Hand Assessment tools

1. Hand Assessment tools M. Mathanraj David. M.O.T.,M.Sc. The Leprosy Mission Trust India. Vadathorasalur. mmmathan@rediffmail.com

2. OBJECTIVES • Introduction. • Standardized Hand Function Tools • Method of using the Tools

3. INTRODUCTION • Impairment in prehension, grip, strength, in-hand manipulation, ROM & bilateral co-ordination greatly affects everyday tasks. • For e.g. Opening jars, writing, buttoning clothes, eating, holding items, etc.,

4. WHY HAND IS EVALUATED • Hand is evaluated to compare dominant & non-dominant hand equally. • Hand is evaluated to measure gains made from therapy.

5. STANDARDIZED HAND FUNCTION TESTS • ARM AND HAND FUNCTION TESTS • DEXTERITY AND FINE MOTOR TESTS • HAND STRENGTH

6. I. ARM AND HAND FUNCTION TESTS • Jebson-Taylor Hand Function Test (JHFT) • Wolf Motor Function Test (WMFT) • Action Reach Arm Test (ARAT) • Manual Ability Measure (MAM -16) • Stroke Rehabilitation Assessment of Movement (STREAM)

7. II. DEXTERITY AND FINE MOTOR TESTS • Purdue pegboard test (Tiffin, 1968) • Minnesota rate of manipulation test (American guidance service, 1969) • Box and block test (Platz et al, 2005)

8. III. HAND STRENGTH • Grip strength: Jamar Dynamometer • Pinch strength : Pinch meter

9. Criteria of Standard Assessment tools • Purpose or intent of the test • Instrument validity & Reliability • Description of the equipment used • Normative data on Demographics • Specific Instructions for administering, scoring and interpretation

10. I. ARM AND HAND FUNCTION TESTS

11. 1. JEBSON TAYLOR HAND FUNCTION TEST • Developed in 1969, by Jebson, Taylor, Treischmann, Trotter & Howard. • It consists of many house hold items such as soap and coffee cans, paper clips, & kidney beans. • Age above 5 years

12. Purpose: • To provide a short, objective test of hand functions commonly used in activities of daily living. Populations used with: • includes stroke, arthritis, SCI, acquired neurological disorders, hand disabilities, & other individuals with decreased hand function. Time to administer: • 15 minutes.

13. Materials needed: checkers, kidney beans, paper clips, bottle caps, coins, index cards, tin can.

14. SUBTEST 1. Writing a 24-letter sentence. 2. Turning over 3×5” cards. 3. Picking up small common objects [paper clip, bottle cap, & coin]. 4. Simulated feeding using a teaspoon & five kidney beans. 5. Stacking checkers. 6. Picking up large light objects [empty tin can]. 7. Picking up large heavy objects [full 1 lb. Tin can].

15. ADMINISTRATION • Generally takes 15 minutes to administer. • Specific instructions are given to set up test activities properly. • No special training is required to administer. • The non-dominant hand is tested first, then the dominant hand, providing a score for each hand.

16. Scoring: Time is recorded in seconds for each of the 7 subtests. • Normative data for both gender in the 20-60 year age range, for both the hands (Jebsen et al., 1969). Psychometric Properties: • Content and construct validity • Inter & Intra rater , Test –retest reliability

17. Wolf etal, 1989 Tasks: Fore arm to table (side) Forearm to box (side) Extend elbow (side): Extend elbow (to the side), with weight: Hand to table (front): Hand to Box (Front): Reach & Retrieve (front): 8. Lift can (front) 9. Lift pencil (front) Pick up paper clip (front) Stack checkers (front) Flip cards (front) Turing the key in lock (front) Fold towel (front) Lift basket (standing) 2. Wolf Motor Function Test (WMFT)

18. It consists of 15 tasks • It is a timed test ( max time limit for each task is 2 min) • It quantifies single or multiple joint upper extremity movement( Item 1-6) • Functional tasks (Item 7-15) • The task are arranged from proximal to distal in order of complexity (wolf etal, 2001)

19. It has high Interrater reliability, internal consistency, test – retest reliability and adequate stability (Morris etal, 2001; Wolf et al., 2001) • It has also been shown to discriminate between higher and lower functioning individuals with subacute stroke ( wolf et al., 2005)

20. Lyle, 1981, Subtests: I. Grasp: (Total score: 18) 1. 10 cm wood block 2. 2.5 – cm wood block 3. 5 cm wood block 4. 7.5 cm wood block. 5. Ball (cricket), 7.5 cm diameter 6. Stone, 10x 2.5x1 cm Test for Adults II. Grip (Total score: 12) Pour water from glass to glass pick up 2.25 cm tube pick up tube, 1x16 cm place washer (3.5 cm diameter) over bolt. III. Action Reach Arm Test (ARAT)

21. III. Pinch ( Total score: 18) 1. Ball bearing, 6mm, third finger and thumb. 2. Marble, 1.5 cm, index finger and thumb. 3. Ball bearing, second finger and thumb. 4. Ball bearing, First finger and thumb. 5. Marble, Second finger and thumb 6. Marble, first finger and thumb. IV. Gross movements ( Total score : 9) 1. Place hand behind head 2. Place hand on top of head 3.Hand to mouth

22. It is test to examine upper extremity function after stroke. • It has Four subscales, (1) Grasp, (2) Grip, (3) Pinch and (4) Gross movement. • 19 test item scored on 4 point scale, 0-3. 0= Can perform no part of the test 1= performs test partially 2= Completes test but takes an abnormally long time or has great difficulty 3= Performs test normally.

23. It has reliability and validity in different neurologic groups ( Daley et al., 1999; Platz et al., 2005; Wang et al., 2002.) • It has been correlated with the upper limb portion of the Fugl-meyer scale (p=0.94) ( De Weerdt, 1985)

24. II. DEXTERITY AND FINE MOTOR TESTS

25. 1. Purdue pegboard test • Tiffin, 1968, • Age: above 5 yrs • It assess picking up, manipulating, and placing little pegs into holes with speed & accuracy. • Purpose: finger dexterity. • Time required: 10 to 20 minutes.

26. It Consists of wooden board that has two centered rows of 25 small holes & aligned vertically. It has reservoirs for pins, collars, & washers across the top.

27. Sub tests • Right hand [or preferred] • Left hand [non preferred] • Both hands • Assembly Administered in sitting position. • The patient is required to put the metal pins in to the holes as fast as possible. Score: • The No. of pins inserted in 30 seconds. • Score for assembly is No. of pins assembled in 1 minute. (Insert pin, washer & Collar)

28. Normative data for preschool children- wilson et al., (1982) • Normative data for 14-19 years old- mathiowetz et al., (1986). • Test-retest reliability

29. 2. Minnesota rate of manipulation test • Developed by American guidance service,1969. • It assess the speed and accuracy of repetitive reaching , picking up, manipulating, and placing disks. • Purpose: measure manual dexterity. • Target population: healthy subjects & in rehabilitation settings.

30. It consists of a frame approximately 3 feet long that has 4 horizontal rows of openings, which are large enough to accommodate 60 round disc [approximately 1.5 inches in diameter]. The disks painted black on one side & red on the other side.

31. Sub tests • Placing • Turning • Displacing • One-hand turning & placing • Two-hand turning & placing Each subtest is administered in the standing position, and is tested 3 to 5 times, the first being a practice trial.

32. Scoring: time to complete each subtest. • Test-retest reliability is high [0.87 to 0.95]. • Interrater reliability • The test has also been adapted & standardized for people with visual impairment. (Mathiowetz, 1995) • Mean and SD available for persons with impaired hand function.

33. 3. Box and Block test • Box and block test was developed in 1957, to test people with severe problems affecting coordination. • Purpose: basic measure of gross motor dexterity. • Age above 7 years • Target population: decreased hand function, patients with severe co-ordination deficits.

34. It Consists of a wooden box with two side-by-side compartments separated by a raised partition. • It includes 1 inch wooden cubes (150 cubes). • The partition is placed at the patient’s midline.

35. Time to administer: the actual test for each hand last a 1 minute. • Trial period: 15-second practice test is included. • Scoring: No. of blocks moved within 1 minute. • Normative data available for neuromuscular conditions & healthy elders. • Concurrent validity = high (0.91). • Test – retest reliability =high { 0.94 & 0.98 for left and right hand}.

36. III. Hand Strength

37. 1. Grip Strength

38. 1. Grip Strength How to use the dynamometer: • Set the adjustable handle to the desired spacing. • Rotate the red peak-hold needle counter-clockwise to 0. 3. Let the patient comfortably arrange the instrument in his/her hand . Have patient squeeze with their maximum strength. The peak-hold needle will automatically record the highest force exerted. 4. Record the reading and reset the peak - hold needle to zero.

39. 1. Grasp Strength • Position: Seated, shoulder adducted and neutrally rotated, elbow flexed at 90º, forearm in neutral position, and wrist between 0º and 30º dorsiflexion and between 0º and 15º ulnar deviation. • Grasp the Jamar Dynamometer • Squeeze as hard as you can! • 3 trials provided with 2 min break • Scoring average of 3 trials

40. 2. Pinch Strength • Tip Pinch • Lateral Pinch • Palmar/Jaw chuck

41. 1. Tip Pinch • The Client pinches the ends of the pinch meter between the tips of the thumb and index finger (Mathiowetz et al., 1985) • The test is administered by first giving the patient instructions and a demonstration. • Then the therapist says, “Ready? Pinch as hard as you can. • Three trials, with a rest between each trial, are completed • The average of three trials is recorded

42. 2. Lateral Pinch • The Client pinches the meter between the pad of the thumb and the lateral surface of the index finger.

43. 3. Palmar pinch/ Three-Jaw chuck • The client pinches the meter between the pad of the thumb and the pads of the index and middle fingers.

44. Psychometric properties • Jamar Dynamometer was found to be accurate to with in ±7% (Schechtman, 2005) • B& L Pinch meter was found to be accurate within ± 1% (Mathiowetz, 2000) Jamar Dynamometer (Fess, 1987) • Test Retest reliability = 0.88 • Inter rater reliability = 0.99 B & L Pinch meter (Mathiowetz et al., 1984) • Test Retest reliability = 0.81 • Inter rater reliability = 0.98

45. Why not a tool from India? • Please think about for a moment and contribute for its development

46. REFERENCES • Agnew, P., & Maas, F. (1982). An interim Australian Version of the Jebsen Test of Hand Function. The Australian Journal of Physiotherapy. 28(20), 23-29. • Bovend’Eerdt, T.J.H., Dawes, H., Johansen-Berg, H., & Wade, D.T. (2004). Evaluation of the modified Jebsen test of hand function and the University of Maryland arm questionnaire for stroke. Clinical Rehabilitation, 18, 195-202. • Chen CC, Granger CV, Peimer CA, Moy OJ, Wald S. Manual ability measure (MAM 16): a preliminary report on a new patient- centred and task oriented outcome measure of hand function. Jour hand surgeon (Br) 2005;30(2): 207-216. • Dittmar, S. S., & Gresham, G.E. (Eds). (1997). Functional assessment and outcome measures for the rehabilitation professional (pp.158-159). Gaithersburg, MD: Aspen Publications. • Hill, K., Denisenko, S., Miller, K., Clements, T., & Batchelor, F. (2005). Clinical outcome measurement in adult neurological physiotherapy (3rd ed.). Victoria: Australian Physiotherapy Association National Neurology Group.

47. Jebsen, R.H., Taylor, N., Trieschmann, R.B., Trotter, M.J., & Howard, L.A. (1969). An objective and standardised test of hand function. Archives of Physical Medicine and Rehabilitation, 50 (6), 311-319. Jebsen summary prepared by Occupational Therapy Program, University of Western Sydney Funded by the Motor Accidents Authority of NSW, May 2006 • Lyle RC. A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int Journal Rehabilitation 1981; 4:483-492 • Mathiowetz, V., Weber, K., Volland, G., & Kashman, N., (1984). Reliability and Validity of Hand Strength Evaluations. Journal of Hand Surgery, 9A, 222-226. • Mathiowetz, V., Kashman, N., Volland, G., Weber, K., Dowe, M., & Rogers, S. (1985). Grip and Pinch Strength: Normative Data for Adults. Archives of Physical Medicine and Rehabilitation, 66(2) 69-74. • Wolf SL, MClunkin JP, Swanson ML, Weiss PS. Pilot normative database for the wolf motor function test. Archieves Physical medicine

48. BIBLIOGRAPHY 1. Occupational Therapy for Physical Dysfunction: 6th Edition, Mary Vining Radomski, CA Trombly 2. Occupational Therapy: 11th Edition, Willard & Spackman 3. Motor Control: 3rd edition, Ann Shumway Cook 4. Occupational Therapy: 6th Edition, Pedritti 5. Concepts in Hand rehabilitation: Barbara G Stanley

49. Thank you