scholarly journals Functional improvement in hand strength and dexterity after surgical treatment of cervical spondylotic myelopathy: a prospective quantitative study

2020 ◽  
Vol 32 (6) ◽  
pp. 907-913
Author(s):  
Tyler S. Cole ◽  
Kaith K. Almefty ◽  
Jakub Godzik ◽  
Amy H. Muma ◽  
Randall J. Hlubek ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Grip Strength ◽  
Upper Extremity ◽  
Cervical Spondylotic Myelopathy ◽  
Hand Function ◽  
Hand Strength ◽  
Pinch Strength ◽  
Dominant Hand ◽  
Nondominant Hand ◽  
The Impact

OBJECTIVECervical spondylotic myelopathy (CSM) is the primary cause of adult spinal cord dysfunction. Diminished hand strength and reduced dexterity associated with CSM contribute to disability. Here, the authors investigated the impact of CSM severity on hand function using quantitative testing and evaluated the response to surgical intervention.METHODSThirty-three patients undergoing surgical treatment of CSM were prospectively enrolled in the study. An occupational therapist conducted 3 functional hand tests: 1) palmar dynamometry to measure grip strength, 2) hydraulic pinch gauge test to measure pinch strength, and 3) 9-hole peg test (9-HPT) to evaluate upper extremity dexterity. Tests were performed preoperatively and 6–8 weeks postoperatively. Test results were expressed as 1) a percentile relative to age- and sex-stratified norms and 2) achievement of a minimum clinically important (MCI) difference. Patients were stratified into groups (mild, moderate, and severe myelopathy) based on their modified Japanese Orthopaedic Association (mJOA) score. The severity of stenosis on preoperative MRI was graded by three independent physicians using the Kang classification.RESULTSThe primary presenting symptoms were neck pain (33%), numbness (21%), imbalance (12%), and upper extremity weakness (12%). Among the 33 patients, 61% (20) underwent anterior approach decompression, with a mean (SD) of 2.9 (1.5) levels treated. At baseline, patients with moderate and low mJOA scores (indicating more severe myelopathy) had lower preoperative pinch (p < 0.001) and grip (p = 0.01) strength than those with high mJOA scores/mild myelopathy. Postoperative improvement was observed in all hand function domains except pinch strength in the nondominant hand, with MCI differences at 6 weeks ranging from 33% of patients in dominant-hand strength tests to 73% of patients in nondominant-hand dexterity tests. Patients with moderate baseline mJOA scores were more likely to have MCI improvement in dominant grip strength (58.3%) than those with low mJOA scores/severe myelopathy (30%) and high mJOA scores/mild myelopathy (9%, p = 0.04). Dexterity in the dominant hand as measured by the 9-HPT ranged from < 1 in patients with cord signal change to 15.9 in patients with subarachnoid effacement only (p = 0.03).CONCLUSIONSPatients with CSM achieved significant improvement in strength and dexterity postoperatively. Baseline strength measures correlated best with the preoperative mJOA score; baseline dexterity correlated best with the severity of stenosis on MRI. The majority of patients experienced MCI improvements in dexterity. Baseline pinch strength correlated with postoperative mJOA MCI improvement, and patients with moderate baseline mJOA scores were the most likely to have improvement in dominant grip strength postoperatively.

scholarly journals Surgical Treatment of Cervical Spondylotic Myelopathy Leads to Functional Improvement in Hand Strength and Dexterity: A Prospective Quantitative Study

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Tyler S Cole ◽  
Kaith K Almefty ◽  
Jakub Godzik ◽  
Randall Hlubek ◽  
Jay D Turner
Keyword(s):  
Surgical Treatment ◽  
Grip Strength ◽  
Cervical Spondylotic Myelopathy ◽  
Hand Function ◽  
Functional Improvement ◽  
Pinch Strength ◽  
Japanese Orthopedic Association ◽  
Signal Change ◽  
Spinal Cord Dysfunction ◽  
Postoperative Improvement

Abstract INTRODUCTION Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in adults. The goal of this study was to establish the functional impact of CSM severity on hand function using quantitative testing and evaluate the response to intervention. METHODS A total of 33 consecutive patients planned for surgical treatment of CSM were prospectively enrolled. A licensed occupational therapist conducted 3 functional hand tests: 1) palmar dynamometry to assess grip strength, 2) hydraulic pinch gauge test to assess pinch strength, and 3) 9-hole peg test to assess upper extremity dexterity. Tests were performed preoperatively and at 6 to 8 wk postoperatively. Patients were stratified into mild, moderate, and severe myelopathy based on modified Japanese Orthopedic Association (mJOA) score. RESULTS 61% patients underwent anterior approach decompression with mean of 2.9 ± 1.5 levels treated. Preoperative pinch (P < .001) and grip (P = .014) strength were lower in moderate and low mJOA patients compared to high mJOA patients. Significant postoperative improvement was observed in all hand function domains with MCI improvement at 6 wk ranging from 33% of patients in dominant strength tests to 72% of patients in nondominant dexterity tests; patients with moderate baseline mJOA were more likely to have MCI improvement in dominant grip (58.3%) compared to low (30%) and high (9%) mJOA groups (P = .041). Dexterity as measured by mean dominant peg percentile was less than 1 in patients with cord signal change increasing in percentile to 15.7 with only subarachnoid effacement (P = .032). CONCLUSION CSM patients achieved significant improvement in strength and dexterity postoperatively. Baseline strength measures correlated most with preoperative mJOA, however baseline dexterity correlated most with severity of stenosis on MRI. Baseline pinch strength correlated with postoperative mJOA MCI improvement, and patients with moderate baseline mJOA were the most likely to have improvement in dominant grip strength postoperatively.

scholarly journals Relationships Among Manual Body Functions, Manual Capacity, and Bimanual Performance Using the Prosthetic Upper Extremity Functional Index in Children With Congenital Hand Differences

2014 ◽  
Vol 94 (6) ◽  
pp. 767-775 ◽  
Author(s):  
Monique S. Ardon ◽  
Wim G.M. Janssen ◽  
Steven E.R. Hovius ◽  
Henk J. Stam ◽  
Magdalena Murawska ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Hand Function ◽  
Surgical Techniques ◽  
Pinch Strength ◽  
Dominant Hand ◽  
Functional Index ◽  
Cross Sectional ◽  
Nondominant Hand ◽  
Bimanual Performance ◽  
Cross Sectional Design

Background Most surgical techniques intervene at the level of body functions of the upper limb, aiming to improve manual capacity and activity performance. However, the nature of the relationships among these levels of functioning and evidence for hand function variables predicting performance have scarcely been investigated. Objective The primary aim of this study was to assess aspects of hand function and manual capacity that influence bimanual performance in children with congenital hand differences (CHDs), ranging from surgically corrected polydactyly or syndactyly to radial dysplasia. A secondary aim was to assess whether the number of items on the Prosthetic Upper Extremity Functional Index (PUFI) can be reduced without losing information on bimanual performance in this population. Design A cross-sectional design was used. Methods One hundred six 10- to 14-year-old children with CHD participated in the study, which was conducted in a university hospital's outpatient clinic. Bimanual performance was evaluated with child self-reports on an adapted version of the PUFI, calculating ease of performance and actual use of the affected hand. Additionally, hand function and manual capacity were assessed. Results The median score on ease of performance was high, and, on average, the children used their affected hand actively in 97% of all activities. Manual capacity of the nondominant hand and lateral pinch strength of the dominant hand predicted attainment of maximum PUFI scores. Nonmaximum PUFI scores were predicted by opposition strength of the nondominant hand and lateral pinch strength of the dominant hand. In addition, in this patient group, only 6 items of the PUFI explained all variance in PUFI scores. Limitations The generalizability of the results is limited by the carefully selected age range. Second, the cross-sectional design of the study limits statements on causality on the relationships found. Conclusion Children with a CHD generally have good bimanual performance and, on average, perform activities with active use of the affected hand. Therapy directed toward increasing manual capacity and finger muscle strength might assist in improving bimanual performance in children with CHD. Furthermore, the number of items on the PUFI could be reduced from 38 to 6 items in children with CHD.

scholarly journals Hands and Health at Home: An Innovative Intergenerational Program for Meals on Wheels Clients

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 7-8
Author(s):  
Meghan Gatward ◽  
Rachel Logue ◽  
Courtney Vanderlaan ◽  
Susan Brown
Keyword(s):  
Self Efficacy ◽  
Hand Function ◽  
Hand Strength ◽  
Pinch Strength ◽  
Dominant Hand ◽  
Meals On Wheels ◽  
Ann Arbor ◽  
Homebound Older Adults ◽  
Home Training ◽  
At Home

Abstract Homebound older adults represent an understudied population who are at greater risk of losing hand strength and manipulation skills that, in turn, can lead to increased disability and cognitive declines (Dayanidhi and Valero-Cuevas, 2014). The Hands and Health at Home program was developed through a partnership with the University of Michigan’s School of Kinesiology and Michigan Medicine’s Ann Arbor Meals on Wheels program to demonstrate the feasibility of an intergenerational approach to address unmet needs of Meals on Wheels recipients. Undergraduate movement science student trainers were paired with a client who they visited twice weekly for 5 weeks. Students received training, including mock training scenarios, from an interprofessional team with backgrounds in social work, nursing, and neurorehabilitation. Home training protocols were developed using commercially available games and occupational therapy tools with the aim of improving hand function and facilitating socialization. Pre- and post-assessments included hand strength and dexterity, and client-reported measures of physical function and self-efficacy. Feedback from clients and students was overwhelmingly positive with several students indicating that the experience had stimulated interest in pursuing gerontology careers. Changes in quantitative assessments were variable across clients although pinch strength increased significantly in the non-dominant hand (p&lt;0.02) and was predictive of measures of self-efficacy (r=.78, p&lt;0.02). To our knowledge, this pilot program is the first of its kind and demonstrates the value of an intergenerational approach aimed at improving quality of life in Meals on Wheels clients, and may be of benefit for other underserved older members of the community.

A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization: An orthosis that promotes function and improvement in patients with the first carpometacarpal joint osteoarthritis

2013 ◽  
Vol 38 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Monireh Ahmadi Bani ◽  
Mokhtar Arazpour ◽  
Stephen William Hutchins ◽  
Fereydoun Layeghi ◽  
Mahmood Bahramizadeh ◽  
...  
Keyword(s):  
Grip Strength ◽  
Clinical Relevance ◽  
Hand Function ◽  
Pinch Strength ◽  
Conservative Approach ◽  
Carpometacarpal Joint ◽  
Custom Made ◽  
First Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
Improved Function

Background and aim: Patients with mild to moderate first carpometacarpal joint osteoarthritis report pain, a reduction in pinch and grip strength and hand function. The purpose of this study was to analyze the effect of a custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization on pain, function, grip strength, and key pinch in these patients. Technique: A total of 11 volunteer patients participated in this study. All the above-mentioned parameters were evaluated at baseline and also 30, 60, and 90 days after using the splint. Discussion: A decrease in pain was observed after 30 days, and this continued to improve during treatment with the splint. After 90 days of using the splint, grip strength was improved. Function and pinch strength also increased significantly and was maintained during the study period compared to baseline. Clinical relevance A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization may be a suitable conservative approach for the treatment of first carpometacarpal joint osteoarthritis.

scholarly journals Impact of Handedness on Disability After Unilateral Upper-Extremity Peripheral Nerve Disorder

Hand ◽  
2018 ◽  
Vol 15 (3) ◽  
pp. 327-334
Author(s):  
Benjamin A. Philip ◽  
Vicki Kaskutas ◽  
Susan E. Mackinnon
Keyword(s):  
Health Status ◽  
Peripheral Nerve ◽  
Upper Extremity ◽  
Dominant Hand ◽  
Disability And Health ◽  
Peripheral Nerve Disorder ◽  
Standardized Measures ◽  
Nondominant Hand ◽  
Alternative Measures ◽  
Dash Questionnaire

Background: Impairment of the dominant hand should lead to greater disability than impairment of the nondominant hand, but few studies have tested this directly, especially in the domain of upper-extremity peripheral nerve disorder. The aim of this study was to identify the association between hand dominance and standardized measures of disability and health status after upper-extremity peripheral nerve disorder. Methods: An existing database was reanalyzed to identify the relationship between affected-side (dominant vs nondominant) on individuals with unilateral upper-extremity peripheral nerve disorder (N = 400). Primary measure of disability was the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Results: We found no differences in standardized measures of disability or health status between patients with affected dominant hand and patients with an affected nondominant hand. However, a post hoc exploratory analysis revealed that patients with an affected dominant hand reported substantially reduced ability to perform 2 activities in the DASH questionnaire: “write” and “turn a key.” Conclusions: Following unilateral upper-extremity peripheral nerve disorder, impairment of the dominant hand (compared with impairment of the nondominant hand) is associated with reduced ability to perform specific activities, but this reduced ability is not reflected in standardized measures of disability and health status. To adequately identify disability following unilateral impairment of the dominant hand with the DASH, individual items must be used instead of the total score. New or alternative measures are also recommended.

scholarly journals The Impact of Sensory, Motor and Pain Impairments on Patient- Reported and Performance Based Function in Carpal Tunnel Syndrome

2017 ◽  
Vol 11 (1) ◽  
pp. 1258-1267 ◽  
Author(s):  
Goris Nazari ◽  
Niyati Shah ◽  
Joy C MacDermid ◽  
Linda Woodhouse
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Hand Function ◽  
Pinch Strength ◽  
Sensory Motor ◽  
Tunnel Syndrome ◽  
And Performance ◽  
Quick Dash ◽  
The Impact ◽  
Vibration Threshold

Background: Research has suggested that persistent sensory and motor impairments predominate the symptoms experienced by patients with carpal tunnel syndrome (CTS); with intermittent pain symptoms, being less predominant. Objective: The study aims to determine the relative contribution of sensory, motor and pain impairments as contributors to patient-report or performance-based hand function. Methods: Fifty participants with a diagnosis of CTS confirmed by a hand surgeon and electrodiagnosis were evaluated on a single occasion. Impairments were measured for sensibility, pain and motor performance. A staged regression analysis was performed. In the first step, variables with each of the 3 impairment categories were regressed on the Symptom Severity Scale (SSS) to identify the key variables from this domain. Models were created for both self report (Quick Disabilities of arm, shoulder and hand- Quick DASH) and performance based (Dexterity) functional outcomes. Backward regression modelling was performed for SSS and then, to allow comparability of the importance of different impairments across models, the 7 significant variables from the SSS model were forced into the models. Results: Variables: age, touch threshold and vibration threshold of the little finger of unaffected hand, median-ulnar vibration threshold ratio of affected hand, mean pain tolerance of unaffected hand, grip strength and pinch strength of affected hand, explained 31%, 36% and 63% of the variance in SSS, Quick DASH and dexterity scores, respectively. Conclusion: Hand function in patients with CTS is described by variables that reflect sensory status of the median and ulnar nerves, the persons pain threshold, grip and pinch strength impairments and age.

Can upper limb taping or exercises improve hand function, writing speed and self-perception of performance in adolescent school children?

2018 ◽  
Vol 0 (0) ◽  
Author(s):  
Hiba Memon ◽  
Apurv Shimpi ◽  
Ashok Shyam ◽  
Parag Sancheti
Keyword(s):  
Grip Strength ◽  
School Children ◽  
Hand Function ◽  
Group Analysis ◽  
Performance Measure ◽  
Pinch Strength ◽  
Self Perception ◽  
Urban City ◽  
Significant Difference ◽  
Non Parametric

Abstract Background The majority of students spend time in writing, which is a prime performance measure in examinations. Enhancement in handwriting should benefit students to attain better academic performance. Objective To assess the effectiveness of taping and exercises on hand function, writing speed, self-perception of writing and to compare these techniques. Methods A randomized control trial was conducted using cluster sampling in adolescent children across four schools in an urban city. A 4-week intervention study was conducted on 123 students divided into taping, exercise and control groups. Outcome measures were grip strength, pinch strength, 12-min writing speed test and the Writer Self-Perception Scale (WSPS). For intra-group analysis, a paired t-test was used for parametric values and the Wilcoxon signed rank test was used for non-parametric values. For inter-group analysis, one-way analysis of variance (ANOVA) for parametric values and the Kruskal-Wallis test for non-parametric values was used. Results The taping group showed a significant improvement in grip strength (1.79 kg; p = 0.00), pinch strength [1.67 lb (757.4 g); p = 0.00] and writing speed (39.77 words/12 min; p = 0.00). The exercise group showed significant improvement in grip strength (2.09 kg; p = 0.00), pinch strength (1.28 lb; p = 0.00), writing speed (28.38 words/12 min; p = 0.00). In the control group, there was a significant increase in pinch strength (1.023 lb; p = 0.01) and writing speed (12.94 words/12 min; p = 0.02). Inter-group analysis showed significant difference in writing speed (p = 0.002) and grip strength (p = 0.00). There was no significant difference in perception (p = 0.071). Conclusion Taping and exercise are equally effective for enhancement of hand function, writing speed and self-perception in adolescent school children.

scholarly journals Less-Affected Hand Function in Children With Hemiparetic Unilateral Cerebral Palsy: A Comparison Study With Typically Developing Peers

2017 ◽  
Vol 31 (10-11) ◽  
pp. 965-976 ◽  
Author(s):  
Tonya L. Rich ◽  
Jeremiah S. Menk ◽  
Kyle D. Rudser ◽  
Timothy Feyma ◽  
Bernadette T. Gillick
Keyword(s):  
Cerebral Palsy ◽  
Transcranial Magnetic Stimulation ◽  
Grip Strength ◽  
Magnetic Stimulation ◽  
Hand Function ◽  
Dominant Hand ◽  
Motor Threshold ◽  
Motor Representation ◽  
Unilateral Cerebral Palsy ◽  
The Mean

Background. Neurorehabilitation interventions in children with unilateral cerebral palsy (UCP) target motor abilities in daily life yet deficits in hand skills persist. Limitations in the less-affected hand may affect overall bimanual hand skills. Objective. To compare hand function, by timed motor performance on the Jebsen-Taylor Test of Hand Function (JTTHF) and grip strength of children with UCP to children with typical development (CTD), aged 8 to 18 years old. Exploratory analyses compared hand function measures with regard to neurophysiological outcomes measured by transcranial magnetic stimulation and between group comparisons of hemispheric motor threshold. Methods. Baseline hand skills were evaluated in 47 children (21 UCP; 26 CTD). Single-pulse transcranial magnetic stimulation testing assessed corticospinal tract and motor threshold. Results. The mean difference of the less-affected hand of children with UCP to the dominant hand of CTD on the JTTHF was 21.4 seconds (95% CI = 9.32-33.46, P = .001). The mean difference in grip strength was −30.8 N (95% CI = −61.9 to 0.31, P = .052). Resting motor thresholds between groups were not significant, but age was significantly associated with resting motor threshold ( P < .001; P = .001). Children with UCP ipsilateral pattern of motor representation demonstrated greater mean differences between hands than children with contralateral pattern of motor representation ( P < .001). All results were adjusted for age and sex. Conclusions. The less-affected hand in children with UCP underperformed the dominant hand of CTD. Limitations were greater in children with UCP ipsilateral motor pattern. Rehabilitation in the less-affected hand may be warranted. Bilateral hand function in future studies may help identify the optimal rehabilitation and neuromodulatory intervention.

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