Jebsen-Taylor Hand Function Test Research Articles

Age- and sex-related changes in motor functions: a comprehensive assessment and component analysis

Age-related motor impairments often cause caregiver dependency or even hospitalization. However, comprehensive investigations of the different motor abilities and the changes thereof across the adult lifespan remain sparse. We, therefore, extensively assessed essential basic and complex motor functions in 444 healthy adults covering a wide age range (range 21 to 88 years). Basic motor functions, here defined as simple isolated single or repetitive movements in one direction, were assessed by means of maximum grip strength (GS) and maximum finger-tapping frequency (FTF). Complex motor functions, comprising composite sequential movements involving both proximal and distal joints/muscle groups, were evaluated with the Action Research Arm Test (ARAT), the Jebsen-Taylor Hand Function Test (JTT), and the Purdue Pegboard Test. Men achieved higher scores than women concerning GS and FTF, whereas women stacked more pins per time than men during the Purdue Pegboard Test. There was no significant sex effect regarding JTT. We observed a significant but task-specific reduction of basic and complex motor performance scores across the adult lifespan. Linear regression analyses significantly predicted the participants’ ages based on motor performance scores (R2 = 0.502). Of note, the ratio between the left- and right-hand performance remained stable across ages for all tests. Principal Component Analysis (PCA) revealed three motor components across all tests that represented dexterity, force, and speed. These components were consistently present in young (21–40 years), middle-aged (41–60 years), and older (61–88 years) adults, as well as in women and men. Based on the three motor components, K-means clustering analysis differentiated high- and low-performing participants across the adult life span. The rich motor data set of 444 healthy participants revealed age- and sex-dependent changes in essential basic and complex motor functions. Notably, the comprehensive assessment allowed for generating robust motor components across the adult lifespan. Our data may serve as a reference for future studies of healthy subjects and patients with motor deficits. Moreover, these findings emphasize the importance of comprehensively assessing different motor functions, including dexterity, force, and speed, to characterize human motor abilities and their age-related decline.

Effects of hippotherapy on upper extremity functions in children with cerebral palsy

Purpose: The purpose of our study was to investigate the effects of hippotherapy on upper extremity functions in children with cerebral palsy (CP). 
 Materials and Methods: The study was carried out with a quasi-hippotherapy design by evaluating the hippotherapy and control groups with pretests and posttests. Sixteen children with CP who were treated with 30 minutes of additional hippotherapy three times a week for five weeks were included in the hippotherapy group. Eleven children with CP who had conventional physiotherapy were recruited for the control group. Upper extremity functions were evaluated before and after the intervention using the Box and Block Test (BBT) and the Jebsen Taylor Hand Function Test (JTHFT). 
 Results: There were no significant differences between the hippotherapy and control groups in terms of their baseline BBT and JTHFT scores. After 5-weeks, no statistically significant difference was found between the BBT scores of the hippotherapy and control groups. Significant increases were detected in all parameters of JTHFT in the posttest in the hippotherapy group, compared to the pretest. Moreover, in the posttest, a statistically significant difference was found between the hippotherapy and control groups in the parameters of turning over cards and picking up small objects, which subscales of JTHFT.
 Conclusion: In children with CP, hippotherapy provided in addition to conventional treatment was an effective practice, especially in improving fine motor skills in the hands.

Pediatric Performance-Based Outcome Measures for Upper Extremity Function: A Scoping Review and Linking to the International Classification of Functioning, Disability, and Health.

Background. Performance-based outcome measures (PBOMs) are objective measures that assess physical capacity or performance in specific tasks or movements. Purpose. 1) to identify which PBOMs are most frequently reported to evaluate upper extremity (UE) function in pediatric rehabilitation 2) to determine the link between constructs of the ICF and meaningful concepts extracted from each identified PBOM. Methods. Pediatric UE PBOMs were searched in four databases. The selection of outcome measures included an initial title and abstract screening, followed by full-text review of the articles to be included based on identified selection criteria. Two reviewers were appointed to link the meaningful concepts identified in the outcome measures independently and a third reviewer was consulted in case of ambiguity to make a final decision. Findings. After the initial screening, 1786 full-text articles were reviewed, 1191 met the inclusion criteria, in which 77 outcome measures were identified and 32 were included in the linking process. From the included 32 outcome measures, 538 items were extracted and linked to the ICF. The most commonly cited measures included Assisting Hand Assessment, Jebsen-Taylor Hand Function Test, Melbourne Assessment of Unilateral Upper Limb. The Activity and Participation domain represented 364 codes followed by the Body Functions domain domain which represented 174 codes. Implications. A majority of the outcome measures identified were linked with the Mobility, Fine Hand Use of the ICF. Therefore, when selecting a PBOM, careful considerations need to be made regarding which concept of health is to be assessed.

Comparison of two different orthoses used in the treatment of lateral epicondylitis.

Lateral epicondylitis (LE) is one of the most common causes of lateral elbow pain, and orthoses are often used in its conservative treatment. However, the number of studies examining the effectiveness of the orthoses used and their differences compared to each other is limited. To determine the effects of 2 orthoses types, wrist orthosis (WO) and counterforce brace (CB), commonly used in the treatment of lateral epicondylitis on muscle activation, grip strength, hand function, and satisfaction level in healthy individuals. Quasi-experimental study. Thirty-seven healthy individuals were recruited. Muscle activation was evaluated by surface electromyography, and maximum grip strength was evaluated with a handheld dynamometer. Hand function and satisfaction level were evaluated with Jebsen Taylor Hand Function Test and Orthotics and Prosthetics Users Survey, respectively. All evaluations were conducted for each individual in 3 conditions (no orthosis, WO, and CB). Extensor carpi radialis (ECR) muscle activation was greater when using CB compared with that when without orthosis (p = 0.036). There was no significant difference in extensor digitorum communis (EDC) muscle activation and maximum grip strength among the conditions (p > 0.05). Hand function was worse when using the WO compared with the other conditions (p < 0.001). In terms of orthosis satisfaction, individuals were found to be significantly more satisfied with the use of CB (p = 0.001). In our study highlight the use of CB in terms of EDC muscle activity, grip strength, hand function, and satisfaction, while the use of WO is prominent in terms of keeping extensor carpi radialis muscle activity low, which has been shown to be important for LE. To obtain definitive results on the effectiveness of different orthoses in the treatment of LE, more research is needed to compare the muscular activation in the extensor carpi radialis brevis (ECRB) and EDC muscles with objective methods.

Permanent deterioration of fine motor skills after the resection of tumors in the supplementary motor area

Supplementary motor area syndrome (SMAS) represents a common neurosurgical sequela. The incidence and time frame of its occurrence have yet to be characterized after surgery for brain tumors. We examined patients suffering from a brain tumor preoperatively, postoperatively, and during follow-up examinations after three months, including fine motor skills testing and transcranial magnetic stimulation (TMS). 13 patients suffering from a tumor in the dorsal part of the superior frontal gyrus underwent preoperative, early postoperative, and 3-month follow-up testing of fine motor skills using the Jebsen-Taylor Hand Function Test (JHFT) and the Nine-Hole Peg Test (NHPT) consisting of 8 subtests for both upper extremities. They completed TMS for cortical motor function mapping. Test completion times (TCTs) were recorded and compared. No patient suffered from neurological deficits before surgery. On postoperative day one, we detected motor deficits in two patients, which remained clinically stable at a 3-month follow-up. Except for page-turning, every subtest indicated a significant worsening of function, reflected by longer TCTs (p < 0.05) in the postoperative examinations for the contralateral upper extremity (contralateral to the tumor manifestation). At 3-month follow-up examinations for the contralateral upper extremity, each subtest indicated significant worsening compared to the preoperative status despite improvement to the immediate postoperative level. We also detected significantly longer TCTs (p < 0.05) postoperatively in the ipsilateral upper extremity. This study suggests a long-term worsening of fine motor skills even three months after SMA tumor resection, indicating the necessity of targeted physical therapy for these patients.

The effects of improvement in upper extremity function on gait and balance in children with upper extremity affected

BackgroundThis study aimed to investigate the effects of functional improvement in the upper extremity on gait and balance in children with upper extremity affected. Research questionWhat are the effects of functional improvement in the upper extremity on gait and balance in children with upper extremity affected? MethodsEighteen children with a diagnosis of rheumatologic diseases and 15 healthy children were evaluated with Shriners Hospital Upper Extremity Assessment, Jebsen-Taylor Hand Function Test, Abilhand Rheumatoid Arthritis Scale, 10-meter walk test and Childhood Health Assessment Questionnaire. For static balance assessment, the Biodex Balance was used. Ground reaction forces (peak forces (heel strike and push-off) and minimum force (loading response), single-limb support duration, Center-of-Force displacement and walking speed were evaluated with the Sensor Medica. Arm swing was evaluated with the Kinovea 2D motion analysis. ResultsBefore treatment, single-limb support duration and push-off force was higher and center-of-force displacement was lower on affected side compared to unaffected side in rheumatologic group. After the 6-week rehabilitation program, upper extremity function, quality of life and functional gait score improved. Single-limb support duration decreased on affected side and increased on unaffected side. On affected side, push-off force decreased. The arm swing parameters were similar before and after treatment. SignificanceImproving upper extremity function can help with gait balance by decreasing the difference in walking and balance parameters between the affected and unaffected sides and providing for more symmetrical weight transfer.

Effect of augmented reality–based rehabilitation of hand burns on hand function in children: A randomized controlled trial

BackgroundDespite the use of traditional rehabilitation methods, hand function may still remain impaired in children suffering from burn injuries. PurposeThis study aimed to assess the impact of implementing an augmented reality (AR) rehabilitation booklet designed for pediatric hand burn on their hand functionality. Study designThis was a randomized controlled trial. MethodsSeventy-two children, aged 8-14 years with a hand burn, were randomly allocated into intervention (n = 36) and control (n = 36) groups. Children in the control group received routine rehabilitation program, while in the intervention group, children performed exercises using a printed booklet with related AR application. The Jebsen-Taylor Hand Function Test was completed before the intervention at the time of the patients' discharge and 1 month later. ResultsThe results of analysis of covariance based on baseline- and fully-adjusted models showed significant intervention effect after discharge as well as after intervention for hand function (mean difference [95% confidence interval] for discharge: −8.2 [−15.0 to −1.4] and for after intervention: −74.0 [−88.8 to −59.1]) and the items (all p < 0.05), except for writing and lifting large light objects for both after discharge and after intervention measures (all p-value > 0.05). ConclusionsA significant decrease in the total time taking to complete the Jebsen-Taylor hand function test was observed in the intervention group compared to the control group 1 month after discharge. Rehabilitation of children with hand burns, using printed educational booklet with related AR application, improves their hand function.

Patient Outcomes After Peripheral Nerve Injury Depend on Bimanual Dexterity and Preserved Use of the Affected Hand

Background Little is known about how peripheral nerve injury affects human performance, behavior, and life. Hand use choices are important for rehabilitation after unilateral impairment, but rarely measured, and are not changed by the normal course of rehabilitation and daily life. Objective To identify the relationship between hand use (L/R choices), motor performance, and patient-centered outcomes. Methods Participants (n = 48) with unilateral peripheral nerve injury were assessed for hand use via Block Building Task, Motor Activity Log, and Edinburgh Handedness Inventory; dexterity (separately for each hand) via Nine-Hole Peg Test, Jebsen Taylor Hand Function Test, and a precision drawing task; patient-centered outcomes via surveys of disability, activity participation, and health-related quality of life; and injury-related factors including injury cause and affected nerve. Factor Analysis of Mixed Data was used to explore relationships between these variables. The data were analyzed under 2 approaches: comparing dominant hand (DH) versus non-dominant hand (NH), or affected versus unaffected hand. Results The data were best explained by 5 dimensions. Good patient outcomes were associated with NH performance, DH performance (separately and secondarily to NH performance), and preserved function and use of the affected hand; whereas poor patient outcomes were associated with preserved but unused function of the affected hand. Conclusion After unilateral peripheral nerve injury, hand function, hand usage, and patient life arise from a complex interaction of many factors. To optimize rehabilitation after unilateral impairment, new rehabilitation methods are needed to promote performance and use with the NH, as well as the injured hand.

Correlation of cognitive function and kinematic movement during self‐feeding activity

AbstractBackgroundSelf‐feeding is the important activity that is most closely related to daily living using motor and cognitive abilities. Especially, movement of self‐feeding includes picking up the spoon and executing the sequence of movement correctly, so it can be related to cognitive aspects. The purpose of this study is to investigate correlation with the kinematic movement during self‐feeding and cognitive function using AI software programMethodThe subjects participated in 4 normal person. In this study, the ‘simulated feeding’ task in Jebsen Taylor Hand Function test was selected. ‘Simulated Feeding’ is a task of transferring 5 beans to cup with a spoon. During task performance, a laptop and a webcam were used to record a video image, and trajectory and time value were recorded from 2D web‐cam image. Cognitive assessment tool used Trail Making Test (TMT). The spearman correlation analysis was conducted to evaluate the correlation with factors of movement and cognition during self‐feeding.ResultIt is possible to determine how far or short the hand moved depending on the length of the trajectory. The average time value shows the subject spent more time to put the beans in the spoon than to put the beans in the cup. Also, movement of self feeding were positively related to cognitive aspects..ConclusionWe believe that quantitative assessment of movement is related to cognitive function during self‐feeding. Through this, the state of cognitive function can be indirectly confirmed. Future study will need to apply movement analysis to evaluate the cognitive decline of the elderly.

Correlation of cognitive function and kinematic movement during self‐feeding activity

AbstractBackgroundSelf‐feeding is the important activity that is most closely related to daily living using motor and cognitive abilities. Especially, movement of self‐feeding includes picking up the spoon and executing the sequence of movement correctly, so it can be related to cognitive aspects. The purpose of this study is to investigate correlation with the kinematic movement during self‐feeding and cognitive function using AI software programMethodThe subjects participated in 4 normal person. In this study, the ‘simulated feeding’ task in Jebsen Taylor Hand Function test was selected. ‘Simulated Feeding’ is a task of transferring 5 beans to cup with a spoon. During task performance, a laptop and a webcam were used to record a video image, and trajectory and time value were recorded from 2D web‐cam image. Cognitive assessment tool used Trail Making Test (TMT). The spearman correlation analysis was conducted to evaluate the correlation with factors of movement and cognition during self‐feeding.ResultIt is possible to determine how far or short the hand moved depending on the length of the trajectory. The average time value shows the subject spent more time to put the beans in the spoon than to put the beans in the cup. Also, movement of self feeding were positively related to cognitive aspects..ConclusionWe believe that quantitative assessment of movement is related to cognitive function during self‐feeding. Through this, the state of cognitive function can be indirectly confirmed. Future study will need to apply movement analysis to evaluate the cognitive decline of the elderly.

Monomelic Amyotrophy/Hirayama Disease: Surgical Outcome in a Large Cohort of Indian Patients

Hirayama disease (HD) is a cervical compressive myelopathy. Anterior cervical discectomy and fusion (ACDF) is identified as the best surgical approach. We evaluated surgical outcomes and factors influencing ACDF in HD. Between 2015 and 2019, 126 patients with HD underwent ACDF. Contrast magnetic resonance imaging of the cervical spine in full flexion was performed. Clinical examination and preoperative/postoperative assessment of hand function using Fugl-Meyer assessment, Jebsen-Taylor hand function test, and handheld dynamometry were performed at 3-monthly intervals for 1 year. Surgical outcomes were assessed as per the Odom criteria and Hirayama outcome questionnaire. Age at onset and duration of illness were 12-31 years (mean, 18 ± 2.7) and 1-96 months (32.7 ± 24.4), respectively. All patients had progressive weakness and wasting of the affected limb. Cord atrophy was seen in 97.1%, with epidural detachment and engorgement of the posterior epidural venous plexus in all. All patients underwent ACDF. Of these patients, 54% had an excellent/good outcome and 39% had a satisfactory outcome as per the Odom scale at last follow-up (mean, 44.9 ± 16.5 months) after surgery. Handheld dynamometry showed improvement from preoperative values to 1 year follow-up. Duration of illness and age at onset had a negative correlation and the preoperative Fugl-Meyer score had a positive correlation with improvement. ACDF resulted in remarkable improvement or stabilization in neurologic deficits in many patients with HD. Because motor disability ensues over time, early surgical intervention during the progressive phase is advocated.

Restoring natural upper limb movement through a wrist prosthetic module for partial hand amputees

BackgroundMost partial hand amputees experience limited wrist movement. The limited rotational wrist movement deteriorates natural upper limb system related to hand use and the usability of the prosthetic hand, which may cause secondary damage to the musculoskeletal system due to overuse of the upper limb affected by repetitive compensatory movement patterns. Nevertheless, partial hand prosthetics, in common, have only been proposed without rotational wrist movement because patients have various hand shapes, and a prosthetic hand should be attached to a narrow space.MethodsWe hypothesized that partial hand amputees, when using a prosthetic hand with a wrist rotation module, would achieve natural upper limb movement muscle synergy and motion analysis comparable to a control group. To validate the proposed prototype design with the wrist rotation module and verify our hypothesis, we compared a control group with partial hand amputees wearing hand prostheses, both with and without the wrist rotation module prototype. The study contained muscle synergy analysis through non-negative matrix factorization (NMF) using surface electromyography (sEMG) and motion analyses employing a motion capture system during the reach-to-grasp task. Additionally, we assessed the usability of the prototype design for partial hand amputees using the Jebsen-Taylor hand function test (JHFT).ResultsThe results showed that the number of muscle synergies identified through NMF remained consistent at 3 for both the control group and amputees using a hand prosthesis with a wrist rotation module. In the motion analysis, a statistically significant difference was observed between the control group and the prosthetic hand without the wrist rotation module, indicating the presence of compensatory movements when utilizing a prosthetic hand lacking this module. Furthermore, among the amputees, the JHFT demonstrated a greater improvement in total score when using the prosthetic hand equipped with a wrist rotation module compared to the prosthetic hand without this module.ConclusionIn conclusion, integrating a wrist rotation module in prosthetic hand designs for partial hand amputees restores natural upper limb movement patterns, reduces compensatory movements, and prevent the secondary musculoskeletal. This highlights the importance of this module in enhancing overall functionality and quality of life.

Reliability of an observation-based scoring grid to assess bimanual performance during unstandardized tasks in adults living with cerebral palsy

Purpose Most activities of daily living (ADLs) require the use of both upper extremities. However, few assessments exist to assess bimanual performance, especially among adults living with cerebral palsy (CP). The aim of this preliminary study is to assess the interrater reliability and convergent validity of the Assisting Hand Assessment (AHA) scoring grid applied to unstandardized ADLs. Materials and methods For this validation study, nineteen adults living with spastic unilateral CP were videotaped performing seven bimanual ADLs. Three raters assessed the videos independently using the 20-item grid of the AHA. Gwet’s AC2 was used to assess interrater reliability. Kendall’s Tau-b correlation was used between the observation-based scoring grid and Jebsen-Taylor Hand Function Test (JTHFT) scores to assess convergent validity. Results Interrater reliability was good (0.84, SD = 0.02). The correlation with the JTHFT was high (τb = −0.74; p < 0.001). Conclusion The results show the potential of using an observation-based scoring grid with unstandardized ADLs to assess bimanual performance in adults living with CP, but further research on psychometric properties is needed. This method allows for an assessment that is occupation-oriented, ecological, and meaningful.

Effects of non-immersive virtual reality intervention on children with spastic cerebral palsy: a meta-analysis and systematic review.

This review aimed to assess the effectiveness of non-immersive virtual reality intervention compared to traditional rehabilitation in improving the functions of the upper and lower extremities, balance, and social participation among children with spastic cerebral palsy. We used librarian-designed searches of 10 databases to identify research articles on randomized controlled trials that assessed the effectiveness of non-immersive virtual reality in intervening spastic cerebral palsy patients up to 4/15/2023. Independent evaluation was conducted by two trained investigators using the evaluation criteria of RCT quality indicated in the Cochrane Manual of Assessment 'risk- of- bias tool.' The PEDro scale was used to evaluate the method and quality of the literature. 21 research articles involving 779 patients with spastic cerebral palsy were included. Significant differences between the non-immersive virtual reality rehabilitation and traditional rehabilitation groups were observed in all indicators, except for the Jebsen-Taylor Hand Function Test. Non-immersive virtual reality intervention is effective in improving the function of the lower extremity, balance, and social participation in children with spastic cerebral palsy, but its effect on upper limb function is still controversial.

Handgrip strength and upper limb functional performance measures in people over 18 years old: Analysis of relationships and influencing factors

BackgroundHandgrip strength is a common, simple, and inexpensive method to measure muscle strength. On the other hand, the functional performance measurement involves a usual task which implies repeating elements between the individuals’ interaction and the environment. This is fundamental for projecting their results to daily life situation. PurposeTo explore the relationship between grip strength and measures of functional performance of the upper limbs (ULs) in people over 18 years of age, and to determine the influence of sociodemographic and anthropometric variables on the relationship. Study DesignA cross-sectional study was conducted under the analytical empirical approach, using linear associations between handgrip strength and functional performance measurement tests (correspondence analysis). MethodsThree hundred sixty-two male and female individuals between 18 and 91 years of age from 4 Colombian cities participated. The grip strength of both ULs measured with a digital dynamometry was associated with the Box and Block Test (BBT, manual dexterity), Nine-Hole Peg Test (NHPT, daily living tasks), and Jebsen-Taylor Hand Function Test (JJT, ability to grasp, pick up, and place). Multiple linear regression analyzes were performed to assess possible explanatory factors of a sociodemographic and anthropometric order. ResultsA significant association was found between the grip strength of dominant and non-dominant ULs with all functional performance tests (ρ > 0.27 and p < .001), except for the writing and simulated feeding subtests of the JJT (ρ ≤ 0.16). An interactive effect of age was found in the relationship between grip strength and the 3 functional performance tests. ConclusionsThese results support the association between grip strength with the NHPT, JJT, and BBT measures and the interactive effect of age on the performance of all tests.

The Application of Soft Robotic Gloves in Stroke Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Wearable robotic devices have been strongly put into use in both the clinical and research fields of stroke rehabilitation over the past decades. This study aimed to explore the effectiveness of soft robotic gloves (SRGs) towards improving the motor recovery and functional abilities in patients with post-stroke hemiparesis. Five major bibliographic databases, PubMed, Embase, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database, were all reviewed for enrollment regarding comparative trials prior to 7 March 2023. We included adults with stroke and compared their rehabilitation using SRGs to conventional rehabilitation (CR) on hand function in terms of the Fugl-Meyer Upper Extremity Motor Assessment (FMA-UE), Fugl-Meyer Distal Upper Extremity Motor Assessment (FMA-distal UE), box and blocks test score, grip strength test, and the Jebsen-Taylor hand function test (JTT). A total of 8 studies, comprising 309 participants, were included in the analysis. Compared to CR, rehabilitation involving SRGs achieved better FMA-UE (MD 6.52, 95% CI: 3.65~9.39), FMA-distal UE (MD 3.27, 95% CI: 1.50~5.04), and JJT (MD 13.34, CI: 5.16~21.53) results. Subgroup analysis showed that stroke latency of more than 6 months and training for more than 30 min offered a better effect as well. In conclusion, for patients with stroke, rehabilitation using SRGs is recommended to promote the functional abilities of the upper extremities.

Hemispheric Differences of 1 Hz rTMS over Motor and Premotor Cortex in Modulation of Neural Processing and Hand Function.

Non-invasive brain stimulation can modulate both neural processing and behavioral performance. Its effects may be influenced by the stimulated area and hemisphere. In this study (EC no. 09083), repetitive transcranial magnetic stimulation (rTMS) was applied to the primary motor cortex (M1) or dorsal premotor cortex (dPMC) of either the right or left hemisphere, while evaluating cortical neurophysiology and hand function. Fifteen healthy subjects participated in this placebo-controlled crossover study. Four sessions of real 1 Hz rTMS (110% of rMT, 900 pulses) over (i) left M1, (ii) right M1, (iii) left dPMC, (iv) right dPMC, and one session of (v) placebo 1 Hz rTMS (0% of rMT, 900 pulses) over the left M1 were applied in randomized order. Motor function of both hands (Jebsen-Taylor Hand Function Test (JTHFT)) and neural processing within both hemispheres (motor evoked potentials (MEPs), cortical silent period (CSP), and ipsilateral silent period (ISP)) were evaluated prior and after each intervention session. A lengthening of CSP and ISP durations within the right hemisphere was induced by 1 Hz rTMS over both areas and hemispheres. No such intervention-induced neurophysiological changes were detected within the left hemisphere. Regarding JTHFT and MEP, no intervention-induced changes ensued. Changes of hand function correlated with neurophysiological changes within both hemispheres, more often for the left than the right hand. Effects of 1 Hz rTMS can be better captured by neurophysiological than behavioral measures. Hemispheric differences need to be considered for this intervention.

Response to Asirvatham (2023): Effects of Robot-Assisted Rehabilitation on Hand Function of People With Stroke.

In Thajus Asirvatham’s letter to the editor, one concern expressed was that, in our 2021 study (Lee et al., 2021), sensory function should have been highlighted as much as motor function. In this response, we add some discussion about sensory function.Sensorimotor function is significantly correlated with Fugl-Meyer Assessment–Upper Extremity (FMA–UE; Duncan et al., 1983) scores, which could affect the interlimb coordination and accuracy of limb positioning during movement. The sensory function did not show significant improvement in our study, which may be due to the motor-focused training that we used. Sensorimotor-focused training should be considered.We argue that the discussion of sensorimotor function was partially presented in the article. In our study, sensorimotor function was significantly associated with FMA–UE scores (Nordin et al., 2014), which may affect interlimb coordination and accuracy of limb positioning during movement. The results of our study showed no statistically significant improvement in sensory function in stroke patients with sensory impairment after robotic therapy. Previous studies have shown considerable improvements in proprioceptive acuity using rehabilitation robots with vibro-tactile feedback (Elangovan et al., 2019). The training in our study improved the use of proprioceptive input, resulting in better perceptual judgments of passive motion. Our program focused on motor training, but on the basis of the Semmes–Weinstein hand monofilament and the modified Nottingham Sensory Assessment (University of Nottingham, 2007), this may not have been beneficial for sensory function. Sensorimotor-focused training can be considered in future research. The second concern Asirvatham expressed was related to performance- or function-based assessment, such as the Action Research Arm Test (ARAT; McDonnell, 2008) or the Jebsen–Taylor Hand Function Test (JTT; Jebsen et al., 1969). We agree that, rather than using self-report or impairment-based measures to assess hand function, performance- or function-based assessments, such as the ARAT or the JTT, could be used. In our study, the Box and Block Test (Chen et al., 2009) and grip strength meter were functional assessments, and these tools were readily available in our clinical setting. The use of the ARAT and JTT will be considered in future studies.We thank Asirvatham for the insightful comments about our study, and we appreciate the attention we have received from other readers. Some suggestions have been made about adjustments that we need to make in future studies, and we appreciate the opportunity to respond.

Comment on Lee et al. (2021): Effects of Robot-Assisted Rehabilitation on Hand Function of People With Stroke

In the January/February 2021 issue of the American Journal of Occupational Therapy, I came upon the article summarizing the randomized controlled experiment conducted by Lee et al. (2021). I applaud the authors’ efforts to describe how robot-assisted rehabilitation helps stroke patients regain hand function and improve their capacity to carry out activities of daily living. However, I would like to share my thoughts on the trial.First, there is not a lot of information provided by the authors about the sensory aspect of robot-assisted rehabilitation. There have been assessments of sensory function, but they were not as thorough or detailed as those of motor function. After a stroke, sensorimotor abnormalities result in restrictions on everyday activities and social involvement (Rudd et al., 2017). Somatosensory disabilities are also linked to decreased dexterity and manipulation abilities, which result in generally poor hand functioning (Doyle et al., 2010). In addition, robotic devices provide feedback that consists of varying sensory information (Daly & Wolpaw, 2008). This suggests that sensory function should be highlighted as much as motor function. The trial’s sensorimotor function may be better understood if the somatosensory function had been given more attention.Second, rather than using a self-report or impairment-based measure to evaluate hand function, a performance- or function-based assessment could have been used. To offer a good image of the function and the locations of the functional deficiencies, additional tests, such as the Action Research Arm Test (ARAT; Lyle, 1981; Yozbatiran et al., 2008) or the Jebsen–Taylor Hand Function Test (Jebsen et al., 1969), could have been used. The ARAT is one of the most clinically useful measures (Connell & Tyson, 2012). Through the lens of occupational therapy, such assessments can offer a greater understanding of the functional utilization of the upper extremity.

Comment on Lee etal. (2021): Effects of Robot-Assisted Rehabilitation on Hand Function of People With Stroke.

In the January/February 2021 issue of the American Journal of Occupational Therapy, I came upon the article summarizing the randomized controlled experiment conducted by Lee et al. (2021). I applaud the authors’ efforts to describe how robot-assisted rehabilitation helps stroke patients regain hand function and improve their capacity to carry out activities of daily living. However, I would like to share my thoughts on the trial.First, there is not a lot of information provided by the authors about the sensory aspect of robot-assisted rehabilitation. There have been assessments of sensory function, but they were not as thorough or detailed as those of motor function. After a stroke, sensorimotor abnormalities result in restrictions on everyday activities and social involvement (Rudd et al., 2017). Somatosensory disabilities are also linked to decreased dexterity and manipulation abilities, which result in generally poor hand functioning (Doyle et al., 2010). In addition, robotic devices provide feedback that consists of varying sensory information (Daly & Wolpaw, 2008). This suggests that sensory function should be highlighted as much as motor function. The trial’s sensorimotor function may be better understood if the somatosensory function had been given more attention.Second, rather than using a self-report or impairment-based measure to evaluate hand function, a performance- or function-based assessment could have been used. To offer a good image of the function and the locations of the functional deficiencies, additional tests, such as the Action Research Arm Test (ARAT; Lyle, 1981; Yozbatiran et al., 2008) or the Jebsen–Taylor Hand Function Test (Jebsen et al., 1969), could have been used. The ARAT is one of the most clinically useful measures (Connell & Tyson, 2012). Through the lens of occupational therapy, such assessments can offer a greater understanding of the functional utilization of the upper extremity.