Dorit H. Aaron

Development of the Functional Dexterity Test (FDT): construction, validity, reliability, and normative data.

Dexterity tests take time to administer; however, the information obtained is an important component of a comprehensive examination of the hand. This article introduces a dexterity test suitable for use as part of routine examination of the hand. The Functional Dexterity Test (FDT) was developed as a measure of dexterity that takes a minimum amount of time to administer, yet provides information regarding the patients ability to use the hand for daily tasks requiring a 3-jaw chuck prehension between the fingers and the thumb. The test was developed over 20 years. Interrater and intrarater reliability ranges between good and excellent. Construct validity was confirmed in 2 clinical studies. Preliminary normative data were obtained in 6 samples of convenience. Along with statistical data, this article provides equipment standards and instructions.

Does Hand Therapy Literature Incorporate the Holistic View of Health and Function Promoted by the World Health Organization

The International Classification of Function (ICF), as formulated by the World Health Organization (WHO), is an accepted international standard for categorizing health and disability. We examined the frequency that ICF domains have been included in 788 Journal of Hand Therapy articles and 78 hand therapy articles from other sources using a scoring system based on the WHO ICF definitions. We found emphasis on body functions and body structures, with less emphasis placed on activities, participation, and environmental factors. This trend has remained stable over time despite the emergence of patient-centered disability measures. We recommend that scientists increasingly incorporate all of the WHO ICF domains in their scientific investigations to demonstrate the societal and personal impact of the profession in a language that is understood and appreciated by a wide array of health care users, policy makers, and third-party payers.

Hand Dexterity in Children: Administration and Normative Values of the Functional Dexterity Test

PURPOSE To document normative values from the Functional Dexterity Test (FTD) for typically developing children and to optimize test administration and interpretation. METHODS A total of 175 typically developing children aged 3 to 17 years participated in the study. Children completed the 16-peg FDT with both hands, and elapsed time was recorded in seconds. Data were analyzed as 16/time, interpreted as speed (pegs per second). A linear regression analysis predicted speed from age and hand dominance. RESULTS Functional Dexterity Test speed increased linearly in typically developing children by 0.04 pegs/s for each year of age. This rate of increase was the same for dominant and nondominant hands. Dominant hands were faster than nondominant hands by 0.09 pegs/s at all ages. There was no sex difference. CONCLUSIONS This study provides age-specific normative values for functional dexterity in typically developing children in 2 formats: as a growth chart of FDT speed versus age and as a regression model that calculates expected speed given a childs age and tested hand dominance. Recommended pediatric modifications to the FDT are to use speed (pegs per second) instead of time (seconds) to report results, and to not assess penalties. The norms presented allow clinicians to compare both speed and rate of change over time of pediatric patients with typically developing children, which makes it possible to distinguish developmental change from intervention. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.

Innovative evaluation of dexterity in pediatrics.

STUDY DESIGN Review paper. INTRODUCTION Hand dexterity is multifaceted and essential to the performance of daily tasks. Timed performance and precision demands are the most common features of quantitative dexterity testing. Measurement concepts such as rate of completion, in-hand manipulation and dynamic force control of instabilities are being integrated into assessment tools for the pediatric population. PURPOSE To review measurement concepts inherent in pediatric dexterity testing and introduce concepts that are infrequently measured or novel as exemplified with two assessment tools. METHODS Measurement concepts included in common assessment tools are introduced first. We then describe seldom measured and novel concepts embedded in two instruments; the Functional Dexterity Test (FDT) and the Strength-Dexterity (SD) Test. DISCUSSION The inclusion of novel yet informative tools and measurement concepts in our assessments could aid our understanding of atypical dexterity, and potentially contribute to the design of targeted therapy programs.

Perspectives on glenohumeral joint contractures and shoulder dysfunction in children with perinatal brachial plexus palsy

Shoulder joint deformities continue to be a challenging aspect of treating upper plexus lesions in children with perinatal brachial plexus palsy (PBPP). It is increasingly recognized that PBPP affects the glenohumeral joint specifically, and that abnormal scapulothoracic movements are a compensatory development. The pathophysiology and assessment of glenohumeral joint contractures, the progression of scapular dyskinesia and skeletal dysplasia, and current shoulder imaging techniques are reviewed.

Gateway to the World of Hand Therapy

In Australia, clinicians are using ultrasound in hand therapy clinics for diagnosis and biofeedback. In Israel, therapists are treating patients using virtual reality. In Sweden, researchers are doing advanced work on the intelligent hand and the plastic brain. In Norway, clinicians use mirror therapy for pain management in phantom limb and complex regional pain syndrome. Imagine a time when therapists from across the globe can come together and share research, innovative techniques, and ideas for the future. In fact, this summer, more than 29 countries will come together to exchange ideas and further the science of hand therapy at the Triennial Congress of the International Federation of Societies of Hand Therapy (IFSHT), which is immediately preceded by the annual meeting of the American Society of Hand Therapists (ASHT) in Orlando, Florida. The IFSHT is a nonprofit Society founded in 1987. Currently with 29 member societies, IFSHT represents more than 5,500 occupational therapists and physical therapists who work in the specialty of hand rehabilitation worldwide. IFSHT coordinates the activities of the various societies for hand therapy internationally and works to increase and enhance the exchange of knowledge of hand therapy. IFSHT holds its Congress in a different country every three years and June 2010 will be the first time it will be in the United States, hosted by ASHT. The ASHT, a member society of IFSHT, was founded in 1977. ASHT serves almost 3,000 hand therapists who are either occupational or

Drawing inspiration from children

Hand and upper extremity function rapidly unfolds from its beginning in utero to an expansion in unimanual and bimanual skill within the first year. After the first birthday, development continues and with experience prehensile skills are refined until adulthood. Atypical development or injury alters this progression and refinement in prehension as exemplified in infants who cannot easily reach-to-grasp for toys or in children with pain associated with musculoskeletal disorders. Fortunately, neuroplasticity and the inherent motivation children have to engage can augment recovery and adaptation to potentially disabling upper extremity challenges. As clinicians, we can use this inherent motivation as inspiration for the design and implementation of creative and evidence based therapeutic interventions. Diversity in congenital and traumatic pediatric disorders requires clinicians to acquire knowledge of new theories and approaches to intervention. This 2015 Special Issue of the Journal of Hand Therapy on pediatric hand and upper extremity rehabilitation introduces the reader to a wide range of topics; from reaching in infancy to pediatric dystonia and medial elbow injuries. The intention is to increase general knowledge of rehabilitation for upper extremity disorders in pediatrics as well as to stimulate growth and innovation in the field. The special issue has four sections: Background, Assessment, Intervention and Clinical Pearls. Background, emphasizes foundational concepts that support development and progression of prehensile skill. This section beginswith a reviewarticle byMoreau and Gannotti on muscle performance and resistive training. The authors share their expertise on the importance of improving the rate as well as the amount of muscle force production; a factor oftenmissed in our therapeutic interventions. This thorough review and case study provide the reader with current information applicable to neurological and musculoskeletal conditions. Next, Krisa and Murray briefly review the neural influences on the developing upper extremity, highlighting the specific features of the peripheral and corticospinal components of the nervous system. This article provides a scientific foundation for understanding conditions secondary to prenatal and postnatal injury. Harbourne and Kamm then give us their perspective on the relationship between postural control and reaching. The authors review three cases at varying ages to reinforce an ecological approach to the treatment of different clinical conditions. The final paper in this section by Lobo, Galloway and Heathcock aims to characterize general exploration, reaching