis (RA), a detailed and early quantification and detection of impaired hand function is desirable to allow personalized treatment regiments and amend currently used subjective patient reported outcome measures. This is the motivation to apply and adapt modern measurement technologies to quantify, assess and analyze human hand movement using a marker-based optoelectronic measurement system (OMS), which has been widely used to measure human motion. We complement these recordings with data from markerless (Doppler radar) sensors and data from both sensor technologies are integrated with clinical outcomes of hand function. The technologies are leveraged to identify hand movement characteristics in RA affected patients in comparison to healthy control subjects, while performing functional tests, such as the Moberg-Picking-Up Test. The results presented discuss the experimental framework and present the limiting factors imposed by the use of marker-based measurements on hand function. The comparison of simple finger motion data, collected by the OMS, to data recorded by a simple continuous wave radar suggests that radar is a promising option for the objective assessment of hand function. Overall, the broad scope of integrating two measurement technologies with traditional clinical tests shows promising potential for developing new pathways in understanding of the role of functional outcomes for the RA pathology.

Production Time and User Satisfaction of 3-Dimensional Printed Orthoses For Chronic Hand Conditions Compared With Conventional Orthoses: A Prospective Case Series.

ObjectiveHand orthoses are often prescribed for persons with chronic hand and wrist impairments. This study assessed the feasibility, in terms of production time and user satisfaction, of 3-dimensional printed hand orthoses compared with conventional hand orthoses for this population.MethodsIn this prospective case series, both a conventional hand orthosis and a 3-dimensional printed hand orthosis were manufactured for 10 participants. Production time (in minutes) of each orthosis was recorded. Each orthosis was worn for one week, after which participants completed a self-designed questionnaire on satisfaction, scored on a 5-point Likert scale. Functionality and orthosis preference were also assessed.ResultsThe mean (standard deviation (SD)) production time for the 3-dimensional printed orthoses, of 112 (11.0) min, was significantly shorter compared with 239 (29.2) min for the conventional orthoses (95% confidence interval (95% CI) 71–182 min, p = 0.001). Satisfaction scores were similar for both orthoses, except for comfort item “fitting method”, which was rated significantly higher for scanning compared with casting (median [IQR] score: 5 [0.0]; 4 [2.0], p = 0.034). Functionality and orthosis preference were rated similar for both orthoses.CONCLUSIONAs the production time was halved, user satisfaction similar, and scanning experienced as slightly more comfortable than casting, 3-dimensional printed hand orthoses seem feasible and potentially beneficial for use in people with chronic hand and wrist impairments.LAY ABSTRACTPersons with chronic hand and wrist impairments often use an orthosis to make it easier to perform daily activities. Three-dimensional scanning and printing can facilitate the manufacturing of hand orthoses. This study compared 3-dimensional printed orthoses with conventional orthoses for persons with chronic hand and wrist impairments, with regard to production time and user satisfaction. Ten participants used a 3-dimensional printed orthosis, as well as a conventional orthosis, each for one week. The results showed that production time of 3-dimensional printed orthoses was half that of conventional orthoses. Satisfaction with both orthoses was similar, except for the “fitting method”, whereby fitting by 3-dimensional scanning was perceived as slightly more comfortable compared with conventional casting. Functionality and orthosis preference were rated similar for both orthoses. In conclusion, 3-dimensional printed orthoses appear to be a potential treatment option for persons with chronic hand and wrist impairments.

Poststroke Effects on Power Production in Older Adults

Muscular power is an important performance component to emphasize in older adults following stroke. Aging affects neuromuscular function reducing strength and power; in turn, this loss is exacerbated in clients with stroke. Stroke can impact both ipsilateral and contralateral extremity power production, which correlates with reduced function in gait, transfers, and impaired hand use. A variety of objective clinical tests assess lower extremity power production. Studies demonstrate that exercise regimens that improve muscular power improve function poststroke. Future research should focus on best practice interventions to maximize extremity power in this population of older adults.