Three-point Pinch Research Articles

Using a Sensor-Embedded Baseball to Identify Finger Characteristics Related to Spin Rate and Pitching Velocity in Pitchers.

Previous investigations have shown a positive relationship between baseball pitching velocity and the kinetic chain involved in pitching motion. However, no study has examined the influence of finger characteristics on pitching velocity and rate of spin via a sensor-embedded baseball. Twenty-one pitchers volunteered and were recruited for this study. An experimental baseball embedded with a force sensor and an inertial measurement unit was designed for pitching performance measurement. Finger length and strength were measured as dependent variables. Spin rate and velocity were independent variables. Pearson product-moment correlations (r) and intraclass correlation coefficients (ICCs) determined the relationship between finger characteristics and pitching performance. Finger length discrepancy, two-point pinch strength, index finger RFD (rate of force development), middle finger impulse, and force discrepancy had significant correlations with spin rate (r = 0.500~0.576, p ≤ 0.05). Finger length discrepancy, two-point pinch, three-point pinch strength, index and middle finger RFD, middle finger impulse, and force combination had significant correlations with fastball pitching velocity (r = 0.491~0.584, p ≤ 0.05). Finger length discrepancy, finger pinch strength, and pitching finger force including maximal force and RFD may be factors that impact fastball spin rate and fastball pitching velocity.

Qualitative age-related changes in fine motor skill performance among 3- to 6-year-old typically developing children

This study described intra-task fine motor skill components of the Manual Dexterity tasks (Posting Coins; PC, Threading Beads; TB, Drawing Trail; DT) of the Movement Assessment Battery for Children-2 Test for typically developing children and investigated age- and sex-related differences. Three- to six-year-old Dutch children (n = 182, Mage 4.5 ± 1.1 years, 51.1% boys) were observed with regard to intra-task fine motor skill components, and changes in intra-task components of the Manual Dexterity tasks were analyzed across age using of the Kruskal–Wallis test with post-hoc Mann–Whitney U tests, and differences between sexes using the Mann–Whitney U test. The following intra-task components were observed: grip type, manipulation, non-dominant or non-writing hand, grip position, posture, head, coin placement, placement of the bead on the lace tip and joint movement. Results showed that the younger children (3-year-olds) more frequently used a grasp with the full hand (PC, TB), more often put the coin on the container and sliding it in (PC), more often supported the side or top of the container (PC), used more bi-manual manipulation (transferring from hand-to-hand or hand, body or surface assist) (TB, DT), more frequently used primitive, too high grips, predominantly used their proximal joints, and did not support the paper (DT). This in comparison with more frequent use of three-point pinch, direct coin placement, grabbing the front or back of the container, in-hand-manipulation, mature grips and correct height, distal joint use and supporting the paper from the side or below by most 5- and 6-year-olds. Furthermore, most sex-related differences were found in the younger age-groups (3- and 4-year-olds) in the DT tasks with girls outperforming boys. Results from this study add to the knowledge on qualitative fine motor skill performance in a convenience sample of 3- to 6-year-old typically developing children. A limitation of the current study was the relatively small sample size of 6-year-old children. The strength of the current study is its novelty in providing qualitative descriptions of intra-task fine motor skill components in typically developing 3- to 6-year-old children.

Hand Joint Hypermobility among Dental Students—A Cross-Sectional Study

(1) Background: Joint hypermobility refers to joint movement beyond normal range. Dentistry requires fine motor skills and manual dexterity; thus, the presence of hand joint hypermobility requires early assessment and intervention. The aim of this cross-sectional study was to assess the prevalence of hand joint hypermobility among first-year dental students and investigate correlations between the severity of their hypermobility and muscular strength. (2) Methods: First-year dental students were evaluated by an occupational therapy team composed of certified hand therapists. The extension of distal interphalangeal, proximal interphalangeal, and metacarpophalangeal finger joints was assessed with bilateral testing of digit hypermobility (with a cut-off of >20° for hypermobility) and classified as high, moderate, or low risk according to number/types of joints involved. Muscular strength was assessed by comparing grip strength, lateral pinch, and three-point pinch to norm values. Right- vs. left-handed individuals, and females vs. males were compared with an independent t-test; the relationships between the variables were investigated using the Pearson correlation. (3) Results: Out of 141 dental students (24.6 ± 3.0, 70% females, 87% right-handed), 15% and 16% were classified as having a high and moderate risk of hypermobility, respectively, with no sex difference. Right-handed students scored significantly higher in the right lateral pinch than left-handed students (18.2 ± 4.8 vs. 13.2 ± 4.1, p = 0.045). A higher severity of hypermobility was associated with bilateral lower grip and pinch strength (p < 0.05). (4) Conclusions: One third of the first-year dental students exhibited moderate to severe hand joint hypermobility. Moreover, those identified as having moderate to severe hand joint hypermobility showed a decreased grip strength.

Neurophysiological and behavioural correlates of ocrelizumab therapy on manual dexterity in patients with primary progressive multiple sclerosis

BackgroundHand dexterity impairment is a key feature of disability in people with primary progressive multiple sclerosis (PPMS). So far, ocrelizumab, a recombinant humanized monoclonal antibody that selectively depletes CD20-expressing B cells, is the only therapy approved for PPMS and recent analysis reported its ability to reduce the risk of upper limb disability progression. However, the neural mechanisms underlying hand impairment in PPMS and the brain networks behind the effect of ocrelizumab on manual dexterity are not fully understood.ObjectiveMain aims of our study were: (i) to investigate neurophysiological and behavioural correlates of hand function impairment in subjects with PPMS, and (ii) to use neurophysiologic and behavioural measures to track the effects of ocrelizumab therapy on manual dexterity.MethodsSeventeen PPMS patients and 17 healthy-controls underwent routine neurophysiological protocols assessing the integrity of cortico-spinal and somatosensory pathways and advanced transcranial magnetic stimulation (TMS) protocols evaluating inhibitory (short and long interval intracortical inhibition, short-latency afferent inhibition) and facilitatory (motor thresholds, intracortical facilitation, short-interval intracortical facilitation) circuits in the primary motor cortex. All subjects also underwent behavioural analysis of hand dexterity by means of nine-hole peg test and finger movement analysis, and hand strength with handgrip and three-point pinch test. Neurophysiological and clinical assessments of hand functionality were also performed after 1 year of ocrelizumab therapy.ResultsAt baseline PPMS patients displayed a significant impairment of hand dexterity and strength compared to healthy controls (all p < 0.03). Neurophysiological study disclosed prolonged latencies of standard somatosensory and motor evoked potentials (all p < 0.025) and an overall reduction of intracortical excitability at TMS protocols, involving both excitatory and inhibitory circuits. Importantly, hand dexterity impairment, indexed by delayed 9HPT, correlated with TMS protocols investigating cortical sensorimotor integration (short-latency afferent inhibition, SAI), p = 0.009. Both parameters, 9HPT (p = 0.01) and SAI (p = 0.01), displayed a significant improvement after 1 year of therapy with ocrelizumab.ConclusionIntracortical sensorimotor networks are involved in hand dexterity dysfunction of PPMS. Ocrelizumab therapy displays a beneficial effect on hand dexterity impairment most likely through intracortical networks implicated in fast sensorimotor integration.

Montreal Cognitive Assessment and Frontal Assessment Battery test as a predictor of performance of unaffected hand function after subcortical stroke.

The objective of this study was to elucidate the association between unaffected hand function and cognitive impairment and to determine whether the cognitive screening test can be a predictor of unaffected upper limb function in patients with unilateral subcortical strokes. A retrospective study of 37 patients with unilateral first-ever subcortical stroke was conducted through a review of medical records. The unaffected hand function and cognitive screening tests were measured upon admission to the neurorehabilitation unit and then 4 weeks later at discharge. The relationship between unaffected hand function and cognitive function was investigated with multiple linear regression analysis. Comparing the initial evaluation of unaffected hand function and cognitive function with the evaluation at discharge, cognitive function improved significantly at discharge; however, grip strength and dexterity of the unaffected hand were stationary except for three-point pinch strength, tip pinch strength, and finger tapping speed. The Montreal cognitive assessment (MoCA) score was found to be a significant predictor of unaffected grip strength (R2 = 0.33, P = 0.004) and three-point pinch strength (R2 = 0.16, P = 0.04) at discharge and the Frontal Assessment Battery (FAB) score to be a predictive value of the unaffected finger tapping test (R2 = 0.46, P < 0.001) at discharge. In subcortical stroke patients with low MoCA and FAB scores, clinicians must ensure that patients participate in rehabilitation therapy including bimanual activity with careful attention to the patient's unaffected hand function.

Importance of ST arthroplasty in the treatment of STT osteoarthritis and concomitant basal thumb osteoarthritis

Basal thumb osteoarthritis is one of the most prevalent forms of osteoarthritis worldwide and is frequently associated with osteoarthritis of the STT joint. The surgical gold standard comprises various modifications of arthroplasty resection. A retrospective study compared the postoperative results of Lundborg's resection-suspension-arthroplasty, modified by Wulle, with and without additional ST arthroplasty. In this study, 50 patients with symptomatic basal thumb osteoarthritis (stages III and IV) were examined. Twenty-one of them were treated with conventional resection-suspension-arthroplasty (RSA) and 29 patients were treated with the same technique and additional ST arthroplasty (RSA-plus). The analysis included an assessment of the Thumb Disability Examination (TDX) score, the Kapandji Thumb Opposition score, the Visual Analogue Scale (VAS) pain score as well as grip force, key pinch force, two-point and three-point pinch force. In both groups, the duration of the operation was comparable. The overall TDX score was 15.9 ± 19.5 in the RSA-plus group and 20.8 ± 24.3 in the RSA group (p > 0.05). A marginally significant difference was noted for the Kapandji score, which was 9.5 ± 1.1 in the RSA-plus group and 8.9 ± 1.6 in the RSA group (p = 0.08). There was no significant difference between both groups for grip strength (RSA-plus: 48.3 ± 21 kPa, RSA: 55.2 ± 24.9 kPa (p > 0.05)), key pinch force (RSA-plus: 32.6 ± 15 kPa, RSA: 37.3 ± 15.4 kPa (p > 0.05)), two-point pinch force (RSA-plus: 30.6 ± 12.9 kPa, RSA: 34.8 ± 12.4 kPa (p > 0.05)) and three-point pinch force (RSA-plus: 36.2 ± 14.2 kPa, RSA: 42 ± 13.6 kPa (p > 0.05)). Both groups demonstrated insignificant differences in pain intensity at rest (RSA-plus: 0.4 ± 1.3, RSA: 1 ± 2.1 (p > 0.05)), during movement (RSA-plus: 0.7 ± 1.8, RSA: 1.6 ± 2.7 (p > 0.05)) and under stress (RSA-plus: 1.6 ± 2.5, RSA: 2.9 ± 3.4 (p > 0.05)). The followed-up patient groups demonstrated no significant differences in the examined variables. This leads us to the conclusion that there are no disadvantages associated with performing ST arthroplasty in addition to conventional RSA. In fact, based on the collected data, we suggest that ST arthroplasty should be more widely indicated in the context of RSA.

Percentage difference of hand dimensions and their correlation with hand grip and pinch strength among schoolchildren in Saudi Arabia.

The study aimed to assess the percentage difference of hand dimensions and their correlation with grip and pinch strength among school children in Saudi Arabia. Anthropometric measurements, hand dimensions, grip, and pinch strength measurements were obtained from 200 healthy schoolchildren in both genders aged 6-16 years. A Jamar electronic handgrip dynamometer was used to measure handgrip strength in kg. Pinch dynamometer was used to measure the two-point pinch strength, three-point pinch strength and lateral pinch strength in kg. Hand circumference was measured following hand arch at the maximum palm level. Hand span from the tip of the thumb to the tip of the little finger with the hand opened as broad as possible. Hand length from the tip of the middle finger to the midline of the distal wrist crease. Palm length from the distal wrist crease to the base of the middle finger. The percentage of difference of hand dimensions between both the genders was statistically significant. Both handgrip and pinch strength were significantly correlated with anthropometric measurements and hand dimensions. Body mass index had mild correlation with both handgrip strength and pinch strength (P < 0.05). Age, hand circumference, hand span, hand length and palm length had moderate to strong correlation with both grip and pinch strength (P < 0.01). The current study provides a source of perspective reference values in clinical settings for hand dimensions. The present study showed significant correlations with handgrip and pinch grip strengths among schoolchildren in Saudi Arabia.

Assessment of hand function and disability in fibromyalgia

Fibromyalgia, apotentially debilitating chronic pain syndrome, is achronic disease. We aimed to compare the hand function of fibromyalgia (FM) patients and healthy individuals and to demonstrate the relationship between hand disability and FM. The study was consisted of 40female patients with FM and 30healthy controls. All participants were evaluated for pain threshold measurements, handgrip strength, and pinch strength. Functional states, hand disability, and hand skills and coordination were evaluated using the Fibromyalgia Impact Questionnaire (FIQ) form, the Disability of Arm-Shoulder-Hand (DASH) questionnaire and the Purdue Pegboard Test, respectively. Handgrip strength values, DASH score, lateral pinch strength test, Pegboard placement time, and Pegboard collection time of the patient group were significantly lower than those of the control group (all p < 0.05). Anegative correlation was found between FIQ score and handgrip strength, two-point pinch strength test, three-point pinch strength test, and lateral pinch strength test in patients with moderate FM (all p < 0.05). Furthermore, acorrelation was observed between DASH score and handgrip strength, lateral pinch strength test, Purdue Pegboard placement time, and Purdue Pegboard collection time in patients with moderate FM (all p < 0.05). Our results show that hand function was decreased in patients with FM compared to healthy controls and decreasing hand function was influenced by FIQ score. As aresult, the evaluation of hand function should be taken into consideration in the management of FM.

Functional outcome after endoscopic assisted release of the ulnar nerve for cubital tunnel syndrome: mid-to-long term results.

The aim of the study was to investigate functional and patient-rated outcome parameters after endoscopic assisted release of the ulnar nerve for cubital tunnel syndrome. One hundred of 204 consecutive patients between 2006 and 2011 met the inclusion/exclusion criteria. Fifty-one of these patients were recruited and evaluated clinically and by questionnaire testing retrospectively after a mean follow-up of 82months (range: 60-116). Neurological parameters (two-point-discrimination, application of Semmes-Weinstein monofilaments, Tinel's test), grip, and three-point pinch strength were not significantly different from the contralateral extremity at the time of examination, whereas key pinch strength was significantly weaker. Mean Disabilities of the Arm, Shoulder, and Hand score was 20.82. Patients' overall opinion was good/excellent for 78% of the study population. The examined surgical procedure proved to be as efficacious as open in-situ decompression regarding functional outcome with fewer post-operative complications. Regarding the results it might be postulated that grip strength and three-point pinch strength determination is not necessarily relevant for ulnar nerve evaluation. Endoscopic assisted release of the ulnar nerve is a reliable and safe treatment option for cubital tunnel syndrome with satisfactory mid-to-long term functional and patient-rated outcomes.

Use of art as therapeutic intervention for enhancement of hand function in patients with rheumatoid arthritis: A pilot study

Background: Conventional physiotherapy treatment for patients with rheumatoid hand emphasizes on single-plane movements and strengthening exercises directed toward improvement of function and prevention of deformities. This may be nondirective and lacks creativity and hence may predispose to a high attrition from therapy. The current study aimed to evaluate the efficacy of art as a creative therapeutic procedure for enhancement of hand functions, self-perception, and quality of life in patients with rheumatoid arthritis (RA). Methods: A single-blinded, randomized controlled pilot study was conducted on 17 participants suffering from RA. The control group received conventional physiotherapy while the experimental group received art-based intervention with bimanual projects (viz., origami, paper quelling, clay modeling, and oil painting). Both groups received intervention for 45 min daily for 4 weeks. Pre- and post-interventional assessment was done using grip and pinch strength, Grip Ability Test (GAT), Jebsen–Taylor Hand Function Test (JHFT), Australian-Canadian Osteoarthritis Hand Index (AUSCAN), Michigan Hand Outcome Questionnaire (MHQ), and Health Assessment Questionnaire (HAQ). Results: There was an improvement in hand functions (grip strength [P = 0.042], two-point pinch strength [P = 0.039], three-point pinch strength [P = 0.043], GAT [P = 0.043], JHFT [P = 0.043]), self-perception (AUSCAN [P = 0.043], MHQ [P = 0.043]), and quality of life (HAQ;P = 0.043) in art therapy patients which was similar to conventional therapy patients. Conclusion: Art is an equally effective therapeutic intervention to conventional therapy for the enhancement of hand functions, self-perception, and quality of life in patients with RA.

The effects of hand strength on upper extremity function and activities of daily living in stroke patients, with a focus on right hemiplegia.

[Purpose] The purpose of this study was to investigate the effects of hand strength on upper extremity function and activities of daily living in patients with right hemiplegia, as well as to provide important fundamental data for rehabilitation after stroke. [Subjects and Methods] This study was conducted from May 1 to December 30, 2013, at the Department of Rehabilitation of P Hospital in Seoul and included subjects hospitalized with a diagnosis of stroke. Patients with right hemiplegia were selected, and their hand strength, upper extremity function, and activities of daily living were evaluated. Hand strength was measured by grip, lateral pinch, and three-point pinch strength. [Results] The effects of hand strength on upper extremity function were evaluated. The results showed that all types of hand strength significantly influenced upper extremity function. However, only grip strength influenced activities of daily living. [Conclusion] In rehabilitation of stroke patients, it is necessary to first improve their general physical condition and basic activities of daily living, and then improve hand movement and hand muscle strength for instrumental activities of daily living training, which requires detailed hand movements.

The results of carpal tunnel release for carpal tunnel syndrome diagnosed on clinical grounds, with or without electrophysiological investigations: a randomized study

We compared the results of carpal tunnel release in patients with the diagnosis of carpal tunnel syndrome based on only clinical grounds and those diagnosed on clinical and electrophysiological grounds. Ninety-three patients, 83 women (89%) and ten men (11%), meeting the criteria of 'typical' carpal tunnel syndrome, were randomly assigned to receive carpal tunnel release with (n = 45, 48%) or without (n = 48, 52%) nerve conduction studies. Patients were followed-up at 1 and 6 months, by assessments that included the Levine scores, filament tests, grip and pinch strength. No significant differences in Levine scores were found at the 1 and 6 months assessments. Statistically significant differences were noted in three-point pinch strength and sensation; however, they were not of clinical importance. The results of the study show that the results of carpal tunnel release in patients with typical symptoms are no better after nerve conduction studies and, therefore, nerve conduction studies can be omitted.

Outcome measures for Charcot‐Marie‐Tooth disease: clinical and neurofunctional assessment in children

Charcot-Marie-Tooth (CMT) disease is the most common inherited neuromuscular disorder, presenting with symptoms often occurring since childhood, and showing a progressive course. At present, there are no valid and reliable measures for evaluation of impairment and disability in the pediatric population. The aim of this study was to determine the usefulness of outcome measures, commonly used in adult patients, in CMT children. We report the results of a comprehensive evaluation of 21 children affected with CMT type 1A, including clinical examinations, measure of hand and foot muscle strength with a hand-held dynamometer, and the following scales: CMT Neuropathy Score or its clinical component CMT Examination Score, Overall Neuropathy Limitations Scale (ONLS), Walk-12 questionnaire, and nine-hole peg test (9-HPT). Hand grip, three-point pinch, and foot dorsiflexion strength were significantly lower than age/sex equivalent in almost all cases. 9-HPT was significantly abnormal in 62% of patients and CMT Examination Score was <10 points in all cases. ONLS showed presence of minor disability in the upper limbs in 57% and mild abnormalities of gait in 71% of patients. Overall, these scales demonstrated limited potential to measure disability and severity of the disease confirming that it is necessary to identify specific scales for children with CMT.

Handgrip strength among older American Indians: the Native Elder Care Study

SIR—Increased age is associated with declines in muscle strength and muscle mass, a condition referred to as sarcopenia [1]. Assessing handgrip strength is an easy test that can provide an approximation of total body muscle strength [2]. Research has found grip strength to be associated with functional disability [3, 4], chronic illnesses [5–8], hospitalisation and longer lengths of stay [9, 10] and mortality [2, 11]. Such studies have led to grip strength being considered a robust measure of frailty [8]. American Indians possess many of the risk factors for weaker grip. Notably they possess disproportionately high rates of functional disability [12] and chronic disease [13, 14]. Only one published study has examined hand strength in American Indians, measured by summing grip strength, two-point pinch and three-point pinch [15]. Given the limited information about grip strength in this population, coupled with their risk factors, we compared grip strength from a sample of American Indians to normative values and identified their correlates of weaker grip strength.

ARTHROPLASTY FOR TRAPEZIUM EXCISION AND TENDON INTERPOSITION IN RHIZARTHROSIS CASES: PROSPECTIVE STUDY

Objective: To prospectively evaluate the results from a series of patients who underwent surgical treatment for rhizarthrosis using the technique of trapezium resection associated with interposition of yarn from the long abductor tendon of the thumb. Methods: From May to August 2005, ten patients underwent surgical treatment for rhizarthrosis. Patients with primary osteoarthrosis of the trapezium-metacarpal joint, in stages II, III and IV of the Eaton classification, with persistent pain that was refractory to clinical treatment, were included. For the functional assessment, the visual analogue scale, DASH questionnaire and Buck-Gramcko score were used. For the overall assessment on the patients, strength measurements were made for palm grip, pulp to pulp pinch, lateral pinch, three-point pinch, opposition and radial and palmar abductions. The migration index for the first metacarpal was also determined on radiographs at rest and under stress. Results: The pain relief was considered to be good (p = 0.005), with functional improvements in modules 2 (p = 0.02) and 3 (p = 0.022) of DASH. The Buck-Gramcko score showed one excellent and three very good results. There was an improvement in almost all of the overall assessment and was only non-significant regarding lateral pinch and abduction. For all patients, there was migration of the first metacarpal. Conclusion: Trapeziectomy associated with interposition of yarn from the long abductor tendon of the thumb was shown to be a relatively simple and effective technique for pain relief and functional improvement.

Artroplastia de excisão do trapézio e interposição tendinosa na rizartrose: estudo prospectivo

OBJETIVO: Avaliar prospectivamente os resultados de uma série de pacientes submetidos ao tratamento cirúrgico da rizartrose, com a técnica de ressecção do trapézio associada à interposição de um novelo do tendão abdutor longo do polegar. MÉTODOS: De maio a agosto de 2005, 10 pacientes foram submetidos ao tratamento cirúrgico da rizartrose. Foram incluídos pacientes com osteoartrose primária da articulação trapézio-metacárpica, estágios II, III, IV da classificação de Eaton, com dor persistente refratária ao tratamento clínico. Para avaliação funcional foi utilizada a escala visual analógica, questionário DASH e o escore de Buck-Gramcko. Na avaliação global do paciente foram mensuradas as forças de preensão palmar, pinça polpa a polpa, pinça lateral, pinça de três pontos, oponência e abduções radial e palmar. Realizou-se, ainda, o índice de migração do primeiro metacarpal na radiografia de repouso e sob estresse. RESULTADOS: Foram considerados bons, no alívio da dor (p = 0,005), com melhora da função na avaliação pelo DASH módulos 2 (p = 0,02) e 3 (p = 0,022) O escore de Buck-Gramcko apresentou um resultado excelente e três ótimos. Houve melhora em quase toda avaliação global, sendo não significante apenas na pinça lateral e abdução. Em todos pacientes houve migração do primeiro metacarpal. CONCLUSÃO: A trapeziectomia associada à interposição de um novelo do tendão abdutor longo do polegar mostrou-se uma técnica de execução relativamente simples e eficaz no alívio da dor e na melhora funcional.

Hand Strengths in Carpal Tunnel Syndrome

The purpose of this study was to determine whether a measurable decrease in isokinetic (dynamic) and isometric (static) hand strengths occurs in carpal tunnel syndrome (CTS) patients. Eighteen CTS patients and 20 healthy controls were included in the study. Isokinetic (eccentric and concentric) and isometric grip and pinch strengths were measured with a Biodex System 3 dynamometer (Biodex Medical System, Inc. New York). All strength measurements, except isometric and isokinetic (concentric/eccentric) three-point pinch and isokinetic (concentric) tip pinch, revealed statistically significant differences between CTS patients and controls. Measurable decrease in hand strengths may exist in CTS despite normal manual assessments. Although both isokinetic (dynamic) and isometric (static) dynamometers are capable of detecting this decrease, neither technique seems better than the other.

Reliability of clinical outcome measures in Charcot-Marie-Tooth disease

We assessed inter- and intra-rater reliability of outcome measures in Charcot-Marie-Tooth disease (CMT) patients. In 40 CMT patients, we assessed reliability of Overall Neuropathy Limitations Scale (ONLS), 10-m timed walk (T10MW), 9-hole-peg test (9-HPT), maximal voluntary isometric contraction (MVIC) of arm (elbow flexion, hand-grip, and three-point pinch) and leg (knee extension, foot dorsiflexion/plantar flexion). Reliability was substantial for ONLS, excellent for T10MW and 9-HPT. For MVIC, inter and intra-rater reliability was excellent for hand contractions; for leg contractions, intra-rater agreement was moderate to substantial, whereas inter-rater agreement was poor. An ad hoc device was produced to immobilize the foot and MVIC reliability was re-assessed in 26 CMT patients, resulting in excellent inter-rater and intra-rater reliability for foot dorsiflexion, and clear inter-rater improvement for foot plantar flexion. All outcome measures appear adequate for CMT assessment. Use of an immobilization device improves foot MVIC reliability, preventing biased findings in patients with greater strength.

The functional results of ray amputation.

Twenty patients (14 males, six females) were assessed at an average of 32 months (ten to 156 months) after ray amputation using the disability shoulder, arm, hand (DASH) questionnaire, physical examination and functional testing. There were 14 border (eight index, six little) and six central ray (five middle, one ring) amputations. Our results showed on average 27% less grip and 22% three-point pinch strength in the operated hands. Peak power output was 22% and average work output 14% less on the operated side than the contralateral hand. The DASH function score was 29.2 (range 3.3-74.2). Nine patients returned to their previous occupation, two had to change jobs and two did not return to work. Six patients were not working, one was of school age. The ensuing disability remained within limits reflected by our measurements and the acceptance of the patients.

The effects of gloves on grip strength and three-point pinch

No-glove, leather-glove, nitrile-glove, and vinyl-glove conditions were evaluated to determine their effects on grip strength and three-point pinch. Forty-one adult volunteers from a local university and local hospital participated in the two-day study. The order of testing was randomly assigned. A hydraulic hand dynamometer and a hydraulic pinch gauge were used to evaluate grip strength and three-point pinch with no glove and with each glove type. Grip strength and three-point pinch were tested on separate days. Grip strength test results showed statistically significant differences (p<0.05) for no glove vs. leather glove, no glove vs. nitrile glove, no glove vs. vinyl glove, leather glove vs. nitrile glove, and leather glove vs. vinyl glove, but no statistically significant difference for nitrile glove vs. vinyl glove. Three-point pinch test results also showed statistically significant differences (p<0.05) for no glove vs. leather glove, leather glove vs. nitrile glove, and leather glove vs. vinyl glove, but no statistically significant differences for no glove vs. nitrile glove, no glove vs. vinyl glove, and nitrile glove vs. vinyl glove. The results indicate that glove type may have clinical applications for occupational and physical therapists whose patients use gloves in the workplace.